Why is SRS "medically necessary," and not "cosmetic?"

[ImagineKate]

The cis woman did not have gender dysphoria.  She did not require treatment for gender dysphoria.

She actually said the reason for her seeking surgeries is because people did not refer to her as "ma'am" or "miss" while they did that to others. It's something we as transgender people experience, actually. So while not male to female gender dysphoria, it is dissatisfaction with her gender presentation.

Why are you so against the idea of me being able to access the surgeries I'd need to feel comfortable?

I am not really. I too would like my surgeries covered by insurance, it is costing me quite a bit out of pocket and I have to make some sacrifices and forego some things and save my money (and I am ineligible for tax breaks on medical expenses). However, the debate here is the rationale behind some surgeries being "medically necessary" and some being "cosmetic." And in your case specifically with some non-surgical changes you "pass" as a woman. In my opinion, and the opinion of some others, you don't really need the surgery, so it is not really "medically necessary." However, you are saying that you don't feel comfortable unless you have these surgeries. What I am asking is, what exactly makes you different from any other woman who doesn't feel comfortable in her own body? I think this is a very valid question, and is a question asked not only by insurance but by Governments who fund universal healthcare at taxpayer expense. It is not and shouldn't be a free-for-all where you can get anything you want. If it is being paid for by others they have a right to ask if it is necessary, and the truth is that anyone can justify anything as being necessary.

Note that there are trans women who absolutely need the surgery, such as those who absolutely cannot look anything like a woman. But I do not see that in your case and in reality those seem to be few and far between.

[ainsley]

I too would like my surgeries covered by insurance, it is costing me quite a bit out of pocket and I have to make some sacrifices and forego some things and save my money (and I am ineligible for tax breaks on medical expenses).

Emphasis, mine.  Why, may I ask, are you not eligible?  H&R Block told me last year to claim the money I spent on medical expenses that exceeded 10% of my income.  Is there a caveat to the expense claim?

[androgynouspainter26]

She actually said the reason for her seeking surgeries is because people did not refer to her as "ma'am" or "miss" while they did that to others. It's something we as transgender people experience, actually. So while not male to female gender dysphoria, it is dissatisfaction with her gender presentation.

I am not really. I too would like my surgeries covered by insurance, it is costing me quite a bit out of pocket and I have to make some sacrifices and forego some things and save my money (and I am ineligible for tax breaks on medical expenses). However, the debate here is the rationale behind some surgeries being "medically necessary" and some being "cosmetic." And in your case specifically with some non-surgical changes you "pass" as a woman. In my opinion, and the opinion of some others, you don't really need the surgery, so it is not really "medically necessary." However, you are saying that you don't feel comfortable unless you have these surgeries. What I am asking is, what exactly makes you different from any other woman who doesn't feel comfortable in her own body? I think this is a very valid question, and is a question asked not only by insurance but by Governments who fund universal healthcare at taxpayer expense. It is not and shouldn't be a free-for-all where you can get anything you want. If it is being paid for by others they have a right to ask if it is necessary, and the truth is that anyone can justify anything as being necessary.

Note that there are trans women who absolutely need the surgery, such as those who absolutely cannot look anything like a woman. But I do not see that in your case and in reality those seem to be few and far between.

Because it induces dysphoria.  That's all there is to it.  Dysphoria is not the same thing as a spoiled girl feeling like the ugly one at the dance.  It's a physical pain.  I don't want FFS so everyone will see me as a girl or some BS, though the safity it'll afford me does come in.  I want it so I can look in the mirror without throwing up.

[ImagineKate]

Emphasis, mine.  Why, may I ask, are you not eligible?  H&R Block told me last year to claim the money I spent on medical expenses that exceeded 10% of my income.  Is there a caveat to the expense claim?

My medical expenses in a given year will probably never exceed 10% of our household income. It sucks because we've done some expensive procedures including IVF and other stuff not covered by insurance. But I'm not really complaining, I can afford it plus insurance covers some stuff like the drugs and monitoring so that knocks down the expense somewhat.

[V M]

Hi friends

Everyone has an opinion and expressing an individual opinion is fine, but let's make sure to keep the conversation civil and not let it devolve into idle circular bickering

Thank you

V M

[Serena]

I don't think FFS is cosmetic, I mean for some people it can be cosmetic, like for lip injections considered part of ffs, no I'm sorry but there are many of women with small lips, so maybe some procedures can be considered cosmetic, but other procedures are not. I do feel dysphoric about my chin, there are times I don't want to show my chin, I would wear a burqa (I actually did sometimes but I figured that people would look at me more that way, and I felt uncomfortable), and the same goes for other male feature I see in my face, and it's hard to have a standard FFS as you said, but some features like the brow bossing, it's something very masculine that we feel dysphoric about. It's not that I want to be prettier, I just want to look like a female, and some features do induce dysphoria to some people... We are all different and have different dysphoria. I might want to have srs, but some other trans woman might not want to have srs, and thankfully here int he us in most of the states you don't need srs to change your gender mark. I also think laser or electrolysis at least of facial hair should be covered, that's something really dysphoric, I really don't know any trans women who would want to shave for the rest of her life, that's just crazy. I really don't understand american insurance that much anyway, because I just moved here 2 years ago, but would an insurance pay for your srs or ffs if done overseas?

Also I know Raiden Quinn had ffs and paid it with insurance (probably not completely), I forgot what states she said she lived in, but she had Dr. Z, and I think other girls in the forum had insurance pay for ffs, so hopefully that will change, and more health insurance will cover ffs. Also when Raiden on youtube talked about her surgery, she did separate the cosmetic to the essential ffs portion that made her feel dysphoric, and I do agree with her, I mean some part of FFS are cosmetic, while other parts of FFS aren't.

[Lady_Oracle]

Yeah this whole debate at least in regards to grs being a cosmetic procedure is a bit off putting since its a major surgery one of the most traumatic surgeries a person can endure. I think it should be covered universally for every one of us just like in the UK or in Canada. FFS and breast augmentation should be done on a case by case basis and like with ffs what specific surgeries would be covered, like the forehead and nose vs the chin/jaw, should the entire cost be covered? If the testosterone effects were very heavy on the face then shouldn't it be argued that said trans woman should get it all covered? I mean like i said this should be handled in a case by case basis since not everyone needs extensive work done but here's another example, say if said trans woman wanted more work done than what she was approved for, then their should be a process in place with the insurance so she can get the extra work covered if she really felt she needed it.

I honestly think the above is what needs to change with insurance here in the states. I think it would help minimize the depression/suicide rate with our community. A lot of the inner turmoil we face with our dysphoria is the physical stuff. Not having the funds nor the insurance to be able to get this stuff covered is disheartening and crippling even.

[androgynouspainter26]

Yeah this whole debate at least in regards to grs being a cosmetic procedure is a bit off putting since its a major surgery one of the most traumatic surgeries a person can endure. I think it should be covered universally for every one of us just like in the UK or in Canada. FFS and breast augmentation should be done on a case by case basis and like with ffs what specific surgeries would be covered, like the forehead and nose vs the chin/jaw, should the entire cost be covered? If the testosterone effects were very heavy on the face then shouldn't it be argued that said trans woman should get it all covered? I mean like i said this should be handled in a case by case basis since not everyone needs extensive work done but here's another example, say if said trans woman wanted more work done than what she was approved for, then their should be a process in place with the insurance so she can get the extra work covered if she really felt she needed it.

I honestly think the above is what needs to change with insurance here in the states. I think it would help minimize the depression/suicide rate with our community. A lot of the inner turmoil we face with our dysphoria is the physical stuff. Not having the funds nor the insurance to be able to get this stuff covered is disheartening and crippling even.

Exactly.  If I had access to these surgeries, I can't tell you all how much better I'd be feeling.  I'm in the middle of a pretty bad spot right now because my dysphoria has become so all-consuming that I can barely leave my dorm room.  I think FFS could help me get my life back.  My face has been ravaged by the effects of testosterone, and having to see those "scars" every time I look in the mirror and having other people see those scars is really painful for me.  I mean, the woman I'm sitting next to while waiting to be called in for jury duty-I'm pretty sure she thinks I'm a guy.  That hurts a ton.  I'm trying not to cry.  If FFS could save me from this, I'd say in a heartbeat it's medically necessary.  As is, either I'm going to have my parents pay for it or detransition because I've realized there is simply no way for me to pay for it. 

[mmmmm]

Dysphoria is psychological distress... gender dysphoria means it is a psychological distress caused by on ones birth assigned gender and everything related. Many biological women feel severe psychological distress because of their facial features or body. If insurance company would cover FFS for transsexual women, THEY MUST also cover plastic/reconstructive/aesthetic surgeries for all other women who feel psychological distress because of their facial features. And should this only be applied to transsexual women, and biological women, or should it also apply to all other transgender women and individuals? What if someone is androgynous, not really transsexual, but he/she also feel psychological distress because of their facial features? Shouldn't they also have FFS or other type of facial surgery for free, like everybody else? Or maybe a crossdresser, who sometimes identify as man, and sometimes as woman, and then feels psychological distress because of their masculine facial features, which cause them psychological distress while going out in full femme mode, and gets misgendered, and verbally attacked, and stared at, just like many of you here do. Shouldn't then they also have some sort of facial surgery covered by an insurance company? Where do you draw the line? You have women with brow bossing, I hear it all the time here on this forums, that Jennifer Lopez or someone else has worse brow bossing than most people who do kindly ask for a honest opinion, and gets a Jennifer Lopez comparison as an example, and claim supported with a link to the picture. Or the same happens with jaw, as Mrs. Jolie has a wider and more masculine jaws than 75% of members here... truth is, many biological cisgender women have masculine facial traits and features, and if you have it, you can't really claim that you would be the only women with prominent brow bossing and wide jaws in the world, and because of that you must have a FFS for free, to fix all that, so you can feel better and more female while looking in the mirror...... My point is... how do you draw the line, and make a rules that would work for everybody? Well, you can't... Like everybody else, all of you have a chance to take a legal route, and prove your points on the court, and hopefully have an insurance cover it. Or you can, instead of putting time and money for legal costs, work hard and pay for your FFS (just like everybody else does).

[androgynouspainter26]

Dysphoria is psychological distress... gender dysphoria means it is a psychological distress caused by on ones birth assigned gender and everything related. Many biological women feel severe psychological distress because of their facial features or body. If insurance company would cover FFS for transsexual women, THEY MUST also cover plastic/reconstructive/aesthetic surgeries for all other women who feel psychological distress because of their facial features. And should this only be applied to transsexual women, and biological women, or should it also apply to all other transgender women and individuals? What if someone is androgynous, not really transsexual, but he/she also feel psychological distress because of their facial features? Shouldn't they also have FFS or other type of facial surgery for free, like everybody else? Or maybe a crossdresser, who sometimes identify as man, and sometimes as woman, and then feels psychological distress because of their masculine facial features, which cause them psychological distress while going out in full femme mode, and gets misgendered, and verbally attacked, and stared at, just like many of you here do. Shouldn't then they also have some sort of facial surgery covered by an insurance company? Where do you draw the line? You have women with brow bossing, I hear it all the time here on this forums, that Jennifer Lopez or someone else has worse brow bossing than most people who do kindly ask for a honest opinion, and gets a Jennifer Lopez comparison as an example, and claim supported with a link to the picture. Or the same happens with jaw, as Mrs. Jolie has a wider and more masculine jaws than 75% of members here... truth is, many biological cisgender women have masculine facial traits and features, and if you have it, you can't really claim that you would be the only women with prominent brow bossing and wide jaws in the world, and because of that you must have a FFS for free, to fix all that, so you can feel better and more female while looking in the mirror...... My point is... how do you draw the line, and make a rules that would work for everybody? Well, you can't... Like everybody else, all of you have a chance to take a legal route, and prove your points on the court, and hopefully have an insurance cover it. Or you can, instead of putting time and money for legal costs, work hard and pay for your FFS (just like everybody else does).

Getting these things covered in court is not realistic.  It's worked only once.  And not everyone has the opportunities required to pay for their own FFS.  "Working Hard" does not equate to finding 40k of disposable income.  You had your parents pay for FFS, right?  Not everyone is so lucky as to have access to these kinds of resources.  You have to think about people who are in my situation.  What do you think I should do?  I'm a full time theatre student and it's too late for me to change my major.  After I graduate-what am I supposed to do?  Finding a job that pays more than minimum wage even with a college degree in this country is hard.  Be a waitress for twenty years?  Sex work?  Being realistic, your options if you are a trans women who does not pass are few and far in between.  Just keep in mind that for me, insurance might be the only way for me to ever afford any kind of surgery.  It made a huge positive difference in your life, no?  What about me?  What am I supposed to do?