Posts Tagged ‘health care’

Our community seems sharply divided on the recent decision by U.S. District Judge Mark Wolf to allow convicted killer Michelle Kosilek to undergo transition surgery while in prison, paid for by the state of Massachusetts.

I understand the anger and frustration of those who have worked three jobs, sold their possessions, and still can’t afford to pay for this surgery. They think, “I have been a law-abiding citizen all my life and I can’t afford to have surgery, but a convicted murderer can get it for free? How fair is that?”

Probably not all that fair, actually. But, in my opinion, the Michelle Kosilek decision is about far more than one person – one murderer, even – getting her transition surgery covered by the state. I think there are some points that we have to look at with regard to this decision, all of which take Kosilek out of the equation entirely.

1. First of all, we have to examine whether or not federal, state, and local governments should pay for medical care for their prisoners. If the answer is yes, then the decision could go no other way. If transition is, in fact, medically necessary, and if, in fact, a civilized government provides health care to those who it incarcerates, then the government must provide medically necessary care to all its prisoners. It cannot discriminate on the basis of some false morality, or on the “worthiness” of the individual receiving the care.

We either treat our prisoners humanely or we don’t, and providing necessary health care is the humane thing to do. It’s not a matter of who “deserves” it and who doesn’t. It’s a matter of whether or not we are going to provide it to our prisoners – period. (more…)


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Question MarkA reader writes: “I have been having serious issues with a urinary tract infection. On a Friday, my doc finally said if it does not get better, go to an emergency room and get an infusion, to flush this thing through and out.

“When I woke up from a sleep a couple of hours later, my face was scarlet and my temperature, at between 102 and 104, was higher than it had ever been. So I took her advice and went to the ER she suggested.

“Apart from issues to do with having to tell the story five times, and not really being listened to, and privacy issues you would not believe, the hospital’s crowning glory came at that moment when a junior doctor asked me, after surveying my patient information and while standing beside me in a busy corridor, ‘So … do you have a penis?’ Of course it was a totally reasonable question in the circumstances, given the different levels of risk to this condition, but there is a time and place for everything.

“At the end of my session there, I went up to her to say this was an inappropriate question to ask in that particular space (I added, ‘So would you ask him or him?’, pointing at what I hope were cis guys). She said she probably would. Oh, yeah?

“So my question is, when colleagues go to health providers, do they always provide full info on surgeries they had and so on? In a hospital environment where I might expect treatment, I do, and to my primary care provider, I have. But I feel that ophthalmologists, dentists, podiatrists and such like don’t need to know this. I always declare the testosterone, though. What do other people do?”

I have always thought that we get the best health care treatment (if we get “best” treatment) by being as honest as possible with our health care providers. However, I am also of the mind that not everyone needs to know everything about my situation.

I understand that medications, including hormones, can have an effect on how some other medications might work. I also understand that past surgeries are important to doctors for a few reasons – they want to know how you might have reacted to and recovered from the surgery, in case something comes up that requires surgery while they are treating you,  it gives them a picture of your health status in general (if I’ve had open-heart surgery, they know I have heart problems), and it can help them rule things out (I don’t think I can get gallstones anymore, because I don’t have a gall bladder, so no use testing for that). I’m sure there are other reasons, as well.

But I’m not sure that my dentist, foot doctor, and eye doctor need to know that I’ve had chest surgery (or lower surgery, for that matter, if I’d had it), unless the problem I was having had to do with possible surgical side effects or complications. (more…)

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Question MarkA reader writes: “I am a 26-year-old transman, and I’ve been on T for 18 months now. For several years I’ve lived without health insurance, because it simply wasn’t affordable, and I chose not to apply for Medicaid out of a concern that it would impact the cost of my hormones. (Currently I get my testosterone through a community clinic in New York City, where I get a huge discount because I am uninsured and live well below the poverty line.)

“Could you please explain how the Affordable Care Act relates to transgender health costs? I don’t see myself living above the poverty line any time soon. Do you know how the new legislation might impact me as a low-income trans man?”

I am not clear on the extent that the Affordable Care Act will benefit trans people. The benefit that I have seen seems to be that health-care providers cannot discriminate on the basis of transgender/transsexual status – you can’t be turned away because you are trans, and you can’t be refused health-care services that might be necessary because of your body configuration, but that are not typically provided to people of your gender.

The Transgender Law Center says, “The law (ACA) for the first time prohibits gender-based discrimination by most health care providers – a ban that extends to discrimination based on gender identity and gender stereotypes, and thus provides critical protection for LGBT people. The law will also prohibit insurers from denying or canceling insurance because a person is transgender or has HIV or another medical condition.”

The National Center for Transgender Equality (NCTE) released a “Know Your Rights” health care guide that says, in part, “The ACA creates new rights and protections for appealing coverage denials by your plan for any reason. In addition, it may be unlawful for a plan to deny coverage for services that are included in your plan solely because you are transgender or because of the gender under which you are enrolled in the plan. For example, it may be unlawful for a plan that receives federal financial assistance to deny coverage for a prostate screening for a trans woman or a pelvic exam for a trans man if these services are otherwise covered.” (italics mine)

The Center for American Progress says that the ACA’s impact law’s impact “will be especially profound for lesbian, gay, bisexual, and transgender people,” and lists the top ten benefits of the law for LGBT people, including data collection with regard to health disparities and the needs of underserved populations. (more…)

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If you’re too young to remember the original movie The Stepford Wives (I didn’t like the remake), here’s a brief synopsis: Women in Stepford love housework. They dress as if they’re going to the Academy Awards just to go to the grocery store. They don’t age, their boobs are firm, and they love to have sex at the drop of a hat (or the drop of a man’s drawers), even with their aging, sagging husbands. And even with all the sex and glamour, they can still keep their homes spotless.

The women in Stepford are ultra-feminine, according to the standards of the day (the film was made in 1972, amidst the women’s rights movement of the time). They reject everything that the women’s rights movement stands for. In fact, they think it is ridiculous – after all, a woman’s job is to cook and clean and keep her man happy. If she can’t do that, she’s no kind of woman.

The women are able to do these things and think this way (in truth, they don’t really think at all) because the men in Stepford have learned how to create robots that look just like their wives and infuse these robots with some of their wives’ sensibilities, but not all of them – not the ambitious, even somewhat rebellious ones that make women want to pursue hobbies and careers and maybe leave the breakfast dishes unwashed for a while.

For the times, it was a movie that made a strong statement – and maybe that statement needs to be made again. A paper from Northwestern University’s Feinberg School of Medicine, appearing in the Journal of Bioethical Inquiry and reported in The Advocate, claims that U.S. physicians are “using a synthetic steroid to prevent female babies from being born with ‘behavioral masculinization,’ or rather a propensity toward lesbianism, bisexuality, intersexuality, and tomboyism.” (quoted from The Advocate report)

In other words, doctors are creating Stepford wives in the womb. Apparently, pregnant women who are at risk of having a child born with congenital adrenal hyperplasia (CAH), an endocrinological condition that can result in female fetuses being born with intersex or more male-typical genitals and brains, are being given dexamethasone, a synthetic steroid, to try to “normalize” the development of those fetuses. Note that the report says “women who are at risk” of having a child born with CAH – the medication is being received by fetuses who do not even have CAH, and, in some cases, by male fetuses.

And even if the female fetus does have the condition, it appears that not much is known about the long-term risks of giving this drug to pregnant women, both for the women and for the children who have been exposed to this drug in utero. The doctors who are administering this drug, and the women who are accepting it, are obviously more concerned about the “femininity” of these female children than they are about potential health hazards. The drug has not even been approved by the FDA for this purpose. (more…)

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Question MarkA reader writes: “I have two related questions about psychotherapists and trans clients when the trans client is not specifically seeking transition-related medical approval stamps, but simply seeking psychotherapy for any number of things that may include trans and transition-related stresses.

“For psychotherapists who are not very familiar with gender variation and trans issues, and who may have clients who are trans and who seek therapy: What would you put on your top three to five things such therapists should know or be aware of?

“For trans people: What would you put on your top three to five things a person should be aware of when pursuing therapy with a therapist who is not very familiar with trans issues?

“The other factor is that I’m sometimes pulled into playing the role of educator and I’m really torn about it because 1) I know nothing about therapeutic worlds and am not trained to be a trainer, 2) I am a client, not a teacher, and 3) I don’t know where else they should be looking. How do therapists train themselves or learn about these things?”

These are interesting questions, and very timely, because the Gender Identity Center of Colorado is having its annual Colorado Gold Rush Conference on March 22-25, and the conference has a two-day clinical track for therapists and other professionals who are working or want to work with trans people (this includes students in an MSW or other counseling program). This is one way that therapists can learn about trans issues.

Since I’m answering your last question first, I will say this – it’s unfortunate that most university MSW and doctorate programs don’t have specific training or classes on trans issues. This should actually be an entire semester-long class in and of itself. What most higher-education programs (and most therapists) don’t understand is that therapists will run into clients with gender issues regardless of what area of counseling they are entering – family counseling, marital counseling, drug and alcohol treatment, child therapy, and pretty much any other area.

Whether or not these therapists choose to treat clients with gender issues or refer them on to someone else, they will see them in their practice. And even if they do refer them to someone else for work with gender issues, they should at least know what to do and how to handle the initial contacts and referrals. (more…)

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Question MarkA reader writes: “As a European living in New York, I find the U.S. health insurance system bewildering, to put it mildly. A German friend just had his bottom surgery done (is in the process of – seems to take a lot of steps, including complications) and there is no question that his health insurance would pay for it.

“In addition, frankly, U.S. medical costs are astronomical. So how does the average U.S. guy pay? At an FTM meeting, I heard a strange comment: ‘I wish I were on Medicaid.’ Is that more likely to pay than health insurance? Seems weird. I checked my own insurance and the alternative available through work, and neither of them pay for ‘gender stuff.’

“At the same time, they have known me as none other than ‘he,’ my documents are in ‘he,’ and even my birth certificate, due to arrive shortly, is in ‘he.’ So if ‘he’ lacks a body part, or the hormones, surely that is no longer gender alignment.”

As an American living in the United States, I find the U.S. health insurance system bewildering as well. In my experience, the bottom line with U.S. healthcare is that most insurance companies will pay for as little as they can get away with, regardless of what medical situation you are in.

However, an increasing number (a very small, very slowly increasing number) are starting to cover some or all aspects of transition. But most do not, and most policies have specific exclusions when it comes to anything related to transition – one thing insurance companies don’t care much about is “gender alignment.”

In a capitalist society, it’s pretty much all about money. Anything that costs money and doesn’t make money is suspect and is examined under a microscope to see how paying for it can be avoided. In addition, and this is my opinion only, I believe that there is an unspoken concept of “morality” underlying many of the decisions that are made about various goods and services that businesses offer to the public. (more…)

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Question MarkA reader writes: “I am currently a transvestite, and I am wondering why anyone would risk possible infection or complications involved with transgender surgery. I would be interested to hear what you think.”

I definitely have an opinion on this (don’t I always?), but in this case, I believe that my opinion is backed up by some pretty substantial research findings and at least one significant legal finding.

When you identify yourself as a transvestite, I’m not sure if you’re using the current U.S. definition, which refers to a man who wears women’s clothing for sexual gratification, or an older definition that would today refer to a crossdresser, a man who wears women’s clothing to express a female or feminine side of himself. If you are not from the U.S., transvestite might have an entirely different meaning for you.

Regardless, I would venture a guess that your gender identity is predominantly or always male. Therefore, it would be just as difficult for you to understand the need for genital surgery as it would for anyone else whose gender identity is in alignment with his or her physical body.

The medical and the legal systems in the United States have determined that genital surgery is a medical necessity for many trans people. Without it, they risk death through suicide or a life so miserable that death would be welcome. For people who need surgery, any possible complications are absolutely worth the risk. (more…)

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