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<p>Those expenditures may be unnecessary, but I think what Brown will be subsidizing is positively harmful.</p>
<p>Well, then, feel free not to get such surgery. I’m not planning to, myself. </p>
<p>If someone in conjunction with his or her physicians and therapists feels this is what they must do, it would be pretty arrogant of me to say that I know better. </p>
<p>I do have a sense that you liked it better when guys were guys and dames were dames and everyone knew their rightful place, as dictated by gender and SAT scores.</p>
<p>“Just curious, are the xy chromosones changed? Is it possible change that?”</p>
<p>If you’re seriously asking this question, you don’t belong in this discussion.</p>
<p>It’s not just Brown. It starts with the insurers. Look at the insurer web sites. This wouldn’t get anywhere if they, their med and psych advisors and money folks disagreed. You can easily find the ins co. guidelines.</p>
<p>I have been thinking about this a lot – it’s a very interesting thread.</p>
<p>I have no doubt that gender dysphoria is very real, and that sex reassignment surgery can make people much happier. I would be interested in seeing the economic case made for the surgery – how many suicides or drug addictions does it prevent, how much more productive are post-surgery transsexuals?</p>
<p>I believe strongly that adequate health care ought to be a right, and this issue raises for me the question of what I mean by that. Because I don’t think “adequate health care” includes every costly procedure that makes people happier. So . . . which ones are in, and which out? How do you tell? Breast augmentation as of right for mastectomy patients, but not twentysomethings who think a bigger rack will further their careers? (And what if the mastectomy was prophylactic? Discretionary?) Surgery to remove prostate cancer that is unlikely to cause death? Orthopedic surgery to improve athletic performance?</p>
<p>What is the baseline? We clearly pay to separate conjoined twins, or to repair congenital heart defects, so restoring someone to his or her original condition can’t be the test.</p>
<p>This is cosmetic surgery, by the way. Major cosmetic surgery, but cosmetic surgery. Surgeons can’t transform a man into a woman, or a woman into a man; all they can do is make one look a lot more like the other, including naked. They can’t make “reassigned” sex organs function as sex organs; they can make them function as elaborate sex toys.</p>
<p>And how do social norms figure in? Does it matter if the vast majority of people sharing the financial burden of a treatment would not agree to pay for it if their children wanted it? The medical profession certainly has a large role in deciding what is medically necessary, but do they have the ONLY role? I don’t think they do now, although it’s close. How about markets?</p>
<p>There is also a prisoner’s dilemma problem here, which is what caught my eye initially. If your college (or grad school) is the only place that offers insurance for this expensive, but desirable, procedure, that’s a lot of pressure to do the procedure while you are there, and a lot of incentive to try to go there if you want the procedure. If other insurance covers it, too, then your decisions aren’t going to be affected so much by financial concerns. Bless you, Medi-Cal. If this is medically necessary – however we determine that – all insurance should cover it. One of the reasons that I hate our current system is the massive inconsistency in coverages really winds up distorting individuals’ decisionmaking.</p>
<p>Finally, I can’t believe the cost is really only $50,000. All-in estimates I have seen are much higher. Around here, I don’t think you can get any procedure done that requires general anesthesia and multiple hospital stays for that little. Plus, there are obvious ongoing medical costs (which may have been incurred with or without the surgery). But I guess it’s possible that $50,000 would cover that part of the procedure that medical insurance might cover,</p>
<p>I believe it’s “coverage up to 50k.”.</p>
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<p>How much misery, including misery leading to suicide, does it cause, when a “reassigned” man realizes he is still unhappy but now in addition can never function normally, be a mate for a woman, or father a child? How much misery does it cause family members who have lost the person they knew?</p>
<p>Actually, Beliavsky, I think the answers to your questions are “close to none.” People may have a tendency to overvalue the difference the surgery will make in their lives, but I don’t think there’s any kind of widespread problem with post-operative regret that you can’t “function normally”. For the people who do this, that ship sailed long, long ago.</p>
<p>As for family members, it’s not like they have a great choice. The choice is more-or-less between a permanent, desperately unhappy transvestite, and a permanent, somewhat more at peace, more successful transvestite. I know from people close to me that there’s a lot of pain to family members (especially spouses) associated with getting to the point where surgery might look like a good option. After that, I’m not certain there’s a lot of pain left to undergo, either way, besides the pain of seeing someone you are close to in pain. And – this goes without saying, but I’ll say it anyway – we generally don’t let parents, spouses, or siblings express their preferences on an individual’s medical choices unless the individual is incapable of making his or her own decisions, even if the relatives have a significant emotional stake in the question.</p>
<p>“How much misery, including misery leading to suicide, does it cause, when a “reassigned” man realizes he is still unhappy but now in addition can never function normally, be a mate for a woman, or father a child? How much misery does it cause family members who have lost the person they knew?”</p>
<p>Uh, Beliavsky, the person transitioning in this case has long since decided she is not interested in fathering a child or performing sexually with a woman the way a man would with male genitalia. I don’t think you have thought this through very well, and are just hung up on the ick factor.</p>
<p>I have sympathy for these people also. But I also have sympathy for women who cannot conceive a child without IVF and insurance almost never pays for that. </p>
<p>I read the article in the Brown paper. For male to female, the insurance will pay for many of the surgeries but breast augmentation was not among them. Maybe that it too cosmetic?</p>
<p>How about breast reduction? I’ve known a number of women who did it to reduce backpain, but they also didn’t like the way they looked. </p>
<p>I just hate our health care system. </p>
<p>Oh and from my grand sample of two. The people I know who have had the surgery are very happy thank you!</p>
<p>As my previous post indicates, I was rather skeptical about the whole transgender issue. But I viewed this 7 minute video with Barbara Walters interviewing a transgender 11 year old and I think I get it. I don’t think anyone could argue that the essence of this child is clearly female.</p>
<p>[Transgender</a> at 11: Listening to Jazz - YouTube](<a href=“Transgender at 11: Listening to Jazz Jennings | 20/20 | ABC News - YouTube”>Transgender at 11: Listening to Jazz Jennings | 20/20 | ABC News - YouTube)</p>
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<p>OK, apart from dropping your jaw at our political incorrectness, what’s the distinction, precisely? A nose is part of your body, right? So if you feel like your nose completely misrepresents who you are, why isn’t that “living in the wrong body”? It’s not likely as serious, of course, as gender dysphoria, but it’s also way cheaper to fix, with much less risk, and the fix is completely effective. With sex reassignment surgery, you are still living in the wrong body when it’s over, but your body looks more like the right body. So it’s easier to cope with the fact that it’s wrong, easier to fool other people (up to a point).</p>
<p>I wonder if they pay for other types of surgery that could greatly affect a person’s emotional state? Maybe gastric bypass for morbid obesity or cosmetic surgery to remove strawberry marks.</p>
<p>The gastric bypass is an interesting one and in a common sense world if gender reassignment surgery is covered, gastric should be too. </p>
<p>Listened to a DR. program yesterday. Mounting evidence that facial expression translates into emotional state. So, if you are depressed and have permanent frown lines botox positively affects the depressive state. If you can’t frown, your mind seems to have a harder time being depressed. I would hope that this treatment will be covered soon under the mental health portion of insurance. </p>
<p>There is much technology and medicine CAN do but it will always run into a resource constraint.</p>
<p>I think it’s possible to be a) empathetic to people with gender dysphoria and be supportive of SRS as they and their health care providers deem appropriate but b) question its coverage in a student insurance program. I think part of what’s happening in this thread is that you have some people who are all agog at the idea of SRS in the first place and “don’t understand” why anyone would ever want that done. </p>
<p>My D goes to an all-women’s college, which puts some unique spin on this issue:
Does a born-female who transitions to male during college still “belong” at a women’s college? Should he be allowed to, say, host prospective students, or upon graduating, do alum interviewing? My D is on our private insurance, not the college’s insurance, so I have no idea if the college’s insurance covers SRS or not.</p>
<p>I feel that I understand a particular individual’s need for the surgery, but I too, get stuck on why it is different from many people who suffer lifetimes of shame or unhappiness about other bodily features that can be repaired cosmetically but are not covered by insurance.</p>
<p>I think where the university would run into problems is the 'why them and not me" situation. Once you start paying for procedures that affect emotional well-being more than physical, then how far down that road will the university go? If they’ll pay for the SRS, then what do they tell other students who have conditions that cause depression or self-image problems due to physical problems that are not covered? Unless this is just a PR situation.</p>
<p>IMNSHO, a person who genuinely identifies and lives as a male does not really belong at a women’s college, except as an exchange student. The stance taken by activists in “the trans community,” M-to-F anyway, is that they are just as much “women” as those of us whom they would label “ciswomen.” If so, then presumably a transman is a man, period. Although I would not accept an application from a person who had already transitioned, certainly wouldn’t kick the person out if they were there already. It really is not that big a deal to accommodate such a tiny minority.</p>
<p>Should he host prospective students? No. A coed school would not expect a 17-yr-old girl to stay with a guy, either. Should he do alumna interviews? More difficult to say. I don’t think it would be a particularly good idea. Again, we are dealing with 17-yr-olds. The focus should be on their needs, and it is pretty certain that being interviewed by a male as an alum of a women’s college would be, to say the least, a major distraction. (There’s no reason why a transman shouldn’t interview for a coed school.)</p>
<p>I personally agree with you, Consolation. I have nothing but support for an FTM, and I wouldn’t kick him out of the college community where he has already made friends, etc., but being a man isn’t consistent with the goals of a women’s college, and I don’t think he should be hosting prospies or doing alum interviewing. I would not have wanted my D doing an alum interview with a man – not that I have any problem whatsoever with someone who had transitioned accordingly, but that’s not part of what she’s looking for in a women’s college. Part of what it’s about is a sort of sisterhood, and if someone is truly male inside (and now just fixing the outside to match that), then they aren’t part of that.</p>