Being transgender isn’t easy. There is a lot of emotional strain that comes with the process of self-acceptance and being publicly out. However, it is even more difficult when you look at the way that health care is handled for transgender individuals in the United States. Between finding accepting health care providers and trying to get approval from insurance to cover procedures that would otherwise cost thousands of dollars, there is a lot of red tape for transgender people to try and cut through to be able to live their lives happily and healthily.

            Of course, every policy is different. There are some states with insurance policies that cover things such as Hormone Replacement Therapy and procedures such as mastectomy and vaginoplasty or phalloplasty without too much hassle on the part of the individual seeking out these procedures. In most cases, HRT approval is prefaced by seeing a gender therapist for a certain amount of time and getting them to write a letter to the insurance saying that the individual being allowed HRT would help significantly decrease the body dysphoria that they feel. However, being approved for surgeries often involves being on HRT for anywhere from six months to two years, as well as seeing a gender therapist.

            For example, through Anthem Blue Cross Blue Shield of New Hampshire, if you are a female to male transgender person, there are a handful of things that need to occur before the insurance will cover a mastectomy.  Firstly you must be diagnosed with gender dysphoria, which involves explaining in detail to a therapist why exactly it is that you know that you are a different gender than you were assigned at birth. You also have to have had the transgender identity for at least two years, and prove that the dysphoria felt isn’t related to any other type of mental illness. You also have to prove that the dysphoria causes clinically significant distress. After that process, the individual would also have to be on HRT for at least one year, and get two referrals from mental health professionals, at least one of which has to have a doctorate or masters in clinical behavioral science, and they also state that in order to be approved for the surgery you must have two XX chromosomes.

These steps are basically the insurance determining if someone is “trans enough” to qualify for surgery. The fact that they have realized that their assigned sex and the gender that they are isn’t enough – as if it’s something that happens all the time and there are people who are pretending to be transgender in order to get gender corrective surgeries. (Spoiler alert – that doesn’t happen). Keep in mind that this is just the policy of one insurance company in New Hampshire, which is thought to be one of the more liberal and accepting states in the country. It can be even harder to acquire for people in other states with more conservative views.

People say that there is not fight left in the LGBT community now that homosexual marriage has been legalized. This isn’t true. Note that there is a ‘T’ in the acronym – which stands for Transgender. Transgender rights have become more and more public this year, with regards to North Carolina’s HB-2 bathroom law. Rights for transgender individuals involve more than just being allowed to use the restroom which they identify with, it also involves being able to have reasonable and accessible health care options in order to have a successful and healthy transition.