Asking about sex affirmation surgery – a review of the numbers

Survey – should medicare pay for sex-change (italics by me) surgery – In one of the responses there’s an enlightening back of the napkin calculation of the potential costs of sex affirmation surgery, which point out important numbers about the prevalence of this rare condition. Much lower than the amount of emotion attached to the non-fact-based responses to the question.

Using the numbers quoted in the WPATH guidelines, I came up with this potential number of trans people in the US, based on 2011 census data:

MTF: 2495 – 9437 people over 18

FTM: 595 – 3911 people over 18

That’s for the entire United States. Some may require psychotheraphy, some may require hormones, some may require surgery, some may require none of these treatments, some may require all.

See: Now Reading: Choosing Wisely : Standards of Care for the Health of Trans People | Ted Eytan, MD

Now let’s discuss the question asked by Medpage today, especially in the context of this determination:

In June 2008, the American Medical Association (AMA) House of Delegates stated that the denial to patients with gender identity disorder of otherwise covered benefits represents discrimination, and that the AMA supports “public and private health insurance coverage for treatment for gender identity disorder as recommended by the patient’s physician.”[link]

The question that should have been asked is

“Given that sex affirmation surgery is recognized as medically necessary by every major medical organization and denial of coverage represents discrimination, should medicare refuse to cover this procedure when recommended by a physician?”

If you don’t ask a question with context, especially with regard to a population that is openly discriminated against in society, you are essentially asking respondents if they like the population or not.

It’s not much different than asking people in 1942 if African Americans should be admitted to white hospitals, or in 1993 if persons with HIV should be treated with modern medications. Going this route ultimately reveals more about the bias of those creating the survey than those answering it.

I wasn’t around in 1942, but I was in 1993. In 2013, we look back in horror at the way the medical profession treated other humans during that period.

I believe we will do the same when we reflect on how trans people are being treated today.

Ted Eytan, MD