Politics & Policy

Their Bodies, Our Bucks

Transgender tennis star Renée Richards
Should taxpayers foot the bill for gender-reassignment surgery?

Massachusetts governor Deval Patrick wants to force taxpayers to foot the bill for gender-reassignment surgery.

Patrick announced two administrative actions in June to provide Medicaid coverage for sex-change surgery. Oregon and California taxpayers already pay for sex changes through Medicaid. The same day Patrick made his announcement, the Massachusetts Division of Insurance moved to prohibit private insurers from excluding individuals undergoing sexual transition from coverage.

The measures follow a May 30 decision by the Department of Health and Human Services (HHS) to reverse a 33-year-old policy to exclude those treatments from Medicare coverage. A few days earlier, the mayor of Rochester, N.Y., announced that municipal employees will have access to “transition-related healthcare coverage” beginning next year.

Many have heralded these measures as significant advances for the health and rights of those suffering from gender dysphoria, a condition in which one’s biological anatomy does not correspond to the gender with which one identifies. Lambda Legal compiled this list of statements by major medical organizations, such as the American Medical Association (AMA), showing support for the transgendered in their plight for gender-dysphoria treatment.

The ACLU “blog of rights,” reacting to the news of the changed HHS policy, declared: “This takes us one big step closer to our ultimate goal: a general recognition in America that transition-related care is basic health care for transgender people that no one should be denied.”

Nevertheless, there are empirical grounds for doubting whether gender-reassignment surgery is effective enough to deserve public subsidy.

A review of more than 100 studies by the University of Birmingham suggests that gender reassignment surgery “found no robust scientific evidence that gender reassignment surgery is clinically effective.”

Likewise, a Swedish study noted high suicide rates and other mortal problems among people who had undergone gender-reassignment surgery. That study did not draw gender-reassignment surgery into question, but concluded that the surgery should be supplemented with additional care.

There is also evidence that gender dysphoria can be resolved without surgical intervention.

A 2008 study of 77 gender-dysphoric children in the Journal of the American Academy of Child and Adolescent Psychiatry. The study concluded: “Most children with gender dysphoria will not remain gender dysphoric after puberty.”

Walt Heyer, who had his sex-change surgery reversed, can attest to the flexibility of gender identity. He now operates the website www.sexchangeregret.com and writes books to draw attention to the phenomenon of sex-change regret, which he says is far more common than generally believed.

“People don’t fare well in life experience after undergoing gender surgery,” Heyer tells National Review Online. “So it’s always kind of troubling for me why we would pay for something . . . that is actually over the long run, [going to] be more harmful than if we left the person alone and dealt with the psychological component.”


Occasionally, cases of gender regret receive media attention.

Mike Penner, a writer for the Los Angeles Times, became Christine Daniels after gender-reassignment surgery, but then came back to the newspaper as a man and was said to be dissatisfied with his decision. He died in 2009, apparently by suicide.

Ria Cooper, whose male-to-female gender reassignment surgery at age 17 made him/her into the Britain’s youngest transsexual, sought to “re-transition” only a year after the surgery.

Last year, a Belgian female-to-male transsexual, Nathan Verhelst, elected to be euthanized in order to escape “unbearable psychological suffering” after his “botched” gender-reassignment surgery made him into “a monster.”

Ben Klein, a senior lawyer of the Massachusetts-based Gay and Lesbian Advocates and Defenders (GLAD), says the push to publicly fund gender-reassignment surgery is driven by science, not ideology.

“There are people who will have their philosophical views,” Klein (whose groups is not affiliated with GLAAD, the former Gay and Lesbian Alliance Against Defamation) tells National Review Online. “But for those people who want to deny people healthcare based on their philosophical views, they are simply flying in the face of mainstream medicine in the world today.”

Klein added that patients with gender dysphoria must undergo a series of rigorous tests and must be carefully observed before they can become eligible for gender-reassignment surgery.

“You can’t just call up a surgeon and order up a gender-reassignment surgery,” he said.

Klein didn’t comment on the University of Birmingham study but said mainstream science has arrived at a consensus in favor of gender-reassignment surgery for extreme cases of gender dysphoria. In support, he cited the pages of studies and statements supporting gender-reassignment surgery in the recent HHS decision. One study of Swedish transsexuals cited in the decision found no cases of regret among a group of 60 five years after sex-change surgery.

Heyer, however, says he has found no compelling objective evidence that gender-reassignment surgery is effective treatment for gender dysphoria. He dismisses the supportive statements by the AMA and other mainstream groups as being driven by ideology rather than science and medicine.

“The people who gain from this really are the people who are trying to transform the whole social concept of gender,” he said. “We’re really on a course for trying to eliminate gender, male and female, that’s where this is all coming from.”

If Heyer is right, gender reassignment surgery does not seem like a pressing public-health priority.

— Spencer Case is an intern at National Review.

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