Guest Post: Trans Perspective on DSM-V Changes Regarding Gender Dysphoria

I’m not the only queer in my family and I’m not the only trans person either.  This is a piece written by a family member, Jesse, on the recent change to the DSM-V regarding gender dysphoria.  It’s no longer classified as a disorder, so that’s a good thing, right?  Some people aren’t so sure, there are concerns that some procedures and care that were previously covered by insurance because of that disorder classification will no longer be covered.  Here’s Jesse’s take:

  There has been some concern that the changes made to the DSM-V regarding Gender Dysphoria (previously Gender Identity Disorder) will cause a negative impact in the availability of insurance coverage by some providers. That because it is no longer classified as disorder it will no longer be considered medically necessary. Though I can agree that being Gender Dysphoric alone may not limit a person’s ability to be successful in and contribute to society in a positive way, I will say that if Gender Dysphoria goes undiagnosed or a person’s identified gender goes un-affirmed and some sort of care isn’t initiated, there is a real chance that other more prominent mental conditions may develop. Eventually those conditions will likely have the potential to affect a person’s ability to be successful at home, work and even in society at large. Those conditions will eventually need to be treated through the care of a mental health provider, and in the case of those with insurance that covers psychiatric care, it will most likely be covered by insurance. If however Gender Dysphoria is not covered or is dropped because it is no longer a disorder, it will go untreated as an underlying reason for the other mental conditions. For some simply seeing a mental health care provider may be enough, for others it is simply a temporary fix or small step in addressing something deeper. The insurance providers will continually fund care of only the resulting conditions of a bigger problem for an indefinite amount of time.

On the contrary, if the insurance companies and employers decide to work with the American Psychiatric Association (APA), The American Academy of Child and Adolescent Psychiatry, other psychiatric institutions and Transgender advocate groups to develop a reasonable and cost effective way to provide full, unrestricted care of transgender people, they may be able to prevent the continued long term care of some patients do to the resulting complications from Gender Dysphoria.

There are already recommended standards of care for Transgender patients in place that can be applied to most cases beginning with initial diagnosis by a mental health professional and, if the it is deemed necessary, irreversible surgeries to align the outward appearance of the body to match the identified gender of an individual. These standards of care can be used as a basis to make policies that will adequately inform, instruct and safeguard the integrity and interests of the insurance providers, healthcare providers and most importantly the Transgender person.

Even if the disorder terminology and diagnosis have been removed from the DSM-V regarding transgender care it is still in the best interest of all involved to continue or begin covering the care (or as one exclusion states “Services, drugs, or supplies related to sex transformation” – Federal Employees Health Benefits Program, Blue Cross Blue Shield Service Benefit Plan, 2013) of a Transgender person. It is very possible that if Gender Dysphoria goes undiagnosed or untreated it may lead to complications both in the mental health realm and in the physical health of a person who is otherwise covered by a plan. Those complications then have the real potential to cause more resources being spent on the person over their life time until the underlying cause is properly addressed.

With those considerations in mind, a successful case can be made to health care providers, insurance providers and the employers who offers the insurance, that the care of a Transgender person for Gender Dysphoria may be medically necessary to relieve or prevent any resulting mental disorders, conditions or physical ailments that ***will ONLY serve TO limit*** the persons quality of life and prevent them from being an even greater asset to the employer.

[Ed. Note:  the latest standards of care are found on the WPATH (World Professional Association for Transgender page: http://www.wpath.org/publications_standards.cfm]

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