Let people understand something about trans people

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Aww, crap ... this discussion has degenerated into another Kurgan v. GGPViper bout.

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Given that 27,5% of everyone with body dysmorphic disorder have attempted suicide, should the government fund T3 hormones? Should it fund steroids (common steroids aren't dangerous if precautions are taken)?



Why are you taking what I write out of context? There are many ways to treat mental conditions. If the US government were to pay for surgery for everyone with a brain more similar to the opposite sex (a procedure that's anywhere between 10 000 dollars and 60 000 dollars), there would be very little money left for more important welfare issues.



Again, you're deliberately misreading what I wrote. Just because you have a brain like a woman, does not mean that you are a woman. This is an extremely common phenomenon. Where precisely in the government budgets do you find room for cosmetic surgery for all these people?



Psychological therapy and cosmetic surgery are two different subjects, regardless of how much information you manage to find with Google.



But not economists, right? Again, I have nothing against transgendered people, they should be free to do whatever they want with their bodies. The governments can't afford to pay for it, not until more important matters are resolved.



Anyone with half a brain can find evidence that there's not enough money to pay for advanced cosmetic surgery for even five percent of the population.

As far as medical importance goes:

The costs of chemotherapy:
http://www.benzene-illness.com/html/med ... enses.html

The cost of heart surgery:
http://www.bloomberg.com/news/2013-07-2 ... -u-s-.html

The cost of kidney transplants a couple of years ago:
http://umm.edu/news-and-events/news-rel ... -shrinking




What confounding variables would keep the attempted suicide rate that high? If the surgery fails to eliminate these confounding variables, why pay for the surgery instead of the therapy?



http://www.ncbi.nlm.nih.gov/pubmed/6648755
http://www.bookrags.com/research/suicid ... se-dat-03/
http://www.theguardian.com/society/2004 ... ntalhealth



Isn't "because important people said so" how you usually back up your arguments?



Anywhere between 3-17% regrets it (with the average being in the middle). People who regret their decision, are often marginalized in the transgender environment. If you're resorting to personal attacks again, it either proves that you know little of economics or little of statistics.

Ja. It took GGPViper triggering my negativism in another thread to get me to finally make this thread and to work to correct things in real life.

Let's just say that I've been experiencing much internal conflict and I just wanted a place to finally express it.

Kurgan, let me ask. If you succeed in your country in removing national health coverage for sex reassignment surgery, what about the autistic transsexual people in your country with executive dysfunction, who can't save up for it themselves. Would you just say, "Too bad," when you hear about their pain? Will you say, "Don't worry. Therapy will work eventually. Just give me time," ad nauseum?

Last edited by beneficii on 29 Oct 2013, 3:00 am, edited 1 time in total.

If anyone bothered to read the APA link, here's a tidbit from it (emphasis added):

Basically, they say correcting someone's gender identity for the purpose of eliminating the need for hormones or surgery is not feasible. The purpose of therapy is to resolve mental health issues and clarify what the individual actually needs.

That answers the question you raised, Kurgan.

I say, pass the popcorn.

Well, I'm trying to hold up my end, too.

Indeed. I'm quite enjoying your contributions.

Mine is I think what is "medically necessary" is something best determined by medical professionals, not popular opinion.

I am of this opinion also. Medical resources are finite and it's best left to their judgement.
We all feel treatment should be free when it affects us, that's only a natural wish. What we want isn't always the same as what we should be entitled to, however.

JanuaryMan,

Then let it be known that many doctors do believe that hormones and surgery are necessary for many trans people.

From the APA Task Force report posted earlier in this thread (page 2, I believe--it's a TinyURL) (emphasis added):

As for the costs of SRS, let's make a comparison.

Denmark currently has 100 percent government funded SRS, and approximately 10 patients annually meet the medical indication for this treatment. An operation costs approx. $ 33,000 (2001 figure, adjusted for inflation), meaning that the total annual expenditure on SRS in Denmark is approximately $ 330,000. That is 0.0014 percent of total government health care expenditure in Denmark (Currently around $ 23.1 billion).

If we assume similar incidence and indication in the US, all who meet the medical criteria for SRS in the US could in the long run* be treated for less than than $ 20 million annually.

Even if we assume that the indication would be 10 times higher in the US (amounting to 5,600 individuals annually) and the procedure costs twice as much, the long run* total cost of treating all individuals in the US who qualify for SRS wouldn't exceed $ 370 million annually, and would amount to 0.03 percent of the total US Federal healthcare budget of $ 1.240 trillion, and 0.013 percent of total US health care expenditure at approximately $ 2.700 trillion.

So if The Tea Party hadn't shutdown the government, for instance (which cost the US $ 24 billion according to Standards & Poors), the money saved could - ceteris paribus - have funded all sexual reassignment surgeries in the US for the next 65 years - under the most exaggerated scenario above.

*In the short run, there would of course be a significant backlog of patients already meeting the requirements for SRS, but this is no different than for any other illness (psychiatric or somatic) where coverage is expanded.

You statement is incomplete, since you have not identified what definition of gender you are relying upon.

From my perspective, human beings can be classified by sex in a minimum of four different, and mutually exclusive ways.

First, there is karyotype. The vast majority of human beings fall into two dominant karyotypes: 46,XX, who are female, and 46,XY who are male. However, a substantial number of people (well in excess of one live birth in 1,000) do not have a karyotype that conforms to either of these. Kleinfelter's syndrome (47,XXY) alone is involved in 1 in 500 live births of physiologically male children, let alone the other intersexed conditions. If you are limiting your statement to karyotype, then I agree with you. Sex reassignment surgery does not change your karyotype
Then there is physiological sex. Again, the vast majority of human beings fall into one of two types: those with ovarian tissue, who are female, and those with testicular tissue, who are male. Note, that it is the presence of gonadal tissue that is the determining factor here--not the presence or absence of other genital organs. Here, again, there are people who do not fall into one or the other of the main classifications. Gonadal agenesis will mean, for example, that a person has no physiological sex. True hermaphroditism involves the presentation of both ovarian and testicular tissue. There are documented cases of people with a 46,XX karyotype who are physiologically male, and 46,XY who are physiologically female. And if we move beyond the definition of physiological sex and move into classification by the presentation of other genital organs (the, "if you have a penis, you're a boy" classification), then we open up a whole other range of ambiguous sexual classification.

In the case of physiological sex, sex reassignment surgery does, arguably, change your sex, because orchiectomy or ovariohysterectomy will result in a person who no long presents testicular or ovarian tissue, as the case may be.

But you used gender, not sex. So perhaps you're focusing on the other two ways that people can be classified: gender identity, and social sex role.

Gender identity appears to be rooted in neurophysiology, and there are initial studies that seem to support the finding that the anatomy of MTF transsexuals is distinct from cisgendered males (both those who identify as heterosexual and as homosexual). Interestingly, here, too, your statement holds up as true, because surgery doesn't change gender, rather surgery service to make outward anatomy consistent with neurology. But I am not altogether sure that you were trying to present so enlightened an understanding of gender identity.

I find the endless debate about suicide rates among people with gender dysphoria more than a little distasteful. A disorder does not have to present a mortality risk in order for medical intervention to be indicated. The practice of medicine is just as much about improving the patient's quality of life as it is about preserving the patient's lifespan. Mortality risk might dictate priorities of access to treatment, but not whether treatment is medically necessary.

There is abundant evidence that sex reassignment surgery improves the quality of life of the vast majority of patients who receive it. Given the very real presentations of patients who have gender dysphoria, the availability of surgical sex reassignment is a potent therapy in the physician's toolkit for healing some of these patients.

(Oh, and for the record, in response to Kurgan's question



I hold a Bachelor of Medicine degree awarded by the University of Cambridge and I am a member of the College of Physicians and Surgeons of British Columbia and the Canadian Medical Association.)

I am probably primarily responsible for introducing the topic of high suicide rates among individuals with gender dysphoria in discussions on this forum.

However, I did this for a very specific reason. Several posters have disregarded the concept of gender dysphoria in its entirety, either by ignoring it ("A man is a man, and a woman is a woman"), trivializing it into oblivion ("SRS is purely cosmetic") or just flat out claiming that it is just "made up" ("Poor parenting", etc.). Kurgan may currently be the worst - but he is not the only one.

Given such anti-medical views, I figured that it would be prudent to introduce the very high suicide rates as the primary argument for acknowledging the existence of gender dysphoria and the need for treatment. If people do not accept this premise, they are probably even less likely to consider the aspects of medical care that are not directly linked to mortality.

Norway has 20,000 transsexuals (out of 5 million people). If everyone got a free surgery, it would then cost the same as 1,500—2,000 bone marrow transplants. If the US were to give it away for free (where a diagnosis is far easier to obtain), there would be no money left for more important operations.

The money saved if the US economy was balanced back on it's feet could also pay for cancer treatment, but not that AND SRS to more than a million people.

http://www.hhs.gov/dab/divisions/appell ... aints.html

^ For the US, there is a case to get Medicare, and by extension Medicaid, to cover sex reassignment surgery. If the case is ruled in the petitioner's favor, then that would likely cause insurance companies to also cover surgery. It was Medicare dropping coverage for surgery back in the early 80s that prompted insurance companies to do the same.

Of course, looking at that page, it seems most claims have been dismissed, so there is probably a long (read: several years) fight ahead.