The Ins & Outs: Health care takes monumental step by covering sex reassignment surgery

Being unhappy with your appearance is hard enough to handle. The struggle to lose the extra pounds, appear taller and get the perfect haircut can psychologically weigh on a person’s soul. But when your biological sex feels wrong, making a change for the better can be almost impossible.

The San Francisco Health Commission recently voted in favor of including sex reassignment surgery in the city’s health care plan to help transgender residents cope with feeling stuck in the wrong body. This makes San Francisco the first city in the United States to do so. The services would be covered under the city’s Healthy San Francisco plan, which provides health and wellness services to uninsured residents between the ages of 18 and 64.

Props to you, San Francisco.

Transgender people are those who live either part or full time as the opposite of their assigned biological role. They represent 0.3 percent of the country’s population, approximately 700,000 people, according to an April 2011 study released by the Williams Institute at UCLA.

Sex change surgeries for government employees are already largely covered in San Francisco, but the ruling would expand the city’s universal health care coverage to include mastectomies, genital reconstruction and other reassignment surgeries for all residents.

San Francisco is unique in offering this procedure because it’s considered nonessential. The city is sending a message that it is beginning to consider mental well being and value of life to be just as important as physical health, a refreshing change to contrast the adversity transgender people face every day.

The reassignment surgery had previously been excluded from Healthy San Francisco coverage by the Health Commission. The city’s health plan already covers free hormones, counseling and routine health services for those who feel they were born the wrong gender or assigned the wrong gender as children.

These services are the preliminary steps leading up to a sex change operation.

“The first step is psychological counseling to confirm that the individual is truly gender dysphoric; one cannot just see a doctor and ask for a sex change. The next step is to live as a member of the other sex, and if a person does so successfully for a designated period, hormones are then administered to masculinize or feminize his or her appearance. Finally, sex reassignment surgery (SRS) is performed,” according to Janell Carroll’s book “Sexuality Now: Embracing Diversity.”

But sometimes, one surgery is not the end.

“It may take two or more surgeries to complete the transition,” Carroll says in her book. There may also be complications and repercussions from the surgeries, leading some transgender people to seek even more corrective surgeries to help them feel at home in their own bodies.

Carroll includes descriptions of how much work the surgeries entail. In men, the penis and testicles are removed entirely, while the penile skin with its nerve endings remains attached. That skin is used to make the inside of the vagina and the labia, and silicone implants are used to create breasts.

Women’s internal sex organs are removed, and then either use hormones to create an enlarged clitoris or have penis and testicles created from abdominal and labial skin. These penises cannot become naturally erect.

Sex reassignment surgery is a costly procedure. According to ABC News, it costs roughly $37,000 for a male-to-female surgery and $77,000 for a female-to-male surgery.

Opponents fear that the surgeries are too expensive for the bill to be handled by taxpayers, a fair concern. This is understandable since Healthy San Francisco provides medical insurance for city residents who are uninsured and make less than $54,480 per person, or $111,720 for a family of four, regardless of citizenship and employment status.

But isn’t it more important that the citizens of our city are comfortable in their own skins?

Transgender advocates, who pushed for the ruling, are trying to get insurance companies to cover all transgender sex change procedures as medical necessities instead of considering the procedure elective surgery.

City public health officials say that the transgender health initiative probably won’t happen until late next year.

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