My Transition-Related Health Care Is Not Cosmetic

In June of 2014 Washington State insurance commissioner Mike Kreidler announced that insurers selling policies in the state cannot discriminate against transgender residents. This was exciting news, because up until that point trans people would have to jump through burning hoops to get the care they needed. While this announcement offered hope for the future, it seems many of us are still struggling to see the change.

When I started my transition, one of the first things I wanted was a hysterectomy, not necessarily because of my transition but because my reproductive organs had plagued me from the onset of puberty. It was a nightmare and, unfortunately, still is. While I no longer get visits from Aunt Flo, I still feel her pain every month.

My doctor at the time told me outright that insurance companies would not approve of this surgery for someone who was still considered female in the eyes of the law. I hadn't even started hormones yet. She explained that insurance companies wanted women to go through a series of steps just to be sure nothing else could be done before permanently removing the uterus.

I could understand to a certain extent why that was, but for a trans man, aching to feel better for the first time in his life, it was disheartening news, especially because I had no plans to bear children. My doctor did say that it would be wise to refrain from changing my information if I ever did want my surgery covered, because once I was no longer technically female, the situation would get even stickier.

A year passed and, contrary to my doctor’s advice, I changed my information. I was and am legally male. My doctor signed the papers and I stood before a judge after my state approved my request for a name and gender change. I decided to make this change because I wasn't willing to start birth control, which is counterproductive to my medical transition and one of many things I'd have to try before the prospect of a hysterectomy would be considered. By that time, I had heard about the change in trans coverage in Washington State and I felt hopeful that I would finally be allowed to have the most vital surgery of my life — something more important to me than top surgery.

Before my transition, my doctors just said I had dysmenorrhea, which means, "painful periods with cramps." I had a sonogram, and nothing showed what was causing the pain. Truthfully, no one really knows why trans men continue to feel pain after our periods stop. Doctors say it's the uterus's way of dying dramatically. How’s that for implicit bias?

Initially, my insurance said no to paying for the hysterectomy — not because I hadn't completed the list of medical prerequisites, but because I was a man, a trans man with a uterus. The insurer doesn’t give men hysterectomies; there was nothing else the people there could tell me other than that their policy hadn't been updated in quite a few years.

At the start of 2016, I was elated to discover that Blue Cross Blue Shield of Michigan had finally included the coverage I so desperately needed. It would cover 80 percent of the cost of my hysterectomy and I would be responsible for the rest. I was floored and so very ready. I had met with my surgeon, Dr. Mason in Seattle. All I had to do was set the date and figure out how I was to come up with the remaining money.

Then, out of nowhere, I lost coverage. I was 25 and still insured under my parents, but my mother lost her job that provided coverage, and therefore I lost coverage too. At this age, I knew I'd have to find my own insurance anyway. I made just too much money to get state insurance and so I went with the only plan I could afford, through Ambetter.

It's now been two years since I began my transition and I'm still struggling to find the care that I need. I crossed my fingers, nearly to the point of breaking, when I made the call to Ambetter just a few weeks ago.

“Hi. I'm a transgender man, and I wanted to ask if you covered hysterectomies,”

“Uh... Let me check... Sorry, no, it's considered cosmetic.”

Cosmetic?! As if anyone can see my uterus.

While discrimination is alive and well among insurance companies, I'm grateful to the companies that worked hard to ensure proper care for people like me. Feeling human, healthy, and comfortable shouldn't be deemed cosmetic. In my case, the removal of my reproductive organs is a medical necessity, not only for my transition but for my overall health. So the question is, what's next? Keep fighting, of course.
In the months to come, I am meeting with my new doctor, who has already expressed her determination to help trans people in this position, and from there, I'll put in my request for the removal of my entire reproductive system. A denial letter will come and I will appeal it. Hopefully, with only a bit of patience and a lot of luck, by the end of the year I could be living happily in a body that is truly my own.

COLE HAYES is a 25-year-old trans man living near Seattle. He is an aspiring author and enjoys documenting his transition through YouTube. Follow him on Twitter @itscolehayes.