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[kevinsovaries]

Insurance- the long journey, pt. 1

After my consultation for top-surgery the nurse in the plastic surgeons office came back into the exam room with a piece of paper and estimated that the cost of the operation before insurance would be $8,000. My mother and I had expected such a large cost and we were thankful to the surgeons office for being so transparent about the price but we were also anxiously aware of how expensive it was. We had had difficulty with out insurance in the past, none of my visits to the endocrinologist had been covered, or my blood-tests, or a single cent of my actual testosterone prescription. But one or two blood tests was one thing, an $8,000 surgery was another. This was also the summer preceding my very first semester of college for which I had received almost no financial aid. The heft of the financial burden weighed on us for about a week before we heard back from the surgeons office. My surgery wouldn’t be covered. 

Upon investigation it was discovered by my mother that her health insurance contract, which was negotiated with her school district, contained a specific contractual exclusion that barred coverage for any care that was in treatment of gender dysphoria. This was confusing and disheartening, “why would they even have that exclusion?” I wondered, I felt targeted and unworthy of care. After my parents very generously paid for my top surgery (we had to take out a lot of money in student loans for school) I put the idea of bottom surgery out of mind. I couldn’t put my parents in that financial situation again. Compared to top surgery the cost of bottom surgery is almost astronomical especially because it is typically more than one operation. Asking my parents to pay out of pocket for phalloplasty or metoidioplasty was unthinkable.

For two years I thought bitterly about my insurance plan and resented that they would deny me care because I was transgender. Bottom surgery felt like an impossibility or at best a very far of reality. For me phalloplasty was always an inevitability but one that was a long ways away. Something that would happen eventually when I was a thirty-something. It wasn’t until fall semester of 2020 that something changed. 

For as long as I could remember my testosterone was never covered by insurance. At the university it was about $60-$70  for a 3 month supply so I didn’t really mind paying for it. At the beginning of this semester when I went to pick up my prescription I was informed that I had a copay and I thought this was very unusual as my payments where usually entirely out of pocket. I wondered why my testosterone would suddenly be covered now after all this time. It was irrational to assume that anything in my insurance contract had changed and I understand this now but at the time there was this spark of hope. Maybe something was different now! I wanted to believe that my care would be covered, I wanted to believe that bottom surgery was possible. I wanted to believe this so bad that I didn’t even try checking my contract I just scheduled a consultation for  hysterectomy with a local surgeon. This is a crazy way to go about doing things but once the door of possibility had been opened I just couldn’t bear to shut it on myself again.

The possibility of my insurance paying for my hysterectomy hung in my mind as an enigma a big question mark and that was far more pleasurable than a solid “No”.

After my consultation for a hysterectomy the lack of information I had about my insurance plan was starting to become a problem. I simply couldn’t move forward anymore without knowing whether or not my care would be covered. The illusion of hope had carried me this far I had come to the end of my rope. I had spent several days in a state of abject anxiety not necessarily about insurance but about my sudden fear of being sterilized, I had had trouble sleeping and spent every other minute of my day brainstorming and research all the ways I could preserve my ability to be a father. This anxiety was predicated on the idea that I would be able to afford a hysterectomy in the first place and came from a place of hope. I got on the phone with my insurance company at 7 PM on a weeknight. I asked the representative if a hysterectomy would be covered if it was in treatment for gender dysphoria, I waited while he typed. 

“Specifically for gender dysphoria?” he asked.

“Yes,” I said.

“Your plan doesn’t cover anything related to gender dysphoria,”

I was stunned silent for a moment, this had been the only logical outcome and yet I was still so shocked that this could be the reality of the situation, that I could still have no access to care. I asked who I could talk to about this and the representative told me to contact my employee benefit’s department. I took note of this but I didn’t feel any better about the phone call. I was absolutely crushed. I felt that there was nothing I could do. I made dinner for my sister and burned everything, we ate the gross food I had made and I sat in the living room listening to her talk, but I was completely non-present. Finally I told her about the phone call and she let me ramble about how it made me feel and about how I couldn’t get the care I needed. It was cold in the house and I felt physically ill. It had been a long time since I had felt depression like this, since I had felt this hopeless. Not since high school, not since before hormones. 

My sister took a shower and I went and sat in my bed, and for the first time in the past couple of hectic days I started to cry. Being denied coverage was a rejection of my humanity and my identity, a statement that I wasn’t worth existing. I recognize this is privilege because the American healthcare system is so incredibly fucked up that people sometimes have to choose between paying for care or dying whereas I can technically choose whether or not to receive care. But gender affirming care IS lifesaving healthcare. 

I had a strange moment of clarity as I sat there in tears, a moment that I realized I would one day look back on. I had been through this all before, there were moments years ago when I had sat in my bed and cried because I didn’t see a reality where I could get on testosterone. But here I was, three and a half years on T. I had thought my transition and happiness where impossible and I was now living proof that it wasn’t. I sat in my bed almost startled with the resilience I had uncovered, I was either going to make my transition happen or I was going to die. There were no other options. My wholeness is inevitable because it is what drives me. I was going to finish my transition or die trying. This inevitability gave me hope and it was uplifted by another surge of resilience, “trans life is resistance” I told myself. The denial of trans care is an agenda to either discourage us from transitioning or encourage us to stop existing, by continuing to exist and be a proud trans-man I was resisting that agenda. “I deserve to exist” I told myself and that was the end of the discussion.

[kevinsovaries]

What’s going on here?

Hi, my name’s Kevin and I have ovaries! I needed a place to write about my transition both to get some stuff out of my head and to maybe help someone else who’s looking for an experience they can relate to. This year has been pretty crazy but it’s been extra crazy because I’ve been trying to take some steps in the medical part of my transition that have left me frustrated, sad, hopeful, and just all over the place on the emotional spectrum. I think it’s important to talk about how complicated transition is and how draining things can become, I just really needed to share. 

First off, some basics. My name is Kevin, as previously established. I’m only 20 and I live in Montana. I’m a full time college student and I’m double majoring in French and anthropology. I’m ftm and I’ve been out for about five or six years, I’ve been on T for almost four years, and I had top surgery in 2018. So I’ve been out here living my life as a boy for a little while so now it’s time to start looking into lower surgery. I had been ignoring my need for phalloplasty since I had top surgery because I knew my insurance wouldn’t cover it (my family had paid for my entire top surgery out of pocket which was about $8,000). I couldn’t bear putting my parents in that kind of financial stress again especially on top of paying for school so I just tabled the idea of phalloplasty and told myself it was a “future” project. But, around the start of this fall semester I began to get a wild hair. I scheduled a consultation with a local surgeon and spoke to them about getting a hysterectomy. 

It is here that the narrative spits and two separate challenges arose, both of which were significantly draining and continue to take a toll on my mental health. The first challenge was my insurance, after contacting my insurance I was informed that my hysterectomy wouldn’t be covered because my contract specifically excludes any treatment for gender dysphoria. Even though I knew that this exclusion was still in my insurance it had been years since I had tried to make a claim about anything related to transition and I had deep down had hoped that something had changed. I was absolutely crushed by this news, there was no way I or my family could pay for a hysterectomy out of pocket. If I was going to have a hysterectomy and later going to have phalloplasty I would have to figure out a way to get insurance coverage.

The second challenge was my fertility. Since I have no desire to be pregnant or rather, any desire I have to be pregnant is significantly outweighed by my desire to have a vaginectomy and bottom surgery, I didn’t have any plans to have a baby. And by extension ever since I started my transition I had ruled out having biological kids. I’ve known forever that I want to be a parent but I decided at the start of my transition that I would adopt kids or maybe my future wife and I would use a sperm donor and I just tried not to think about it too much. But as the reality of a hysterectomy crept closer I began to panic. How would I want to build a family in the future and what are my options? 

I can always be an adoptive parent no matter what procedures I have and I hold firm to this truth. But I see myself marrying a female partner and I feel a growing desire to experience pregnancy with my future wife. I know this a pretty basic biological urge and sometimes I feel ashamed of it, but if I find this urge compelling now, how intense will it be when I’m in a long term relationship with the woman I love? So the next obvious option is using a sperm donor. This option is a good one, but I don’t actually like it very much. As a transgender man it’s easy to feel inadequate about not having any sperm and being totally uninvolved with conception of my child is an uncomfortable idea. I shouldn’t feel this way because fatherhood is much bigger than siring offspring, being a father mean being loving, supportive, and showing up. Not being my children’s biological father does not make me any less of their dad. Plus lot’s of cisgender couples use sperm donors, I would not be the first man to struggle with infertility. I also have a brother who could ideally be the perfect donor to represent my side of the family, however our relationship is very complicated and having a known (not-anonymous) sperm donor, especially a family member can lead to a host of problems. So after a lot of searching I realized that the best option I have is to preserve my eggs in the hopes that they can be used in an IVF procedure to impregnate my wife with embryos made from my eggs and donor sperm. This would allow me to play a role in conception and be my kid’s biological father (or one of them at least) and it would allow me and my future wife to experience pregnancy together. That’s my ideal plan but there are no guarantees in life, I could end up spending my life with someone who cannot get pregnant or doesn’t want to, or our attempts at pregnancy could fail, we can still be parents we just won’t be making a baby together. But, I’ve decided it’s in my own best interest to preserve at least the possibility of using my eggs for IVF. The next question is how best to do that and when?

If you’ve read this far thank you very much. I’m primarily writing for my own self-care but I hope if you are also trying to make decisions about your transition that this is useful to you. I’d also like to acknowledge the incredible amount of privilege I have just to be at this point in my transition and to have a family that will help support me through it. Thanks again, have a wonderful day :)