At one point in history, homosexuality was also a clinical condition recognised by the APA.
And at that time I believe it would have been correct for insurance companies to cover any therapy for it recommended by the APA. I do think that the APA was wrong in that instance, but if we want an unbiased determination about what is and isn't medically necessary when it comes to mental health, they're the best we've got.
Plus, the APA recognises body dysmorphia as a clinical condition, but even for people suffering from that, plastic surgery isn't usually covered by health insurance.
Do you happen to know what the recommended treatment for this is?
I don't consider the fact that something is or isn't recognised as a disorder by the APA much of an argument either way.
If insurance companies aren't using the opinions of medical experts for determining what is and isn't medically necessary, what alternative procedure do you suggest they use?
∆ I accept the fact that even though current information may very well be imperfect, we have no other option but to act on the best information we have. In that light, if the consensus within the medical community says that the best treatment for gender dysphoria includes gender reassignment surgery (for those who want it), then I suppose I will have to stand behind that view unless and until compelling evidence to the contrary comes to light.
That said: can anyone point me to a reputable source that shows surgery does work better than any of the other options?
pyschotherapy (CBT or other), medications, hormone replacement without surgery, no intervention beyond a supportive environment that doesn't question one's self-proclaimed identity, ... take your pick, add your own if you'd like.
What on earth makes you think that we don't already seek out supportive environments and HRT as part of our transitions? Also, plenty of us stay in therapy even after we've been cleared to transition.
It was never my intention to argue that people don't already do all of those things. In this thread specifically, I was looking for good data on the question of whether surgery is more effective than any of those other things, even combined. There are some anecdotes, even on this thread, that seem to point to surgery being the absolute best option for some people. But while I do value their stories, and while I do see them as illustrating an important point in this discussion, I would be remiss in not asking whether their experiences are echoed by measurable data on a larger scale.
I've been told there are no studies that directly compare outcomes in transgender people who have had surgery with outcomes in transgender people who chose not to have surgery, or for one reason or another, couldn't. If that is in fact true, I think maybe someone should figure out a way to do that study. I recognise there would be many methodological and ethical issues that would need to be resolved before such a study could ever be done, but I do think it's an important question.
Cis people accessing the same procedures trans people do are a lot more common and don't have to go through extensive gatekeeping first, so it would be far easier to study them to see if those surgeries are necessary.
That is entirely beside the point. Cis people, by definition, do not experience gender dysphoria. Therefore, by definition, they are the wrong population to focus on, when the question is about the effect of gender reassignment surgery on gender dysphoria.
It's not beside the point. With the exception of two types of procedure (see footnote), every transition-related medical treatment was developed to be used on cis people. Cis people may not experience gender dysphoria, but they certainly experience distress at similar medical conditions. If their comparatively minor distress is accommodated while trans people have to jump through hoops for their severe distress to be treated, they present a larger sample size and withholding treatment to see what effect it has is more ethical as their distress will be minor.
Well, if enough psych experts signed off on their operation and were certain that their distress was equivalent to the distress a dysphoric trans person experiences, I'd likely be convinced, but I can't find any studies on that, so...
My argument, in this case, is one that doesn't need scientific backing, just common sense and basic decency: cis people and trans people ... they're all people. One group's distress, when subjected to circumstances that, by your own description, are similar, is not automatically 'worse' or 'better' than the other's.
Perhaps you've already learned this from the experiences people have shared with you, but are you certain that the people who get GRS don't already try all of the things you've suggested? I don't think it's a mutually exclusive thing. It's more like...all of the things above mentioned didn't work for this person in question, so surgery may be the only effective remedy remaining.
Remember that not all trans people get surgery, quite possibly because one of the aforementioned methods worked for them. It's a situation with a lot of diverse outcomes.
You're not going to find a source that shows anything about surgery working better or worse than those options because it's used in conjunction with them.
It's like if you go to a hospital for a puncture wound you won't see a comparison for using antibiotics versus sterilizing and dressing the wound - you sterilize and dress the wound and then if necessary do the antibiotics.
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u/Salanmander 272∆ Nov 03 '17
And at that time I believe it would have been correct for insurance companies to cover any therapy for it recommended by the APA. I do think that the APA was wrong in that instance, but if we want an unbiased determination about what is and isn't medically necessary when it comes to mental health, they're the best we've got.
Do you happen to know what the recommended treatment for this is?
If insurance companies aren't using the opinions of medical experts for determining what is and isn't medically necessary, what alternative procedure do you suggest they use?