Ah. “The surgery.” To the uneducated it’s when you “get your dick chopped off” (that, actually, would be a bad thing). To those who know what it is, it’s a complicated, messy, painful, life-changing experience and surgery. There are also surgeries for trans men, but as I’m not one, I’ll leave that to the professionals.

It’s also something the American Medical Associaton (AMA), the American Psychological Association (APA), American Academy of Family Physicians (AAFP), National Association of Social Workers (NASW), World Professional Association for Transgender Health (WPATH), National Commission on Correctional Health Care, American Public Health Association (APHA), and American College of Obstetricians and Gynecologists all agree it is often a vitally important part of improving the lives and mental wellbeing of transgender people. In fact it can be a life saving factor in their medical care. There’s a whole mess of guidelines written up by WPATH called the Standards of Care that are strict, and take a long time to get through so that someone doesn’t do this by mistake and end up harming themseslves through it. Not to mention, it’s only 68 pages long. So, of course this means that insurance covers it right?

So incredibly fucking wrong.

Most insurances in most states not only don’t cover surgery, but they have specific non-coverage clauses. The usual reason? It’s experimental and there is nothing showing it actually works.

Luckily, pre-existing conditions don’t matter anymore, but before the Affordable Care Act, they did. You were often denied any medical insurance at all, based off the assertation that by simply being trans, you had a pre-existing condition. Unfortunately, even with the help of the ACA laws, it is still very difficult for trans people to get insurance coverage in some states.

There are some states that have made huge strides. California and Oregon’s medicaid both cover surgery now, and Colorado’s private insurers must carry plans that cover surgery. This does not extend to Medicaid (relevant information under Inpatient Medical/Surgical Care). On a federal level, Medicare decided in May 2014 that it was a requirement to cover transgender surgery. Thus far, that decision has not made it’s way over to Medicaid.

So, how do trans women who want/need “the surgery” end up getting it? Well, the short answer? Usually it doesn’t happen. Most trans women are unable to pay for it because pre-care, surgery and post care is generally incredibly expensive. and have to find some way to deal with the mind fuck that is between our legs.

This is a serious problem because you are usually unable to change your birth certificate without surgery.

It is incredibly important to point out that everyone’s story and bodily comfort is different. There absolutely are trans women who are happy with the body they have and do not want any kind of surgery. (This is a shameless plug for the wonderful Mara, and you should go and check out her blog, cause she’s awesome and funny.)

I am not one of them.

My dysphoria is bad. Excluding my mental illnesses, it has lead me to suicidal thoughts and depressingly bleak outlooks on life.

One particular problem that I have is that I’m just a little (see: a lot) into sex. It’s fucking fantastic, pun totally intended.

So why is it a problem? My ultimate naughty time wish is to, you know, have a vagina. I want to be the one being fucked. It’s hard being comfortable with sex when you’ve got the wrong parts. So loving sex + wrong parts = good way to fuck with your head.

So surgery will also help that.

Sex isn’t the only reason that anyone wants surgery, and that goes for me to.

It just feels wrong. When I walk or sit. As I’m showering or changing clothes.

Also, tucking isn’t the most healthy thing. Making it look like you have nothing hanging out down there is no small daily feat. You have to package it all up and have it sit all nice and snug right next to your asshole. You know, not the most pleasing experience. That and when you first start you tend to sit on your testicles. A lot. And for anyone that has them, you are probably cringing right now. Sorry about that.

So, to sum up, surgery is really fucking important. It’s one of the biggest things for those trans people who need it. There is no reason that SRS should be considered elective by any means, especially if your doctor is saying it would be in the absolute best interest of you as a patient. You have to work so damn hard and jump through so many hurdles. I’m so sick of having to go through gatekeepers. That’s hard enough as is. Two psychiatrists, at least one physician. Hair removal (required for most SRS), hormones, blood tests, so many appointments, so much double checking, so much making sure that any mental illness you may have isn’t going to fuck with the situation.

After all of that, after at least a year, and likely quite a bit more to get through all those hoops…

It doesn’t even matter*, because surgery is not affordable and insurance won’t cover it, even though it’s medically necessary.

I can see things changing, but it’s agonizingly slow. Hopefully, one day soon, Medicaid will decide to follow in the footsteps of Medicare. Until then…

A girl can dream right?


*Of course it does matter, and it’s still important, but it feels like it doesn’t. You know what I mean?


14 thoughts on “Surgery

  1. I really liked your post. And not just because you shamelessly plugged me ❤
    I liked the compilation of links, and think you handled a really broad topic super well!

    Liked by 1 person

    1. While I understand the sentiment, I think this is a comparison of apples and oranges.
      Rather a better comparison? Acupuncture, which shows absolutely no scientifically solid, despite a whole lot of studies done on it, is often covered by insurance.


      1. I know what you mean. And I bet you’ll find that approved and agreed medications are availoable, not because of their effectiveness but because of their profitability. I’m sorry that you’re not able to get the surgery you need Ivy.

        Liked by 1 person

        1. It’s okay. I’ve thought a lot about sending up some sort of “fund my surgery” account, but… My self esteem gets in the way of that, I figure it will just sit and never gain anything.


            1. Yeah… Unfortunately that is overwhelmingly common. Trans people going to the correct prisons is the less common of the two. It’s like that in the US too.
              It ties into how difficult it is to get a new birth certificate (or in the case of states like Ohio, where they absolutely will not change or amend your birth certificate regardless of what you do.)


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