Tennessee Republicans, in introducing their first bill for the 2023 legislative session on Wednesday, argued that gender-affirming medical procedures were being administered to those under 18 with “rapidly increasing frequency.” But health care for people who are transgender, especially children, has never been simple, widely accessible or affordable, advocates tell Scene sister publication the Nashville Post.
Jace Wilder, education manager for the Tennessee Equality Project, has been insured on and off throughout his transition, he says. Because he was uninsured, he went to Planned Parenthood and was able to access hormone therapy with sliding-scale payments. He experienced hormone imbalance and interruptions in his treatment because he couldn’t get appointments in a timely manner. After six months without testosterone, he switched to another area clinic. Planned Parenthood declined to comment for this story.
Vanderbilt University Medical Center doesn’t accept TennCare or his current insurance, either, Wilder says. While he hasn’t been able to benefit from it, Vanderbilt provides good care as Wilder sees it. He hasn’t heard any complaints from friends undergoing gender-affirming treatment there.
Wilder, now 22, explains that when he was in the market for gender-affirming surgery as a minor, Vanderbilt denied everyone who was under 18, and now it is one of the few Tennessee facilities that will even consider services for minors. In light of allegations by Matt Walsh of The Daily Wire, Wilder says he has heard stories of doctors treating trans patients taking fewer patients and taking calls from hiding. VUMC declined to comment for this story.
“Even if there was more competition, which I am 100 percent for, people would still choose Vanderbilt because they provide great care and they are experts in this area,” Wilder says. “They have really, really dedicated themselves to being the cornerstone of research and understanding of trans health care.”
Monroe Carell Jr. Children's Hospital at Vanderbilt.
VUMC’s Pediatric Transgender Clinic found itself at the center of controversy following a post by Walsh in September. VUMC announced it would temporarily pause gender affirmation surgeries on patients younger than 18, while noting that the organization does around five surgeries per year on minors, and none are genital surgeries.
Healthcare.gov explains that many health plans use exclusions such as “services related to sex change” or “sex reassignment surgery” to deny coverage to transgender people for gender-affirming treatments.
TennCare, the state’s Medicaid program for low-income people, does not cover gender-affirming surgeries for minors, according to spokesperson Amy Lawrence. Hormone blockers are covered if deemed “medically necessary.” Additionally, TennCare does cover reconstructive breast surgery as a result of a mastectomy, Lawrence says.
Henry Seaton, trans health advocate for the American Civil Liberties Union of Tennessee, says he doesn’t know anyone who had their gender-affirming surgery fully funded by insurance.
“Some insurances will cover a good amount of it, but in Tennessee, the majority of the time, the lack of funding from insurance companies is a huge barrier for people who are pursuing gender affirming surgery specifically,” he says.
It’s unclear what Vanderbilt requires as far as documentation of gender dysphoria for treatment of minors. Some clinics require that someone has socially transitioned for a period of time, Seaton notes.
“No parent who fundamentally loves their child and wants the best for them goes into helping their kid get hormones, or get these medical interventions, without really thinking about what those permanent effects are going to be,” Seaton says. “It's in constant conversation.”
Seaton calls long-lasting and permanent effects of hormones “the elephant in the room.”
For example, if testosterone causes a person’s voice to drop or grow facial hair, that may not completely reverse if hormone use is discontinued. However, reproductive abilities can come back if hormone therapy is discontinued, Seaton says. Having transitioned from female to male, Wilder and Seaton can develop some of the same health tendencies as cisgender males, such as a higher risk of heart disease.
Transgender people make up a small percent of the population: 0.5 percent of adults and just over 1 percent of people ages 13 to 17. Wilder says the stigma around trans health care, especially in recent months, is the biggest barrier to care.
“We shy away from it because it's seen as a political issue, rather than an issue of taking care of someone in need, which is incredibly disruptive to someone's quality of life overall,” Wilder says. “You're not going to have that same access to life, liberty and all that if your identity is seen as the political question of the day rather than a part of a society.”
This story first ran via our sister publication, the Nashville Post.
