Facial Feminization Surgery: The Ethics of Gatekeeping in Transgender Health

Abstract

The lack of access to gender-affirming surgery represents a significant unmet health care need within the transgender community, frequently resulting in depression and self-destructive behavior. While some transgender people may have access to gender reassignment surgery (GRS), an overwhelming majority cannot afford facial feminization surgery (FFS). The former may be covered as a “medical necessity,” but FFS is considered “cosmetic” and excluded from insurance coverage. This demarcation between “necessity” and “cosmetic” in transgender health care based on specific body parts is in direct opposition to the scientific community’s understanding of gender dysphoria and professional guidelines for transgender health. GRS affects one’s ability to function in an intimate relationship, while FFS has the same impact on social interactions an, therefore may have a far greater implication for one’s quality of life. FFS is a cost-effective intervention that needs to be covered by insurance policies. The benefits of such coverage far exceed the insignificant costs.

Keywords:

• gender/sexuality
• health care delivery
• insurance

This article is referred to by:

Facial Feminization Surgery: Privacy, Personal Identity, Compensatory Justice, and Resource Allocation

The Democratization of Facial Feminization Surgery and the Removal of Artificial Barriers

Faces Matter

From Interest to Applause to Despair

Acknowledging the Transition Spectrum

In Favor of Covering Ethically Important Cosmetic Surgeries: Facial Feminization Surgery for Transgender People

Facial Feminization Surgery in Gender Dysphoria Should Be Reimbursed Like Genital Surgery, but the Main Problem Lies Elsewhere

Accepting Things at Face Value: Insurance Coverage for Transgender Health Care

A Queer, Feminist Bioethics Critique of Facial Feminization Surgery

‘Medical Necessity’ and Domination

The Biopolitics of Passing and the Possibility of Radically Inclusive Transgender Health Care

Extending Health Insurance for Body Modifications for Gender Transitions

Notes

1. AL, AK, CT, DE, HI, ID, IA, KS, ME, MS, MT, NE, NH, ND, OK, SC, SD, UT, VT, WV, WY.

2. AK, KY, LS, MN, MO, NM, WV.

Additional information

Funding

Financial support for this study was provided in part by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (AR060231-05, Fraenkel). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The funding agreement ensured the authors’ independence in designing the study, interpreting the data, and writing and publishing the report. ▪