Though the Yale Health Plan extended insurance coverage to gender-affirming surgeries in 2013 in order to benefit gender-questioning students at Yale, Yale Health’s current approval process for these surgeries can undermine care options for students who do not conform to a binary gender, according to two transgender students.
Yale Health follows the standard of care for transgender health and sex reassignment surgery, as defined by the World Professional Association for Transgender Health. According to WPATH standards, surgeons, prior to performing sex-reassignment surgery, “must be confident that the referring mental health professional(s), and if applicable the physician who prescribes hormones, are competent in the assessment and treatment of gender dysphoria.” Once gender dysphoria — a condition in which one’s psychological gender identity differs from one’s biological sex — has been documented by a mental health professional, the surgeon may then consult with the patient about an operation.
On the Yale Health Plan, Yale Mental Health operates as the gatekeeper between students and the required medical consultations for gender-affirmation surgery. Still, this system has attracted the criticism of Yale students who claim that the process favors students who identify as either trans man or trans woman over those who are gender nonconforming and therefore may not match Yale’s definition of gender dysphoria.
“It was all tremendously emotionally draining,” said a Yale alum who was refused a consultation under Yale’s health plan. “I also had the sense that Yale had drawn out the process of rejecting me because I was about to graduate and lose health insurance and had not been forthright with me about how my application would be considered.”
The former student, who identifies as trans, said they began their application for a sex-reassignment surgery consultation in spring 2016, but was ultimately rejected by a Yale Health committee that determined their request for surgery to be “cosmetic.” The committee also justified its rejection by arguing that the student had not been living as the opposite gender.
The alum told the News that Yale Health’s decision perpetuates a false belief that only trans men or trans women require surgery and that other trans identities between the male and female binaries, like the anonymous student’s, are not legitimate. The committee never met the student in person, but grounded their judgment on letters written by the student’s psychiatrist and therapist.
The Director’s Office of Yale Health referred all questions to Yale’s Office of Public Affairs & Communications, but Yale spokespeople did not respond to questions about the exact process by which Yale Health judges applications for consultation.
Yale, Brown, Cornell, Dartmouth, Harvard and Penn all cover transition-related medical expenses on their student health insurance. Princeton does not cover gender-affirming surgeries, but does offer hormone therapy to students. The fall 2015 Yale College Council Task Force on LGBTQ Resources also noted that Brown and Columbia are the only two Ivy League schools to offer gender-neutral rooming, a detail that trans students interviewed during the report identified as an area for change.
According to Maria Trumpler GRD ’92, director of the Office of LGBTQ Resources, the coverage of sex-reassignment surgeries under the Yale Health Plan has significantly improved the lives of many Yale students. Still, she noted that the insurance plan is “self-reflective” and reviewed periodically by a committee to improve students’ medical care.
“For several years they’ve been discussing the issue, which is that there is not a particular gender identity that someone has to have to access hormones or surgery,” said Trumpler. “You do not have to identify as a transgender male or transgender female.”
Still, the anonymous alum said they also ran into difficulties making a case for a consultation because mental health professionals typically assume patients have already decided they want to go through with the surgery prior to their first consultation. However, the alum in question wanted to talk to a medical professional about potential surgery before making an informed decision. Additionally, the former student told the News in an email that the committee member who communicated with them over the phone was “unknowledgeable about the nuances of trans* experiences and at times offensive.”
Isaac Amend ’17, a staff columnist for the News, said that this type of decision from Yale Mental Health prevents gender nonconforming people from receiving much-needed treatment.
“The medical establishment is prejudiced against nonbinary people, ignoring the fact that gender fluidity exists,” Amend said. “Doctors can propagate a notion of ‘not being trans enough,’ which is toxic to the mental health of patients.”
Amend added that there is a community of nonbinary or gender fluid students at Yale, and that he knows of students who have had to tell psychiatrists that they are “more trans” than they feel, out of a fear that the doctors will withhold treatment if they appear more gender fluid.
Laurence Bashford ’18 and Kyle Ranieri ’18, the respective 2017 and 2016 coordinators of the Yale LGBTQ Co-Op, said in a joint email to the News that there have been “great steps” made by the Yale administration to guarantee needed and deserved treatments to trans students within the student community.
“We are particularly wary of the fact that many important treatments — for instance, laser hair treatment as part of the transitioning process — are deemed unimportant or cosmetic and, so, are not available through regular University coverage,” Bashford said.
The Yale Health Center was completed in 2010.
Contact Britton O’Daly at firstname.lastname@example.org .