Facial Feminization Surgery and The Standards of Care

publish “before and after” photographs of herself on the Internet she has also beenprofoundly important in the dissemination of information concerning FFS to thetransgender community.As a member of the Harry Benjamin International Gender Dysphoria Association(HBIGDA, now known as WPATH) I have taken it upon myself to bring this issuebefore the officers of the organization. I hope to prompt the organization (HBIGDA) toseriously consider this request and to accommodate discussion of this issue at theconference in Chicago next year (September 2007). I currently plan to attend theconference and look forward to participating in the discussion.Legislative developments and the University of CaliforniaLast year, the State of California passed legislation making it illegal to discriminateagainst transgender individuals with respect to health insurance (AB 1586, AppendixF). Based on this legislation the University of California began providing a“Transgender Surgery Benefit” to faculty and staff of the University and it’s affiliatedlaboratories. California Bill AB 1586 specifically bans discrimination in healthinsurance based on gender identity (Appendix F). Although AB 1586 does not mandatethat any particular benefits be provided, the University of California Office of thePresident (UCOP) negotiated a “Transgender Surgery Benefit” with each of the healthplans that contract with the University (Appendix E) 3 . The decision to provide healthinsurance benefits for transgender surgery was guided in part by the programinstituted by the City and County of San Francisco in 2001 for city and countyemployees (Appendix E). Many of the initial fears that the program would beexcessively expensive proved groundless (San Francisco City and CountyTransgender Health Benefit letter) and the program has continued to expand anddecrease in price.The need for a reevaluation of Facial Feminization SurgeryThis letter is first and foremost a plea for a considered examination of facialfeminization surgery (FFS) within the context of transgender health care and itscodification within the Standards of Care. It is also a personal plea for support fromthe organization and the individual members of the committee in presenting my caseto Blue Cross of California. Developments in transgender health care always seem tobegin with the treatment of a single individual; someone always seems to become thefocal point of the discussion. Due to an accident of timing and circumstances I appearto be such an individual for the discussion of facial feminization surgery and healthinsurance. As a scientist employed by the University of California I have become oneof the first individuals to take advantage of new health insurance benefits specificallydesigned to provide for transgender surgery. The importance of facial feminizationsurgery in my own transition has led me to build a case for inclusion of FFS within thecurrent benefits. For this reason, this letter is addressed to the Committee of theHarry Benjamin International Gender Dysphoria Association responsible formaintaining the Standards of Care.A proper and detailed discussion of facial feminization surgery within an updatedversion of the Standards of Care would be a persuasive argument for convincing BlueCross of California to include FFS under the current benefits. But changing theStandards of Care will take time, careful discussion and considerable thought. Giventhe time constraints of my own transition a simple response from HBIGDA discussing- 4 -