My Health Care Is Not Cosmetic

In June of 2014, Washington State Insurance Commissioner Mike Kreidler announced that insurers selling policies in the state could no longer discriminate against transgender residents. This was exciting news because, up until that point, trans people had to jump through burning hoops to get the care they needed. The announcement offered us hope for the future. Three years later, many of us are still struggling, and have yet to experience the promised change.

When I started my transition, one of the first things I wanted was a hysterectomy. My reproductive organs had plagued me from the onset of puberty. Every period was a nightmare. And unfortunately, while I no longer get visits from Aunt Flo, I still feel her pain each and every month.

At the time, my doctor told me outright that insurance companies would only approve this surgery for someone who was still considered female in the eyes of the law. Furthermore, she explained that insurance companies wanted women to go through a series of steps just to be sure nothing else could be done before permanently removing the uterus.

I could understand to a certain extent why that was, but for a trans man, aching to feel better for the first time in his life, it was disheartening news, especially because I had no plans to bear children. I hadn't started hormones yet and my doctor did say that it would be wise to refrain from changing my information -- name and sex -- if I ever did want my surgery covered, because once I was no longer technically female, the situation could get even stickier.

Despite the advice, within a year I had changed my information. I became legally male. My doctor signed the papers and I stood before a judge after the state approved my request for a name and gender change.

Why didn't I follow the doctor's advice? One of many things I'd have to try before the prospect of a hysterectomy would be considered by insurance was being on birth control. I wasn't willing to start birth control because the hormones would have been counterproductive to my medical transition. By that time, I had also heard about the change in trans coverage in the state and I felt hopeful that I would finally be allowed to have the most vital surgery of my life -- something even more important to me than top surgery.

Before transition, my doctors said I had dysmenorrhea, which means "painful periods with cramps." When the pain continued even after transition I had a sonogram, and it revealed nothing obvious causing the pain. Truthfully, no one really knows why some trans men continue to feel pain after our periods stop. I've heard doctors say it's the uterus's way of dying dramatically. How's that for implicit bias?

Initially, my insurance said no to paying for the hysterectomy -- not because I hadn't completed the list of medical prerequisites, but because I was a man. It didn't matter that I was a trans man with a uterus. The insurance company doesn't give men hysterectomies; there was nothing else the people there could tell me other than that their policy hadn't been updated in quite a few years.

At the start of 2016, I was elated to discover that my insurance finally included the coverage I so desperately needed. It would cover 80 percent of the cost of my hysterectomy and I would be responsible for the rest. I was floored and so very ready. I had met with my surgeon, Dr. Mason in Seattle. All I had to do was set the date and figure out how I was to come up with the remaining money.

Then, out of nowhere, I lost coverage. I was 25 and still insured under my parents, but then my mother lost the job that provided that coverage, and therefore I lost coverage too.

I'd have to find my own insurance. I made just over the amount to qualify for state assistance and so I went with the only plan I could afford, through Ambetter. I'm still struggling to find the care that I need. This spring I had a conversation with Ambetter that went like this:

"Hi. I'm a transgender man, and I wanted to ask if you covered hysterectomies,"

"Uh--. Let me check--. Sorry, no, that's considered cosmetic."

Cosmetic? As if anyone can see my uterus.

While discrimination is alive and well among insurance companies, I'm grateful to those companies that are working hard to ensure proper care for people like me. Feeling human, healthy, and comfortable shouldn't be considered cosmetic. In my case, the removal of my reproductive organs is a medical necessity, not only for my transition but for my overall health.

So the question is, what's next? Keep fighting, of course. In the months to come, I am meeting with a new doctor, who has already expressed her determination to help trans people facing these kinds of issues. From there, I'll put in my request for the removal of my entire reproductive system. A denial letter will come and I will appeal it. Hopefully, with only a bit of patience and a lot of luck, by the end of the year I could be living happily in a body that is truly my own.

COLE HAYES is a 25-year-old trans man living near Seattle. He is an aspiring author and enjoys documenting his transition through YouTube. Follow him on Twitter @itscolehayes.