Pathologization vs. Medical Nessessity

Posted: June 4, 2010 in DSM, GID, ICD-10, ICD-9, Insurance, medically necessary, pathologized, Transgender

So many of us today face different diverse issues throughout our transition which make us all have unique paths. But there is is always a middle ground where we have the same issue, SURGERY. With surgery there is finances and a lot of transgender people with need do not always have the allotted amount for surgery or in most cases surgeries. Now with that in mind say the said person is 20 years old no family a few friends, job, and barely getting by, how likely is this person will get to that said goal of at least in the US 4600? Need I remind you thats JUST for the surgery you still have the factor in travel, lodge, time off from work, bills, and surgical aftercare. Then thats just one need met what if the have need for lower procedures then what? On the low end of surgical transition your looking at for top and bottom surgery roughly $23,000. That price is reflective of overseas surgery thats about as good as the price will get for top, hysto, and lower if the lower is metiodioplasty if not tack on about another 5-10K. In my opinion prolonged exposure to dysphoria can cause deeper issues which lead to all sorts of other turmoil. Case and point why not alleviate the cause of these issues with the proper treatment that has been proven multiple times over?
Prolonged exposure to said “mental illness” wouldn’t that worsen the conditions if evaluated by medical professionals? For those not familiar with DSM IV lets read some of the coding as well as what GID is shall we?

“Gender identity disorder (GID) is the formal diagnosis used by psychologists and physicians to describe persons who experience significant gender dysphoria (discontent with the biological sex they were born with). It is a psychiatric classification and describes the attributes related to transsexuality, transgender identity, and transvestism.

Gender identity disorder in children is usually reported as “having always been there” since childhood, and is considered clinically distinct from GID which appears in adolescence or adulthood, which has been reported by some as intensifying over time.[1] Since many cultures strongly disapprove of cross-gender behavior, it often results in significant problems for affected persons and those in close relationships with them. In many cases, discomfort is also reported as stemming from the feeling that one’s body is “wrong” or meant to be different.

Some transgender people and researchers have criticized the classification of GID as a mental disorder for several reasons, including evidence from recent studies about the brains of transsexual people.[2] The treatment for this disorder consists primarily of physical modifications to bring the body into harmony with one’s perception of mental (psychological, emotional) gender identity, rather than vice versa.[3]”


Also see:

F64.8         Other gender identity disorders
F64.9         Gender identity disorder, unspecified
Gender-role disorder NOS


2010 ICD-9-CM Diagnosis Code 302.85
Gender identity disorder in adolescents or adults; 302.85 is a billable ICD-9-CM medical code that can be used to specify a diagnosis on a reimbursement claim.


MedlinePlus: 001527

Gender identity disorder is a conflict between a person’s actual physical gender and the gender that person identifies himself or herself as. For example, a person identified as a boy may actually feel and act like a girl. The person experiences significant discomfort with the biological sex they were born. [CLICK HERE FOR FULL ARTICLE]

MeSH: D005783


Now that we have that all cleared up I would like to go over 2 very important words:

Main Entry: pa·thol·o·gize
Pronunciation: \pə-ˈthä-lə-ˌjīz\
Function: transitive verb
Inflected Form(s): pa·thol·o·gized; pa·thol·o·giz·ing
Date: 1649
: to view or characterize as medically or psychologically abnormal <natural hormonal shifts have been pathologized — Joyce C. Mills>

Medical necessity is a United States legal doctrine, related to activities which may be justified as reasonable, necessary, and/or appropriate, based on evidence-based clinical standards of care. Other countries may have medical doctrines or legal rules covering broadly similar grounds. The term clinical medical necessity is also used.

Ok so with all the information gathered I find it extremely disturbing that in this country we have a lack of provided health care coverage for things that are pathologized also known as abnormality which in most every other case is a medical necessity that needs to be treated right away. With all this applicable information coverage is still denied, but on what grounds?

Many of the surgeries that we are in need of are seen as cosmetic. Cosmetic surgeries aren’t covered by insurance companies unless those said procedures and/or hormonal treatments are seen as medically necessary. But wait a minute, how can something that has been pathologized, researched through treatment studies proving feelings of said “condition” can be “cured”, and improvement of life for the patient not be seen as medically necessary? Once you actually read whats there it really makes you wonder why we have to go through so much just to get the medical insurance coverage we need and deserve. Not only that but for many of us having dysphoria for long periods of time and combination of years on T can cause other health problems with organs that are no longer functional. So many of the procedures a transman would need like a hysterectomy wont be covered simply because he is a transgender male. BUT if he were a cis-gender female he would be covered for surgery with no issues. We are all human and deserve the right of happiness so why is it that for us it’s so hard?

In the 70’s our condition was pathologized as a mental disorder, hence why we have to see therapists, see medical professions giving us formal consent, etc. In no way am I downing the consent through knowledgeable mental health professionals because its surgery and you should be physically AND mentally prepared to deal with what shall come with any surgery. Where i do not agree is the fact that cis-gender people do not have to go through the same steps we do as far as evaluations for cosmetic or medically necessary procedures (unless it is an emergency situation). It boggles the mind it really does. At the same time a mere 30 years ago homosexuality was also pathologized as a sexual orientation disorder. So maybe there is still hope for us after all.

The way they have it set up is brilliantly confusing but not brilliant at all. It’s a bunch of contradictions over and over. If you claim something is a medical abnormality then why exactly it is not considered medically necessary for coverage of health insurance? I think this is the point where some companies start making their own laws about what they want and feel is right. If they did the work they would see that in every way HRT and/or SRS-GRS is a sufficient “cure” for this “disorder”. After all isn’t health insurance supposed to be there to aid in medical care to keep this country healthy? A lot of foreign countries have gotten the memo on the need for these procedures. They find to do them in a short period of time it alleviates a lot of the prolonged affects of dysphoria. So why are we not deciding the same for our citizens? How can they let a disorder so well known go untreated and not relieve the stress of thousands of men and women? Yet they still label us like some defected human specimen, how does that really work out as even grounds for a fight to “cure” anything?

It’s just really annoying to sit and read over and over how things are supposed to be covered but some how or another due to personal choice they find a way to not cover it and consider it cosmetic. Pure and utter blasphemy at it’s best that we have been tricked into believing is right and the way it’s always going to be. No, not at all it just took a group of people with their heads on their shoulders tight to sit down and say “this is not cool anymore”. Then there becomes other ways of surgical means through insurance and even better some insurance companies have done that without the extra push. It’s amazing what standing up for what you know is right can do as seen below in the following PDF:

[Clarification on Medical Necessity for Sex Reassignment Surgery]

With that being said I hope that in the near future there aren’t select places with coverage but everywhere with equal coverage available for transgender healthcare and services. It’s going to be an excellent day in this community when that happens. Just to know that a simple medical resource and/or surgical procedure can alleviate so many years of recurring hardships is so mind blowing but this is what we go through every day. One step at a time, first is DSM 5 de-psychopathologisation of all gender variance worldwide. I believe it should still be a medically needed condition but label it more closely to intersex. When you really think about it what makes us really any different? Some intersex characteristics are not seen right away just like some transgender characteristics are not acknowledged right away. Things will solve its self over time though I have nothing but good faith about it.


  1. Pathologization vs. Medical Nessessity…

    I found your entry interesting do I’ve added a Trackback to it on my weblog :)…

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