Experts confirm gender identity is biological and say insurers should cover trans health needs

The Endocrine Society, an international organization of medical experts and biological researchers, has released a new set of guidelines for caring for transgender patients. Along with the guidelines, the organization has issued a position statement calling on federal and private insurers to cover the costs of all medical interventions a physician might prescribe for a transgender patient, including hormone replacement therapies and surgeries.

The updated guidelines and position statement reflect the latest research on gender identity and the shift away from understanding gender dysphoria as a mental illness. “Considerable scientific evidence has emerged demonstrating a durable biological element underlying gender identity,” the statement reads. “Individuals may make choices due to other factors in their lives, but there do not seem to be external forces that genuinely cause individuals to change gender identity.”

Research has not exhaustively explained “the specific mechanisms guiding the biological underpinnings of gender identity,” but the Endocrine Society joins the “evolving consensus that being transgender is not a mental health disorder.” The statement notes the following findings from scientific studies:

Attempts to change an intersex person’s gender identity to match their anatomy are unsuccessful.

Identical twins are more likely to both be transgender than fraternal twins.

Individuals with XX chromosomes exposed to higher levels of androgens in utero are more likely to identify as transgender men, while individuals with XY chromosomes and complete androgen insensitivity syndrome are more likely to identify as transgender women.

Brain scans have found patterns across gender identity despite differences in external genitalia or chromosomes.

According to the Endocrine Society’s new guidelines, hormone therapy, surgeries, and other procedures that help resolve an individual’s gender dysphoria are “medically necessary and should be covered by insurance.”

“Medical intervention for transgender individuals (including both hormone therapy and medically indicated surgery) is effective, relatively safe (when appropriately monitored), and has been established as the standard of care,” the position statement concludes. “Federal and private insurers should cover such interventions as prescribed by a physician as well as the appropriate medical screenings that are recommended for all body tissues that a person may have.”

States vary in terms of guaranteed coverage for transgender health issues and some still have explicit prohibitions. In Iowa, for example, a trans woman has sued the state, challenging its decades-old regulation that prohibits Medicaid from covering such procedures because “[s]urgeries for the purpose of sex reassignment are not considered as restoring bodily function.” Not only does the antiquated regulation conflict with research confirming that these surgeries may be medically necessary, it also contradicts Iowa’s own gender identity nondiscrimination protections.

In 2015, the Obama administration issued a new rule applying the Affordable Care Act’s nondiscrimination protections to transgender patients nationwide. Last year, however, a group of states led by Texas challenged the rule and a notoriously anti-LGBTQ federal judge ruled in December that the protections could not be enforced. The Trump administration decided to pause that litigation — i.e. stopped fighting for the Obama-era protections — and has reportedly been rewriting the rule so that it no longer applies to transgender people.

President Trump, in defending his ban on transgender people serving in the military, indicated that one of his primary motivations was that he didn’t want the federal government to pay for their health care needs. His order, which is set to take effect next March, explicitly states that the Department of Defense and Department of Homeland Security will cease all funding for transition-related surgical procedures.

If the Trump administration proceeds with these plans to block transgender people from receiving the health care they require, it will be doing so against the direct recommendation of the experts and doctors tasked with providing that care.