Coverage fortransgender surgery has been increasing in the U.S., not just inMedicare/Medicaid but also in state-sponsored private plans andemployment insurance. (Photo: Shutterstock)

Greater acceptance of transgender individuals, as well as an end on theMedicare/Medicaid ban on transgender surgeries, have led to an increase in the number ofsuch surgeries—but there is concern among health care advocatesthat the current administration will fail to enforce the Affordable CareAct's ban on discrimination on the basis of gender identity andthreaten the availability of such surgeries.

The Washington Post reports that the first U.S. study of itskind on transgender surgeries has found that the number ofgender-affirming operations increased fourfold from 2000 to 2014.The study, published in the journal JAMA Surgery, also finds that the rise may berelated to an increase in insurance coverage for theprocedures.

“Early on we recognized there's been a lot of work on healthdisparities having to do with age, race and so on that getcollected in health-care settings,” Brandyn Lau, an assistantprofessor of surgery and health sciences informatics at the JohnsHopkins University School of Medicine, is quoted saying in thereport. Lau adds, “One of the things we need to know is whether[lesbian, gay and transgender] patients are getting the samecare.”

Related: 4 steps businesses can take to be inclusive oftransgender employees

Most surgeries occurring between 2000–2011, the report finds,were for patients not covered by health insurance. Between2000–2005, approximately half the transgender patients in the studypaid out of pocket, with the percentage rising to 65 percentbetween 2006–2011. But between 2012–2014, the numbers tickeddownward, with just 39 percent having to pay out of pocket.According to the study's authors, a lot of that decrease is thanksto Medicare and Medicaid; in May of 2014, Medicare ended its33-year ban on transgender surgeries.

Says the report, “Virtually every major medical association inthe United States has described transition-related surgeries as'medically necessary' for both the physical and mental health oftransgender people. They also have stipulated that health insurancecoverage for such operations should be no less available than it isfor other types of surgery.”

Coverage for transgender surgery has been increasing in theU.S., not just in Medicare/Medicaid but also in state-sponsoredprivate plans and employment insurance.

“These changes are driven by a growing expert consensus on themedical necessity of gender transition, new legal interpretationsprohibiting insurance discrimination against transgender people,and mounting evidence that transgender-inclusive coverage iscost-effective,” writes Kellan Baker, of the Johns HopkinsBloomberg School of Public Health, in the New England Journal ofMedicine in 2017.

While few studies exist in the U.S. on the outcomes oftransgender surgery, Europe has taken the lead, with more andlarger studies conducted on the results. A study published in 2014in the German Medical Association's official bilingual sciencejournal Deutsches Arzteblatt found that 90.2 percent of 119transgender women said that “their expectations for life as a womanwere fulfilled postoperatively.”

And while Section 1557 of the Affordable Care Act barreddiscrimination on the basis of gender identity and helped ensurethat more transgender men and women would be covered for surgicalprocedures, including genital reconstruction, it's by no meansassured that that provision will continue to be honored under theTrump administration.

“There's going to be rough sailing ahead,” plastic surgeon LorenSchechter, who specializes in transgender surgeries, is quotedsaying. Schecter adds, “There is concern in the community and amongproviders that many of the gains already made are in jeopardy.”