Austen Crowder

The Catch 22 of Transgender Care and Acceptance

Filed By Austen Crowder | March 31, 2009 8:00 PM | comments

Filed in: Living, Transgender & Intersex
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Finding yourself is financially stupid.

Being financially independent is a long-term goal of mine. I'm sure it's on the minds of many people, but I've made a hobby of reading financial advice. Dave Ramsey has helped me turn my finances around, particularly. Yet I'm spitting in the face of my own financial advice in going through with transition: changing gender is just not a financially sound move. Being transgender carries a heavy, heavy tax.

People mean well by tolerating who we are, sure, but it's always worrisome to hear their hesitation when the topic of surgery comes up. Why is it important that transgender care be recognized? After all, we're just asking for someone to fulfill a strange need or a sexual fantasy or severing the last connection to our poor, confused selves. No matter how justified it may be, the majority of insurance companies refuse to see the utility of SRS. If we want it badly enough, we should pay for it ourselves.

Yet to be accepted by law in our proper gender, we must get the surgery - insurance or no. Without the insurance we have little in the way of rights, and without the rights we are bereft of job opportunities. And that is what begins and ends the cycle of transgender discrimination.

Take, for example, a conversation with a coworker about her time at the airport that came up over diversity training. She nonchalantly related to me a story about a transgender woman at the airport; the TSA, knowing the transgender lady's situation, asked my coworker to go into the restroom and escort her from the premises. The lady had been living full time for a long while; she was on her way to have her SRS surgery performed. But because she was pre-op she was simply not "woman" enough to go to the bathroom. My coworker meant well, and has nothing against transgender people, but it was all I could do to correct her when she kept saying "he" over and over again when referring to this lady.

I hear more than my fair share of prejudice coming from Indiana. Just a month ago, a transgender lady in Franklin was raped; when she reported the rape she was arrested for filing false charges -- after all, no man can be raped in the state of Indiana. In my hometown, I could be arrested for female impersonation thanks to antiquated laws. A high school acquaintance meeting my roommate shot her a half-cocked glare and said "Yeah, I remember school with your roommate. I hear he went a little different."

(It should be noted that I don't have links on these issues, and for that I apologize. It's hard to get more info on the grapevine.)

Society, from my anecdotal perspective, seems to accept SRS as "adequate evidence" that a transgender person is serious. Everything up to that point is considered playful or somehow less dedicated than someone who had the whole change. Up until surgery we are not gendered under the eyes of the law: too male to be female and too female to be male.

This leads to a terrible squeeze-play on transgender people:

  • If I don't have SRS, I cannot be accepted by the letter of the law.
  • If I am not accepted by the letter of the law, I may be the victim of job discrimination.
  • If I am the victim of job discrimination, I will struggle to make money to save.
  • If I can't save money, I can't have SRS.

(Hey. If I turn this into a neat graphic and sell it to the HRC, I could afford surgery! Genius!)

The point remains despite my hyperbole: affording surgery often requires surgery. I find myself dealing with a decision of honesty and ethics: can I continue to live a lie for the next two to four years so I can afford to be myself later? If I want to have the surgery sooner, will I have to tank my credit rating?

More importantly, should I have to ask myself these questions?

And while I struggle with the high cost of surgery, I watch insurance companies cover hair restoration drugs, sexual dysfunction treatments, etc. Economically, I understand the need, as lots of people want new hair or a new libido and will invest in insurance companies that provide it. How many transgender individuals does insurance have to screw over before someone gets the right idea?

So we go it alone, quietly relying on the good grace of honest businesses to allow us the privilege of earning our womanhood. How would that look on a resume? "Goal-oriented individual: will not stop until goal is completed no matter the cost." Or how about "Wants to be a woman so badly she picked up two and a half jobs?" What about "Look, if I make enough money I won't be that weirdo man in a dress anymore?" I think that would grab someone's attention in the interview.

(Oh, and to any HRC representatives reading this article: my services as a corporate flowchart artist/writer are available for a one-time, after-tax fee of $20,000. I consider it a steal!)


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Amber, You DON'T need SRS to fully transition. Here in the good state of Indiana, my spouse has completely, legally transitioned (MTF) and she has NOT had SRS. All you need is a letter from your Dr. for the BMV stating you are undergoing treatment for GID and have fulfilled requirements for transition. This is vaguely worded enough that surgery isn't even mentioned. If I recall correctly, you were seeing Dr. A. That's also my spouse's Dr, and she got her letter from him. She got her driver's license amended "F" with this letter, and had no problems at all. With her amended license, she could change all her accounts, her employment records, everything.

Also, in the city of Indianapolis, it is against the law to discriminate against GLBT employees; yes, that includes gender identity.

You are absolutely correct on the health care issue. My wife has challenged her employer about their discriminatory health care offerings, and written an amazing, well-researched paper on this subject. There are several major companies who now offer SRS in their insurance plans. It's only a matter of time that more will follow suit. Just keep talking about it!

Thanks for the clarification. I knew of the ENDA in Indianapolis, and should have clarified: I was speaking of federal standards for gender switches, which does include SRS. WIthout that change a transgender employee will still fall victim to no-match letters from the SSA, which can negatively affect potential interviews.

I'd love to read this paper!

FYI, I'm Melissa, I just commented, I wasn't properly signed in, sorry.

No worries. If you aren't signed in, your comment is still there but an editor has to go and approve it.

This is a great post. Maybe we can resolve the issue by trying to tone down the obsession with SRS?

I mean, I've heard from trans folk and know that when I discuss trans issues w/ other non-trans folks that one of the first questions that comes up when someone says "He's a trans man" is "What surgery has he undergone?"

I know it's cold comfort to say, "Well, that's not my problem if you don't accept me as the gender I am," especially when someone else's problem becomes your own, and I don't really know any way around it other than trying to de-stress SRS as something so enormously strange, pivotal, and foundational that it has to be the first thing discussed when talking about transgender people or issues.

That would be _precisely_ the issue we need to address! Why do I need to afford a non-covered surgery to prove that I'm serious about being a woman? It seems that society accepts SRS as the Gold Standard on whether or not a trans-person should be called a man or a woman.

The question, then, is this: how do we make this happen?

Cheryl Cristello | April 5, 2009 3:04 PM

I am a TS woman. While it is true that there are numerous problems associated with transition, for me I really had no good choice other than to live MY TRUTH. My doctors don't understand when I keep telling them that I feel blessed that they really do care for my health and well being "in spite of my being transsexual". So many of my sisters and bothers are not so fortunate.
In my experience, having surgery or not makes essentially no difference in the eyes of other people as to my really being a woman or not. To people that did not know me as male, I am seen as I see myself, a woman. To those who did know me as a male some see me as a woman but most see me as an interloper, a fake, a fraud, one of those "weird transsexuals".
I feel very fortunate to be living in the State of Washington where we have an all inclusive ENDA. I will always believe that it was only because of this law that my employer had the incentive to not fire me after being here over 28 years. Still the working environment has been anything but good. Irrespective, I choose to hold my head high, be proud of who I am - I AM living MY TRUTH, and it's a really big deal. My hope is that as people become accustomed to seeing me, working with me, getting to know me, that the positive impression that I make as a very competent professional woman will be more powerful than ENDA can ever be. Yet, I firmly believe that the nation as a whole must have an all inclusive ENDA to provide the incentive for everyone to do the right thing. This is why I will be in DC at the end of the month to encourage our congress people to pass an all inclusive ENDA to the benefit not just TS people but even more importantly, the nation as a whole.

"This is a great post. Maybe we can resolve the issue by trying to tone down the obsession with SRS?"

This is what infuriates me about the "transgender" umbrella. Classic transsexuals NEED srs to be complete, it's not cosmetic, not to "fit in" better, it is the defining nature of being transsexual. By erasing the meaning from that word, attacking those who have the condition as "elitists" and lumping everyone gender transgressive "transgender" fuel has been given to insurance companies to deny necessary (to transsexuals) medical care.

Obsession Alex?.......not for those who are born classic transsexuals. Why is it so damn impossible to recognize transsexuals have different needs from transgenders, acknowledge those differences and then seek to work together for the common elements of civil rights needs for transgenders and transsexuals?

They ARE different groups but they can work together but only if classic transsexuality is allowed to be visible, transgenders stop deliberately claiming to speak for transsexuals and transgenders stop, once and for all, claiming they ARE transsexuals when they do not meet the definition or feel the compelling need to put mind and body in congruence that IS classic transsexuality.

Transheretic, there is no such thing as a "classic transsexual".

Disclaimer here: Even within the trans community, there is so much sniping back and forth about who gets to be under the trans umbrella, who's "real" and who's "not real", it's divisive and undermines the whole point of ENDA - to be inclusive, regardless of your identity. There's no "right or wrong" way to be gay, for instance, and there are also many wonderful shades in between, and they all belong.

That said, I wanted to clarify, for the purposes of Amber's original post, that I agree with the premise that SRS should NOT be considered a Gold Standard or Holy Grail for ANY reason; not socially, culturally, and certainly not for employment or identity purposes. Many trans people live without surgery, just as they are, and for a variety of reasons.

SRS is not available to everyone - does that mean you aren't a "true" transsexual? You can be transsexual/transgender to the marrow of your bones, but if you don't have a spare $20,000 in your pocket, you aren't getting SRS. Does that make you less of a transsexual? If you won the lottery, but such a major surgical procedure would kill you, due to a serious precluding medical condition, does that make you less transsexual/transgender? No and no.

So many trans people have to live with the anomalies they were born with, and there are many choices they can make: Cry and whine about it, make the best out of a crappy situation and hold their heads up high, actively engage in the community to promote awareness, MAKE A DIFFERENCE in others' lives.... you get the idea.

But again, SRS is not, nor should it be, the defining event for a transsexual or transgender person. IMHO, of course.

Radical Bitch; The first thing you might do to get along better with non-op trans people(I guess I'm doomed to be "non-classic" unless I undergo dangerous surgery with a risk of losing my sexual sensation forever..ah well)would be to quit referring to us as "transgenders".
Sorry, I can just somehow see someone in overalls in a pickup truck talking about "them transgenders".
By the way; should "classic" transsexuals be allowed to wear a badge that lets everyone know their special genital status?
Just wondering.

Just to clarify, I don't think it's an obsession for someone who wants surgery or for the people who support him/her to think about it. What I was talking about are people who think about surgery right off the bat when they find out someone is trans. That is a cultural obsession.