Medical Organization Statements
Leading medical groups recognize the medical necessity of treatments for gender dysphoria and endorse such treatments. Many of these groups have also explicitly rejected insurance exclusions for transgender-related care.
Children and adolescents who are growing up gay, lesbian, bisexual, gender nonconforming, or gender discordant experience unique developmental challenges. They are at risk for certain mental health problems, many of which are signiﬁcantly correlated with stigma and prejudice. Mental health professionals have an important role to play in fostering healthy development in this population. Inﬂuences on sexual orientation, gender nonconformity, and gender discordance, and their developmental relationships to each other, are reviewed. Practice principles and related issues of cultural competence, research needs, and ethics are discussed.
Founded in 1947, the AAFP represents 129,000 physicians and medical students nationwide. It is the only medical society devoted solely to primary care.
The AAFP opposes all discrimination in any form, including but not limited to, that on the basis of actual or perceived race, color, religion, gender, sexual orientation, gender identity, ethnic affiliation, health, age, disability, economic status, body habitus or national origin.
AAFP also agreed "to send a letter to the top national payers stating our opposition to plans that exclude coverage for the treatment of gender dysphoria."
The American Academy of Nursing serves the public and the nursing profession by advancing health policy and practice through the generation, synthesis, and dissemination of nursing knowledge. The Academy's more than 2,400 fellows are nursing's most accomplished leaders in education, management, practice, and research.
The American Academy of Nursing supports initiatives to address the health needs of transgender individuals (TI) and supports policy initiatives that reduce the heath care barriers that most TI encounter. There is a great need for the development of strategies and policies to eliminate the health care disparities of approximately 700,000 TI in the United States.
The American Academy of Pediatrics works toward all children and adolescents, regardless of gender identity or expression, receiving care to promote optimal physical, mental, and social well-being. Any discrimination based on gender identity or expression, real or perceived, is damaging to the socioemotional health of children, families, and society.
The AAP recommends that youth who identify as transgender and gender diverse have access to comprehensive, gender-affirming, and developmentally appropriate health care that is provided in a safe and inclusive clinical space and that insurance plans offer coverage for health care that is specific to the needs of youth who identify as transgender and gender diverse, including coverage for medical, psychological, and, when indicated, surgical gender-affirming interventions.
The American College of Nurse-Midwives (ACNM) is the professional association that represents certified nurse-midwives (CNMs) and certified midwives (CMs) in the United States. It is the position of ACNM that midwives
- Exhibit respect for patients with nonconforming gender identities and do not pathologize differences in gender identity or expression;
- Provide care in a manner that affirms patients’ gender identities and reduces the distress of gender dysphoria or refer to knowledgeable colleagues;
- Become knowledgeable about the health care needs of transsexual, transgender, and gender nonconforming people, including the benefits and risks of gender affirming treatment options;
- Match treatment approaches to the specific needs of patients, particularly their goals for gender expression and need for relief from gender dysphoria;
- Have resources available to support and advocate for patients within their families and communities (schools, workplaces, and other settings).
To facilitate these goals, ACNM is committed to
- Work toward the incorporation of information about gender identity, expression, and development in all midwifery educational programs;
- Make available educational materials that address the identities and health care needs of gender variant individuals in order to improve midwives’ cultural competence in providing care to this population;
- Support legislation and policies that prohibit discrimination based on gender expression or identity;
- Support measures to ensure full, equal, and unrestricted access to health insurance coverage for all care needed by gender variant individuals.
The American College of Obstetricians and Gynecologists, the nation's leading group of professionals providing health care for women, notes that "[w]ithin the medical community, transgender individuals face significant barriers to health care. This includes the failure of most health insurance plans to cover the cost of mental health services, cross-sex hormone therapy, or gender affirmation surgery. This barrier exists despite evidence that such treatments are safe and effective and that cross-gender behavior and gender identity issues are not an issue of choice for the individual and cannot be reversed with psychiatric treatment." The American College of Obstetricians and Gynecologists "urges public and private health insurance plans to cover the treatment of gender identity disorder."
The American College of Physicians recommends that public and private health benefit plans include comprehensive transgender health care services and provide all covered services to transgender persons as they would all other beneficiaries.
The American Counseling Association is a not-for-profit, professional and educational organization that is dedicated to the growth and enhancement of the counseling profession. Founded in 1952, ACA is the world's largest association exclusively representing professional counselors in various practice settings.
The American Counseling Association is committed to nondiscrimination and to the prevention of harassment in all forms—verbal, physical, sexual, emotional, and psychological—including protections for transgender, gender non-conforming, and LGBTQ+ individuals.
The American Counseling Association's Association of Lesbian, Gay, Bisexual, and Transgender Issues in Counseling has issued competencies for counseling transgender clients that include "affirm[ing] transgender mental and medical health care (e.g., hormone therapies, sexual reassignment surgery, safe and trans-positive general medical services) through the entire lifespan."
The American Medical Association, the largest association of physicians and medical students in the United States, articulates in Resolution 122 that an "established body of medical research" shows both the medical effectiveness and necessity of "mental health care, hormone therapy, and sex reassignment surgery" in treating gender dysphoria. The AMA has resolved "[t]hat our American Medical Association support public and private health insurance coverage for treatment of gender identity disorder as recommended by the patient’s physician."
The AOA represents more than 137,000 osteopathic physicians and medical students, promotes public health and serves as the primary certifying body for DOs.
H445-A/15 Gender Identity Non-Discrimination: "The American Osteopathic Association supports the provision of adequate and medically necessary treatment for transgender and gender-variant people and opposes discrimination on the basis of gender identity." 2010; reaffirmed 2015
The American Psychiatric Association, the world’s largest psychiatric organization and publisher of the Diagnostic and Statistical Manual, notes that “Significant and long-standing medical and psychiatric literature exists that demonstrates clear benefits of medical and surgical interventions to assist gender variant individuals seeking transition. … Access to medical care (both medical and surgical) positively impacts the mental health of transgender and gender variant individuals," and states the following:
- Recognizes that appropriately evaluated transgender and gender variant individuals can benefit greatly from medical and surgical gender transition treatments.
- Advocates for removal of barriers to care and supports both public and private health insurance coverage for gender transition treatment.
- Opposes categorical exclusions of coverage for such medically necessary treatment when prescribed by a physician.
The American Psychological Association, the largest association of psychologists worldwide, states the following:
"Therefore be it resolved that APA opposes all public and private discrimination on the basis of actual or perceived gender identity and expression and urges the repeal of discriminatory laws and policies; ...
Therefore be it further resolved that APA calls upon psychologists in their professional roles to provide appropriate, nondiscriminatory treatment to transgender and gender variant individuals and encourages psychologists to take a leadership role in working against discrimination towards transgender and gender variant individuals; ...
Therefore be it further resolved that APA supports the provision of adequate and necessary mental and medical health care treatment for transgender and gender variant individuals;
Therefore be it further resolved that APA recognizes the efficacy, benefit and medical necessity of gender transition treatments for appropriately evaluated individuals and calls upon public and private insurers to cover these medically necessary treatments;
Therefore be it further resolved that APA supports access to appropriate treatment in institutional settings for people of all gender identities and expressions; including access to appropriate health care services including gender transition therapies; ..."
Policies and practices that exclude transgender and gender-nonconforming people have a negative impact on gender minority health by permitting discrimination and reinforcing stigma. APHA advocates for the adoption and application of inclusive policies and practices that recognize and address the needs of people and communities identifying as transgender or gender nonconforming. Inclusive policies and practices are those that recognize transgender and gender-nonconforming identities as valid and deserving of equal consideration and treatment. Inclusive policies and practices are critical to reduce health inequities experienced by transgender and gender-nonconforming people. Transgender is an umbrella term that refers to individuals who do not conform to binary gender norms that correspond with their assigned sex at birth. This term includes a wide spectrum of individuals, including but not limited to people whose gender identity differs from the gender typically associated with the sex they were assigned at birth, those who embrace gender fluidity, and those who do not identify as either men or women. The term gender nonconforming is also used in this policy statement to describe those with nonbinary gender identities. Although transgender and gender-nonconforming people may experience similar gender-related bias and discrimination, they are diverse in terms of factors such as age, race, ethnicity, ability, income, sexual orientation, socioeconomic status, and immigration status. APHA urges Congress, state legislatures, and other public and private entities to ensure that policies and practices across all sectors are explicitly inclusive of transgender and gender-nonconforming people.
The American Society of Plastic Surgeons (ASPS) is the world's largest organization of board-certified plastic surgeons. Representing more than 7,000 Member Surgeons, the Society is recognized as a leading authority and information source on aesthetic and reconstructive plastic surgery. ASPS comprises more than 94 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the Society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada. ASPS advances quality care to plastic surgery patients by encouraging high standards of training, ethics, physician practice and research in plastic surgery.
"We would be remiss to not also ask the Agency to review current policy for breast implant placement for trans females. As we are sure you are aware, in the typical patient, estrogen therapy alone does not result in what would be considered adequate growth of breast tissue. Augmentation procedures are necessary, and should be included as a reimbursable service.
We would encourage CMS to review the nuances of CPT coding for breast prosthesis, and adjust existing policy that excludes augmentation mammoplasty (CPT 19325) as a covered service for MtF patients undergoing gender confirmation surgery."
Founded in 1916, The Endocrine Society is the world's oldest, largest, and most active organization devoted to research on hormones and the clinical practice of endocrinology. They have published clinical guidelines, Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline. The Guideline is co-sponsored by the American Association of Clinical Endocrinologists, American Society of Andrology, European Society for Pediatric Endocrinology, European Society of Endocrinology, Pediatric Endocrine Society, and World Professional Association for Transgender Health.
The Endocrine Society has also taken the following positions:
- There is a durable biological underpinning to gender identity that should be considered in policy determinations.
- 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. 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.
- Increased funding for national research programs is needed to close the gaps in knowledge regarding transgender medical care and should be made a priority.
Therapeutic treatment, including hormone therapy, mental health therapy and gender affirming surgeries, are medically necessary for the treatment of gender dysphoria. These gender-affirming medical and surgical treatments should be covered by all public and private insurance plans.
The National Association of Social Workers "supports the rights of all individuals to receive health insurance and other health coverage without discrimination on the basis of gender identity, and specifically without exclusion of services related to transgender or transsexual transition (or sex change), to receive medical and mental health services through their primary care physician and the appropriate referrals to medical specialists, which may include hormone replacement therapy, surgical interventions, prosthetic devices, and other medical procedures."
Because jails, prisons, and juvenile confinement facilities have a responsibility to ensure the physical and mental health and well-being of inmates in their custody, correctional health staff should manage transgender patients in a manner that respects their biomedical and psychological needs. The National Commission on Correctional Health Care recommends that the following principles guide correctional health professionals in addressing the needs of transgender patients: ...
6. Because transgender patients may be under different stages of care prior to incarceration, there should be no blanket administrative or other policies that restrict specific medical treatments. Policies that make treatments available only to those who received them prior to incarceration or that limit transition and/or maintenance are inappropriate and out of step with medical standards and should be avoided. ...
9. Accepted treatments for gender dysphoria should be made available to people with gender dysphoria. Providing mental health care, while necessary, is not sufficient. ...
14. When determined to be medically necessary for a particular patient, hormone therapy should be initiated and regular laboratory monitoring should be conducted according to community medical standards.
15. Sex reassignment surgery should be considered on a case-by-case basis and provided when determined to be medically necessary for a patient.
The Pediatric Endocrine Society Special Interest Group on Transgender Health joins other academic societies involved in the care of children and adolescents in supporting policies that promote a safe and accepting environment for gender nonconforming/transgender youth, as well as adequate mental health and medical care. This document provides a summary of relevant definitions, information and current literature on which the medical management and affirmative approach to care of transgender youth are based.
The World Medical Association (WMA) is an international organization representing physicians. The organization was created to ensure the independence of physicians, and to work for the highest possible standards of ethical behavior and care by physicians, at all times. Membership consists of 111 National Medical Associations. The WMA recommends, among other things, the following:
- The WMA emphasises that everyone has the right to determine one’s own gender and recognises the diversity of possibilities in this respect. The WMA calls for physicians to uphold each individual’s right to self-identification with regards to gender.
- The WMA asserts that gender incongruence is not in itself a mental disorder; however it can lead to discomfort or distress, which is referred to as gender dysphoria (DSM-5).
- The WMA affirms that, in general, any health-related procedure or treatment related to an individual’s transgender status, e.g. surgical interventions, hormone therapy or psychotherapy, requires the freely given informed and explicit consent of the patient.
- The WMA urges that every effort be made to make individualised, multi-professional, interdisciplinary and affordable transgender healthcare (including speech therapy, hormonal treatment, surgical interventions and mental healthcare) available to all people who experience gender incongruence in order to reduce or to prevent pronounced gender dysphoria. [...]
The World Professional Association for Transgender Health (WPATH) is an international, interdisciplinary, professional association devoted to the understanding and treatment of individuals with Gender Dysphoria (GD). Founded in 1979, and currently with over 1500 medical, mental health, social scientist, and legal professional members, all of whom are engaged in clinical practice and/or research that affects the lives of transgender and transsexual people, WPATH is the oldest professional association in the world that continuously has been concerned with this clinical specialty.
Recognized by the AMA as "leading international, interdisciplinary professional organization devoted to the understanding and treatment of gender identity disorders," WPATH issues the widely followed Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People.
"The WPATH Board of Directors urges health insurance carriers and healthcare providers in the United States to eliminate transgender or transsexual exclusions from their policy documents and medical guidelines, and to provide coverage for transgender patients; also to include in their policy documents and medical guidelines the medically prescribed sex reassignment or gender affirming/confirming services necessary for subscribers’ treatment and well-being; and to ensure that ongoing healthcare, both routine and specialized, is readily accessible and affordable to all their subscribers on an equal basis."