Art of Transliness

Zak: First off, I love your tumblr name (huge doctor who fan). But anyway, down to business. The best thing to do is to get in contact with your insurance provider. Someone at the school should be able to help you with this (maybe at the health center or business office). If I were you I wouldn’t elaborate on your situation if you can avoid it because sometimes insurance will cover certain medications but not for off-label use (which is what ftm transition would be). Just straight-up ask if your plan covers prescribed hormones.

What I did was I looked up my plan online and saw that they covered testosterone. I have a fairly major insurance provider (blue cross, blue shield) and so this was easier for me than it might be for you. It took a bit of looking, but I finally found it on a list of specific medications they cover (I had to know the name brand). Anyway, Walgreens also did a good bit of investigative work for me, calling the company and making sure I got a good deal. This has happened for me at multiple Walgreens stores in two different states (Missouri and Florida) so I’m pretty impressed with Walgreens as a chain in general. You may even be able to go in there and ask them this question before you get your script filled. 

Good luck and hope you’re able to get your T covered!

Adrian here: SO! I am sitting next to my mother who is the director of operations of MY health insurance and this is what she said. You can either 1) Call the number on your insurance card to find out the number of the Pharmacy Benefit Manager (PBM) your card may even list it specifically. Call your PBM and they should know. OR 2) Take it to a Pharmacy - you’ll do well to go to a major pharmacy like CVS or Walgreens (not a little local pharmacy OR Walmart, mom said Walmart is BAD) And ask them to fill it. They, right there in the store, will dial into the PBM system and determine your eligibility right on the spot. They have to do this so they know what to charge you. You can ask them the amount of the script before they even fill it! There are only like three major PBMs in the country, Caremark, Express Scripts, and the other one my mom can’t think of - but this could even be labeled on your card as well (some times you’ll have a separate card for this).

I hope this helps!

Yeah I was born in Lincoln. So there are conflicting answers to this and I’ll tell you what I know from my experiences.

Driver’s License: You need a letter from an M.D. or Ph.D. saying that you’ve undergone irreversible therapy. Ryan Sallans designed the paperwork (I think) for this process to be especially vague. I had my endocrinologist sign this paperwork for  me and I got my gender changed on my license like a year ago. The paperwork for that is on the DMV website. You’ll take this paperwork to your local DMV, get your picture taken again, and pay for a new license.

Top surgery doesn’t actually count for anything in the state of Nebraska because some asshole decided to protest the notion that top surgery is irreversible, saying that we could always get implants. So top surgery alone means nothing.

Birth Certificate: to have your gender marker changed on your birth certificate, you have to have “irreversible sex reassignment surgery” and in the eyes of the people of Nebraska, this means a hysterectomy. For a while maybe five or six years ago guys were able to get Dr. Johnson, the top surgeon out of Omaha, to write them a letter for this purpose and it worked out fine, that is until the definition of irreversible became more strict. NOW top surgery will not suffice. Only a hysterectomy will these days.

Social Security: I attempted to change my gender at social security after having had top surgery in November but they wouldn’t let me. I am unsure if this is because of the part of the country I was in (rural Missouri) or if, like for the birth certificate at a state level, you need to have had “irreversible sex reassignment surgery” in the form of a hysterectomy to change it at the federal level.

So that’s the long form.

I guess the short form could kind of go like this:

Driver’s License: you (probably) have to be on Testosterone to get your gender changed here, unless you can find an MD or PhD that will do the paperwork for you without you being on it.

Birth Certificate: You have to have a hysterectomy in the state of Nebraska.

Social Security: You MIGHT get by with top surgery, but you might also need to have a hysterectomy for this to be changed.

Any of our followers have experience with changing the gender marker at social security?

Zak: I don’t know of anyone personally, and the blog I followed that was written by someone in a similar situation was recently deleted : ( 

Hopefully someone out there knows of someone and will respond to this. Please? 

Zak: Just a guess, but your binder is probably too big. 

Adrian here, and I am unsure of the incidence of transguys getting hysterectomies. I actually think a fair amount do end up getting the procedure done, but those guys are older/longer on T (aren’t on tumblr). There are a couple of benefits to having the procedure done:

1) Some states require it as THE gender reassignment surgery, where an irreversible surgery was done (these states do not allow the double mastectomy, or top surgery, to be defined as irreversible and therefore that surgery does not qualify it for gender reassignment surgery). And without this surgery - you cannot change your gender marker on your birth certificate.

2) Some guys have large medical issues with their reproductive organs. Be it ovarian cysts, wacky hormone imbalances, whatever - they get the procedure because it’s medically advised that they do.

3) When you don’t have your female reproductive parts, you no longer have competing hormones because you no longer are making large amounts of estrogen and progesterone. This means that testosterone is THE sex hormone in your body, and you will no longer have to take as much testosterone as you had to before the procedure.

4) Having this procedure drastically reduces your risks for estrogen related cancers and other cancers of the female reproductive organs. While many transguys kind of ignore this part of their internal anatomy - that doesn’t mean that your health risks associated with having these organs disappears. Having a hysterectomy is actually a big high-five to preventative care.

I am sure there are a lot of other reasons guys get the procedure as well, these are just the first things that come to mind.

As to why it isn’t more popular? Hmm…

I want to say that it’s because it’s so expensive, but 9 times out of 10 it’s covered by insurance…

Honestly I am unsure how far ahead some guys are thinking in terms of their transition. It could be that some guys want to leave doors open in terms of possibly having biological children. Or even leave the door open in terms of a possible de-transition. It is a scary thing because it is permanent - there’s no going back - you are effectively sterilizing yourself, and that’s kind of hard to swallow. Not only are you sterilizing yourself but you are committing to a life of exogenous hormones, be it testosterone OR estrogen. All of these things need to be taken into consideration.

The second question was tricky and all I can do is speculate.

I hope this helps!