Art of Transliness

10 Common Myths About Medically Transitioning

*This post is most applicable to people in the United States, but can be useful to others who reside elsewhere*

1) Only an endocrinologist can write you a prescription for testosterone.

Why this is wrong: Your family doctor as well as your OB-GYN can also write you prescriptions for testosterone. Remember testosterone is a controlled substance, so in most states nurses cannot give authorization for testosterone, but basically any doctor can.

2) Insurance companies will not cover the costs of your medical transition.

Why this is wrong: While many Insurance companies do not cover the costs of medical transition, SOME do. This is something to ask your insurance company about. Zak’s testosterone is partially covered by insurance, for instance, while his top surgery was not covered at all. Adrian’s testosterone and surgeries (top and hysto) were both covered by insurance and they will also cover bottom surgery. Call your insurance company and ask if they specifically exclude transgender healthcare under your policy.

3) You cannot write off and claim deductions on your medical costs for tax purposes. 

Why this is wrong: Ever since the ruling in favor of O’Donnabhain v. Commissioner on Feb 2, 2010. Transgender individuals could begin claiming transition related medical deductions on their taxes. These transition related medical treatments include mental health therapy, hormones, and surgeries (they may not allow breast augmentations for MTF individuals due to their statement that estrogen allows breast tissue growth so an augmentation would be cosmetic). [From Ryan Sallans]

4) You have to be diagnosed with “GID” to get a prescription for testosterone. 

Why this is wrong: You do not need a formal diagnosis with “informed consent” which is now clinically acceptable across the United States as well as internationally as the Standards of Care have been updated to its most recent version, version 7.

5) You cannot have top surgery without having been on testosterone prior to your surgery date.

Why this is wrong: Many guys that we have known personally have gotten top surgery before being on T or have had top surgery without ever being on T at all. There are surgeons out there who will perform top surgery on guys who have not started or do not plan to start testosterone. It is no longer a requirement as the standards state that physicians should comply with the standards as individualized as possible and according to the patient.

6) Your body fat will not redistribute until you lower it to less than 4%.

Why this is wrong: Only in extreme cases will this prompt the stubborn fat to redistribute. Most guys experience the redistribution within the first 6months-1year on testosterone, and attribute the redistribution to testosterone. This is why many top surgeons performing the keyhole/peri procedure like to have their patients be on testosterone for at least 6mos before the surgery to have the fat redistributed and have the best results. Even so, some guys never lose fat in historically feminine places.

7) Top surgery and other gender-conforming surgeries are cosmetic.

Why this is wrong: It’s pretty plain and simple, both the American Medical Association along with the World Professional Association for Transgender Health (WPATH) and many others view transgender healthcare as medically necessary and non-cosmetic.

8) You no longer need gynecological exams once you start testosterone.

Why this is wrong: You need to get these check-ups as long as you have the parts they are checking up on! With these organs/parts you are still prone to all general medical issues concerning them, plus others as a result of long-term testosterone use. Get these exams done every year starting when you’re 20 or when you begin having sex!

9) You can put excess testosterone cream/gel topically on places that you want to masculinize i.e. your face for facial hair growth or your dick for downstairs growth.

Why this is wrong: The gel may be applied topically, but it works systemically so applying it somewhere for extra changes isn’t going to work. Testosterone does not act on local tissues, it is an endocrine hormone that is transported throughout the body via the bloodstream, it is an entire-body drug. 

10) You must go to a gender therapist in order to get surgery or hormones.

Why this is wrong: Gender therapists are actually just regular therapists who call themselves gender therapists either because they have experience with trans* patients or usually work with trans* patients, it is NOT an official title. Any therapist with a proper license (in the U.S. this means a Licensed Mental Health Practitioner L.M.P.H., a Ph.D., an M.D., and a D.O.) can write your letters for testosterone and surgery. Most, if not all, surgeons require a therapists letter of some sort, but not all places that prescribe hormones do (ask your doctor or clinic what their requirements are to see). Some physicians will accept letters from people with other degrees.