Many surgeons require people who want to undergo gender reassignment surgery to live through a waiting period and to bring documentation from a therapist.
It’s impossible to know exactly how many transgender people want to have surgery to change their bodies and align with the gender with which they identify. But it’s not a stretch to guess that they are having trouble getting the procedure covered by their insurance company, or that they simply can’t find a doctor to do the surgery.
Therapists Julia Gottlieb and Jasper Liem work at Philadelphia’s Mazzoni Center and spend a lot of time helping transgender people navigate the sometimes rocky shore of gender reassignment.
Most surgeons require, at minimum, a letter from a licensed therapist confirming that the person requesting gender reassignment surgery has sought counseling and been deemed able to have the procedure. Surgeons in some states require people to have lived in the gender they intend to transition to for as long as two years.
Unfair, says Gottlieb.
“I see this as another way to marginalize a population,” she says. “If you think about it, there are a lot of plastic surgeons out there that trust that if somebody’s coming into their office and they’re saying, ‘Hey, I have agency over my body, I know what decisions I want to make to medically change my body’—like breast augmentation or rhinoplasty—that those surgeons are saying, ‘We need you to prove who you actually say you are.'”
Lieb says this double standard can put those hoping to transition in a precarious position.
“For trans folks, a lot of times, it’s not realistic to have that one year of living in the gender you identify as,” agrees Liem. “So, in plenty of states—Virginia, for example—you can still get fired for being trans. So even though we do see a lot of progress, that doesn’t necessarily mean we’re safe to follow those protocols.”
When pressed how she would solve this issue, Gottlieb simply responds that people should be able to make choices about their bodies freely.
“I’m a firm believer that a person is their own best expert,” she says.
In our interview with Julia Gottlieb and Jasper Liem, they mention the 2015 U.S. Trans Survey. If you want to participate, you can find it here.