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Thursday, May 2, 2013

Anonymous asked: The Yale Health SRS says "medically necessary": what does that mean? Does it really cover trans people?

Great question! Yale’s recent decision to cover gender confirmation surgery in its student health plan is indeed a move to be inclusive of trans people.

The reason they use the phrase “medically necessary” is that being trans is currently pathologized, and access to hormone treatments and surgeries are regulated by the medical establishment. Being transgender is classified as Gender Identity Disorder (GID) by the American Psychological Association. There are lots of people who don’t think that being trans should be considered a mental disorder, much like how people fought to get homosexuality removed from the APA’s diagnostic manual of disorders in the 70s.

Right now, the medical community regulates access to trans-related hormone therapy and surgeries in a similar way to other types of medical care. A doctor won’t give someone heart surgery unless they’ve been diagnosed with a heart problem, and under current medical guidelines, a person can only receive gender confirmation surgery if they have a GID diagnosis - this is the “medical necessity.“

This is problematic because not every person who considers themselves trans or who wants surgery necessarily fits into the GID diagnostic criteria. There is a documented history of trans people giving doctors the narrative they want to hear rather than the truth in order to get a diagnosis and access hormones/surgery.

On the other hand, the “medical necessity” is useful in this current system to counter the argument that trans surgery is cosmetic, and shouldn’t be covered by insurance.

Yale HEALTH has not yet published its official eligibility guidelines for trans surgeries. When I spoke with members of its Care Management department, they said the guidelines will be based on the recommendations of the World Professional Association for Transgender Health (WPATH), and that treatment decisions will be made with patients on a case-by-case basis. The guidelines will likely require a mental health assessment, and a period of being on hormone therapy and/or living in the desired gender role. We will publish the guidelines once they are released.

Thanks again for your question, Anon. If anyone has additional knowledge or opinions about this topic, feel free to submit them as asks or reblog with commentary!


Thursday, November 29, 2012

Anonymous asked: This is going to sound ridiculous, but I'm "well endowed" and my girlfriend and I have been having some problems with sex: namely, the condoms I use somehow manage to break very frequently (I've had a condom break maybe four times in the past month alone). I use large condoms and they fit fine, and I know I'm putting them on properly, so I think it may just be that we have sex for too long (usually around an hour) and the condoms just wear out… What should I do?

This isn’t a ridiculous question at all! “Different studies on latex condom breakage tend to reflect a breakage rate of around .4%, or only 4 breaks in every 1,000 uses.” There are a couple reasons for which condoms might break:

  1. Have you checked the expiration date?
  2. Leaving room in the tip? This is both for better fit, and it may be more comfortable!
  3. Using enough lubricant? Plus, putting a drop or two of lube inside the condom, as well as more liberally on the outside, makes condoms feel a lot better, too. Just remember that oil-based lubes or oils, lotions or vaseline are NOT okay to use with latex condoms.
  4. Are you or your partner hanging around after ejaculation or starting intercourse again without changing condoms?
  5. Don’t forget about the female condom!
  6. Here is some more information from Scarleteen, which we always find to be super helpful. Have you also tried switching brands? Good luck!

    - SeLF

    For some more answers, click here!