Gender dysphoria can be a difficult feeling to explain to another person. But when Carolyn Ward senses the prickle of hair on her face, a sensation takes over: a deep self-loathing or disgust – an oppressive anxiety.
The facial hair is a constant reminder the gender she was assigned at birth doesn’t align with her sense of who she is.
Growing up in Kentucky, Ward didn’t have a clear understanding of why she felt different or why she buried herself in video games, often avoiding her peers and much of society. It wasn’t until her 20s – and a severe mental health breakdown in college – that she started to understand that she was assigned the wrong gender at birth.
Now, in her late 20s and living in Eugene, Ward said she has a lot more clarity about why she was so depressed. She’s in a better place now, both physically and emotionally, but her transition is not over.
“Getting electrolysis and not having the constant drain on me every single day, to be at peace and have comfort with that part of my body would help so, so much,” she said.
While states across the country are considering ways to limit gender-affirming care or prevent insurance coverage from paying for it, a bill in the Oregon Legislature would require Medicaid and private insurers to expand coverage of gender-affirming care to include laser hair removal and facial feminization surgery. The measure, House Bill 2002, also aims to protect access to abortions and protect providers from legal repercussions for providing reproductive care.
So far, it’s proven to be the most emotionally-charged measure of the 2023 legislative session. In a nearly five-hour hearing last week, the topic of gender-affirming care emerged as the biggest wedge issue.
“I hear a panic that we are opening up the gates, allowing young patients to come in and cajoling them and pressuring them to start pubertal suppression and pursue surgical procedures,” Dr. Christina Milano, a doctor who provides such care at Oregon Health & Science University, said in testimony.
She added that her team always works with a coalition of providers that also includes endocrinologists and psychologists. “Our teams work with exquisite caution and thoughtfulness,” she said.
Milano said surgery is reserved for a small population.
Since 2015, the Oregon Health Plan and private insurance have been required to cover many gender-affirming medical care, including hormone treatment and some surgeries. This measure would expand the list of what is covered.
The transgender community in the United States is estimated to include 1.3 million adults. A Washington Post-Kaiser Family Foundation poll released this week showed most people who identify as trans said their lives have improved post-transition. But what that means also looks very different person to person.
There is a social transition, such as changing names, clothing and outward appearance. Some people, like Ward, have used hormone replacement therapies to help with their transition, but far fewer, only about 1 in 6 people, have had surgery to alter their appearance, according to the poll.
The American Medical Association wrote that “evidence has demonstrated that forgoing gender-affirming care can have tragic consequences” and said prohibiting such treatment can harm people’s mental and physical health.
A similar measure to the one under consideration in Oregon passed the Washington Legislature and took effect in January 2022. Public and private insurers in Washington are now required to cover gender-affirming treatments, such as counseling, voice therapy and puberty blockers.
For Ward, of Eugene, the ability to transition has allowed her to start her life.
“I think it’s important for me to say that gender-affirming care is lifesaving care,” she said. “I wouldn’t be here today without it, and it’s allowed me to start living in the real world rather than hiding in it.”