Shane Stinson said he feels frustrated because transgender people need to have money to validate their identity. Courtesy Rob Lindsey

He looked to his insurance company and found not only no financial support but no understanding.

“The way that I’ve felt is helpless,” Stinson said of his experience in navigating his insurance policy. “Because my needs are less of an issue because you don’t want to take the time to understand it.”

“The majority of private and public insurance companies have discriminatory exclusions to our health care, even though the medical community has said it is medically necessary,” said Dru Levasseur, a lawyer with the LGBT advocacy organization Lambda Legal.

“Someone has to do something.”

A few changes have been made in policy, at least regarding public insurance. At the end of May, the Obama administration lifted the 33-year ban on gender reassignment surgery coverage through Medicare. While Medicare covers people 65 or older or on disability, the decision is expected to influence other insurance providers to cover transgender-related surgeries. The Affordable Care Act prohibits discrimination based on gender identity, but some in the transgender community have taken issue with the fact that the law leaves defining discrimination to individual states.

But in the meantime, Stinson, like many, is left feeling that a medical transition is something only the wealthy can undertake.

“If you are not affluent or don’t have the resources to pull from, a medical transition is nearly impossible,” he said. “The fact you have to have money to feel validated in your identity …”

He trailed off, unable to find the words.

The vast majority of the medical community has come out in support of the removal of financial barriers to transgender health needs. The American Medical Association’s policy is that the “AMA supports public and private health insurance coverage for treatment of gender identity disorder as recommended by the patient’s physician.”

Those last words are key, Levasseur said. Gender identity disorder, commonly called gender dysphoria these days, has no set manifestation. The identity and subsequent needs vary from individual to individual. Stinson needs hormone treatment and reconstructive surgery on his chest to feel validated. Another transgender man might have other needs entirely.

“There’s this idea that there is the magical formula to transition,” Levasseur said. “It is an individualized process, and that’s the doctor’s determination of medical necessity.”

The problem is that many insurers, private and public, have long considered these operations cosmetic.

“That is where the ignorance lies,” Levasseur said. “In the meantime, people are really suffering,”

He went on to describe hearing stories of attempted self-castrations after some individuals felt they have run out of options. A 2014 survey found that transgender individuals report an attempted suicide rate of 41 percent.

“These exclusions will be a dark point in LGBT history,” Levasseur said.