The remaining states, however, largely argued that such procedures — including genital reconstructive surgeries, mastectomies and facial contouring procedures — are cosmetic in nature and therefore not eligible for coverage. In those states, transgender individuals have to pay out of their own pockets for these procedures, which can cost tens of thousands of dollars.

A big part of the problem is a lack of public understanding, accompanied by a heavy dose of prejudice against transgender individuals. After Rochester, N.Y., announced that it would be offering transgender-inclusive health insurance options to city employees, two popular local radio hosts, Kimberly Ray and Barry Beck, launched into a 12-minute tirade, referring to transgender people as “nut jobs.” (To the station’s credit, they were quickly fired.) Even sympathetic liberals often wonder, quietly, why genital reconstructive surgery, hormone replacement therapy or a host of other procedures commonly sought by transgender individuals should be considered medically necessary rather than cosmetic.

Consensus in the medical community aside, those forms of treatment do so much more than alter one’s appearance. In early 2012, just before I came out as transgender, I found myself struggling to keep suicidal thoughts away. I’d attempted to end my life by overdosing on pills years earlier, and I felt that uncontrollable depression beginning to seep back into my life.

At the time, I was regularly meeting with a psychiatrist and had been prescribed a small pharmacy’s worth of antidepressants. None of it helped. I knew I had two choices: stop denying who I was or put an end to my life.

I came out as transgender shortly after, and while I felt a certain sense of relief in accepting my inner self, the thoughts of self-harm and desperation wouldn’t let up. I began to worry that I’d never be able to shake those feelings, and so that October, I began hormone replacement therapy — reducing my body’s testosterone output, increasing my body’s estrogen levels.