San Francisco's foray into paying for sexual reassignment surgery for the poor and uninsured is so far a success, officials said.

Fifteen people have had sexual reassignment surgeries paid for by The City in the last nine months, when the Department of Public Health started covering the once-controversial procedures.

Insurance providers in California have been required to pay for gender reassignment surgery since last year.

However, San Francisco remains the only city in the state to cover gender reassignment surgery for the poor and uninsured with gender identity disorder. Gender identity disorder, or gender dysphoria, is the condition where a person does not identify with the sex with which they were born.

San Francisco has set aside $300,000 to cover sexual reassignment surgery for the uninsured this fiscal year, which runs from July 1 through June 30. There is also $500,000 in the budget for next year.

A total of 87 people without health insurance have entered the program, according to Barry Zevin, who heads the Transgender Health Project in the health department. About “five to 10” new requests are received each month, he said — and at a negligible cost.

The City provides chest and breast procedures at San Francisco General Hospital, but it has contracted out with a pair of private surgeons to provide genital procedures.

New patients usually receive hormone therapy for a year as well as regular counseling before electing for surgery. It is unclear how may of the 87 people in the program will take the final step of undergoing surgery.

Health department officials are also uncertain if the number of people seeking surgery will remain steady, or if they are representative of a “backlog” of patients who have been waiting for years for the procedure.

About 0.3 percent of people in America are estimated to be transgender. In San Francisco, the figure is higher but probably no bigger than 1 percent, Zevin said.

Only about “a dozen” surgeons in the entire country perform sexual reassignment surgery. Zevin has heard stories of patients in California having to “resort to legal help” in order to compel their insurance company to cover the surgery.

San Francisco was the first municipality in the country to cover sexual reassignment surgery for its employees, a change that was made in 2001.

The progress made today would have been “unimaginable” 10 years ago when the only feasible option for gender assignment surgery required a flight to Thailand, according to the Transgender Law Center's Anand Kalra, but there's still more The City can do.

Procedures like electrolysis for facial hair follicles and mammoplasty — viewed as “cosmetic” surgeries but often the final step towards acceptance in a new gender — are not yet covered.

Still, “just knowing that this is an option and is now acceptable is nothing short of life-changing,” said Royce Lin, an HIV physician and transgender specialist. “It's this kind of thing that makes me proud to be a San Franciscan.”

Bay Area NewsSan Francisco Department of Public HealthSan Francisco General HospitalTransgender Health Project

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