Gender reassignment surgery still rare in CT

This 2015 image provided by courtesy of E! shows Caitlyn Jenner in the first official promotional trailer for the new documentary series, "I Am Cait," in Malibu, Calif. This 2015 image provided by courtesy of E! shows Caitlyn Jenner in the first official promotional trailer for the new documentary series, "I Am Cait," in Malibu, Calif. Photo: E!, Via AP Photo: E!, Via AP Image 1 of / 5 Caption Close Gender reassignment surgery still rare in CT 1 / 5 Back to Gallery

Though born male, Rudy never felt as though that was who she really was, not even as a child.

"I always identified as female," said the Connecticut resident, who asked that her real name not be used. "All of my friends were girls. I was not interested in anything my brother was interested in. I remember seeing girls in their Brownie uniforms and think `Damn, I don't want to wear a suit and tie. That's not me.' "

Rudy first dressed as a female when she was a college freshman, and began physically transitioning from male to female in her early 20s. By age 21, she'd had breast augmentation surgery and some facial surgery. By 23, she had gender reassignment surgery to become a woman.

But, like many transgender people in the state, she had to leave Connecticut to get the procedure. That's because few doctors in the state perform gender reassignment surgery, also known as "bottom surgery," in which the genitals are surgically changed from those of one gender to the other.

Slowly, that's starting to change. Yale-New Haven Hospital, for one, is starting a gender reassignment surgery program, involving professionals from a variety of disciplines, including urology, plastic surgery and mental health. Other places, including the Circle Care Center in Norwalk, offer other gender transition services, including hormone replacement therapy and counseling.

But for the most part, transgender people in the state looking to transition from one gender to another have to go elsewhere. Rudy, for example, had to travel to Florida. Gender reassignment programs also exist in such places as California, Montreal and Philadelphia.

The high-profile transition of the former Bruce Jenner -- an Olympic athlete who went to high school in Connecticut -- into Caitlyn Jenner has sparked a national conversation on the topic of gender reassignment. Many see the conversation as positive.

"This is great for the transgender population," said Dr. Stanton Honig, a urologist who is leading the program at Yale. "It gives them an opportunity to have a conversation about what they want to do."

More Information Fast facts on gender transformation

According to the National Center for Transgender Equality, there are about 700,000 transgender adults living in the United States.

Gender reassignment surgeries range in price from $15,000 to $50,000 for male to female surgeries and $50,000 to $100,000 for female to male surgeries.

The global consulting firm Mercer found that in 2014, 8 percent of all large employers provided coverage for gender reassignment surgery, up from 5 percent in 2013. However, only another 3 percent say they are considering covering the procedures.

It's unclear, however, whether this greater understanding could lead to greater availability of gender reassignment services.

"Nationally, there are going to be more centers, I think, over the next three to five years," he said. "(But) you really have to have a clinical interest in this field."

What is gender reassignment?

The national discussion on Jenner's transformation -- sparked by a recent Vanity Fair cover story -- has, among other things, raised a deceptively simple question: How easy is it to physically transition from one gender to another?

According to the National Center for Transgender Equality, there are about 700,000 transgender adults living in the United States. However, not all people who are transgender choose to medically change genders -- a complicated, and expensive process that involves multiple surgeries, possibly (but not always) including "bottom surgery."

Other elements involved in transitioning include hormone therapy and altering the face and chest to create a more feminine or masculine appearance.

Those changing from one gender to another can choose some or all of these options, but many adhere to a set of guidelines laid out by the World Professional Association for Transgender Health. These guidelines, called the standards of care, outline a variety of steps medical professionals advise people to take before medically changing genders.

These steps including dressing (and essentially living as) the target gender for at least a year, having hormone therapy for at least a year and getting a letter from a mental health professional stating that the patient is a good candidate for transitioning.

It's difficult to get hard numbers on exactly how many people have transitioned because "many procedures deemed necessary for transitioning already exist and are undergone by non-transgender people," said Vincent Villano, director of communications for the National Center for Transgender Equality.

Honig said it's both easier and less expensive to transition from male to female than to go from female to male. Depending on how involved the surgery is, Honig said, male to female surgery costs from $15,000 to $50,000, while female to male surgery can cost from $50,000 to $100,000.

Though costly, the surgery is covered by an increasing number of insurance companies. In a study released earlier this year, the global consulting firm Mercer found that in 2014, 8 percent of all large employers provided coverage for gender reassignment surgery, up from 5 percent in 2013. However, only another 3 percent say they are considering covering the procedures. Specific companies that cover the surgery, and some related services, include Aetna and Anthem Blue Cross Blue Shield.

Evolving options

Despite this progress, experts said there are still few places in Connecticut where people can access gender reassignment services.

Circle Care Center in Norwalk doesn't offer surgery, but does provide access to hormone therapy, mental health services and other help for those who are transitioning.

The majority of people who seek these services at Circle often have to travel out of state for surgery, said A.C. Demidont, who oversees transgender health care and other services at the center.

"It sucks for them," Demidont said of those who have to travel for their surgeries. "They have to go and stay in a hospital for a while" in a place they might not be familiar with.

Demidont wasn't aware of the growing program at Yale, but was pleased something was in the works.

Honig, who is trained in sexual and reproductive medicine, joined Yale about a year and a half ago. He has done a handful of male-to-female gender reassignment surgeries, and is hoping to offer a formalized surgical program at Yale within a few months.

In addition to offering surgeries, Honig also provides follow-up care to those who, like Rudy, have already had the surgery. Rudy said she was thrilled to know there was someone providing care in her own state.

"I know a lot of girls who can't afford to travel" for the surgery, she said.

Honig said, unlike the gay, lesbian and bisexual populations, which have made a lot of progress toward acceptance, "the transgender community has probably progressed the least. I think (Jenner) is going to bring this much more to the forefront."

Others aren't sure what the impact of Jenner's transition will be. "I think it's wonderful that she came out," Demidont said. "But how Caitlyn looks is not the norm" for those who have transitioned.

Rudy also had a mixed view on the potential impact of Jenner's transition. Though she, too, believed Jenner drew more attention to the issue, she pointed out that not all the attention is positive.

"It's a little disheartening," Rudy said. "You see a lot of people on social media making nasty comments about it. A lot of people aren't ready."