Matt Pasini was sitting in a therapist’s office with his parents just before his 15th birthday, a year after he first came out as trans, when he told them: “I can’t keep living like this.”
Pasini, who grew up in Queens, New York, was grappling with gender dysphoria, which the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-V), describes as a feeling of distress caused by identifying as a gender other than the one you were assigned at birth. That distress was getting worse with puberty: people misgendered him in public, he was self-conscious, and every month, his menstrual cycle would cause a mental crisis.
“It became a constant reminder that I was born in the wrong body and I didn’t have any control over that,” Pasini, now 19, told the NewsHour.
Puberty can cause enormous stress for transgender youth, adding to their already-high rates of anxiety and depression. But relief has come for some in the form of puberty blockers. Originally developed to allay early onset puberty, these drugs give transgender youths more time to decide how to move forward in their transition. Lupron and other puberty blockers are rarely covered by insurance for people under 18 — but in New York, that could change as early as December, potentially making a difference for trans youth in the state.
Along with his parents, therapist and doctor, Pasini, decided after that session that he would start Lupron, one of the most common puberty blockers. Pasini said he noticed a change in how he carried himself, how he interacted with others and how he felt about his body. “I didn’t have as much anxiety in school because of that, and I felt somewhat more comfortable in my body,” he said. “It made me feel a lot more confident. … It made me feel a lot less depressed about myself.”
For some, a ‘life-saving’ treatment
Twelve states and Washington, D.C., cover transition-related health care under Medicaid for transgender people. But most often, that coverage is for adults, so treatments that address gender dysphoria in children remains a gray area.
In 2014, Oregon became the first state to cover puberty blockers for youths under Medicaid, and California’s Department of Managed Health Care has also ordered insurers to cover care related to gender transition. But Dr. Johanna Olson-Kennedy, a pediatrician and medical director of the Center for Transyouth Health and Development at Children’s Hospital Los Angeles, said denials are still common.
New York is the latest state to grapple with the issue, with three recent court decisions extending Medicaid coverage to trans people. In March 2015, the New York State Department of Health announced that Medicaid could cover some “medically necessary” services, a common designation used by insurers. Four months later, U.S. District Judge Jed Rakoff ruled that Medicaid must also cover procedures the state had previously called “cosmetic,” including breast augmentation and tracheal shaving. However, these decisions still excluded coverage for people under 18 years old.
That changed in October of this year, when the New York State Department of Health filed a proposed rule that would extend its Medicaid coverage to treating gender dysphoria in individuals under 18. The department cannot officially adopt the rule until Dec. 5, after it has considered public comments. But the New York State Department of Health intends to move forward, according to a spokesman.
The recent change in New York “is a great thing for transgender young people,” Kim Forte of the Legal Aid Society said. Her group along with The Sylvia Rivera Law Project and Willkie Farr & Gallagher LLP brought a lawsuit against the New York State Department of Health in 2014 that resulted in New York’s expansions of Medicaid coverage for trans people.
“The truth of the matter is that this care can be life-saving for some people,” Forte said.
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