Need help from transsexual DUers

[ayeshahaqqiqa]

I work for a non-profit health foundation. We have a demonstration clinic, and I'm the receptionist/bookkeeper/webmaster/whatever. A new patient is coming in who is transgender, and we are going to help that person in their transition from male to female via hormone treatments. The person identifies as female, and uses a female name, but that is not the name on her insurance, etc. If Doc orders lab, I know that I will need to put down the patient's birth name--but how do I identify her gender? I don't want to disrespect her, but I do want the lab results to come back without delay. The patient didn't know herself, as she's just started the process. Any help you can give me will be greatly appreciated.

[Hepburn]

1. I am not transgendered....but I am a retired lawyer and here is what I think:

Until the birth certificate is LEGALLY changed from M to F, the patient is legally male. Plus, unless there has been a LEGAL name change, the patient's name is whatever appears on the birth certificate ~~ I am assuming that is the name on the insurance card.

IMO, this is not a matter of offending anyone, but rather a matter of getting the necessary treatment. Use the legal info. One is a social issue and the other is getting things in legal order to get what is needed done.

JMHO

[ayeshahaqqiqa]

6. Thank you!

This is what I was thinking. And I don't think she (the patient) will be offended, but since she's just starting her transition, you never know. I can explain the legal issue, thanks to you, and I think she will understand.

Heck, she nearly cried on the phone when we said sure we'd treat her and were looking forward to meeting her. In Arkansas, there is a lot of prejudice.

[FreeState]

2. Can you include something like this on the forms?

Patient: Birth Name (Current Name)? That might help clear up some confusion and meet the requirements? Im not transgendered so hopefully someone else might know a better solution!

[ayeshahaqqiqa]

5. Thanks for the suggestion

Our clinic is small, and we won't have a problem with this--but we do send work out to labs that are pretty particular about things. We have other patients whose legal names are different than the ones they go by (I'm a prime example of that!) and we know who is who. But those labs are verrryyyy particular, and will hold up results for little things sometimes.

[XOEnterprises]

3. My gut says male.

She's still legally a male, and the records should be consistent until the birth certificate change. It could also have medical repercussions, too--I don't know much about it, but I would imagine lab techs might have to look for different things for males and females.

My boyfriend (FtM) says he wouldn't mind his doctor listing him as female when ordering tests, just as long as the doctor referred to him as male when they interact.

[ayeshahaqqiqa]

4. Thanks

I'm very comfortable referring to our patient as female--and I know Doc will do the same.

[readmoreoften]

7. My partner is about to transition (FTM). Heck, when you find out, please let me know.

We have no idea. Also, we have no idea what to do about passports, driver's licenses, and so forth.

Thanks for being considerate of the patient.

[ayeshahaqqiqa]

8. I'm thinking Hepburn gave good advice

You may wish to read her answer upthread. And best of luck to your partner on his transition!

[readmoreoften]

17. Unfortunately, in Texas changing birth certificates is a mess.

I expect that he's going to have to establish residency in another state and apply for a BC change there. In three states AND in 32 counties in Texas (just to make it confusing) a person cannot legally have their birth certificate changed since the jurisdictions insist that birth sex is confined to genetic test results (so many intersexed infants will grow up to fall into a caste of untouchables as well I suppose...) My partner will soon be in legal limbo. A male with a female drivers license and records. Changing jobs ain't gonna be easy it seems. Or buying beer.

Since many states seem to approve documentation change only after surgery, I'm not sure where he is going to go. Genital surgery/oopherectomy/hysterectomy would all be uncovered by insurance and together run close to $200,000 or more. Beyond that, very few transmen want genital reconstruction anyway.

Even if he gets his documentation in order, in 32 counties within the state we live he will be legally female while in the others he will be legally male.

[XOEnterprises]

19. Was he born in Texas?

Birth certificates are done by the state of birth. My friend had to go through California for his change, even though he lived in Washington at the time, and my guy has to go through NC even though he lives in SC now. But, because of S. Carolina's laws, Monte will be a male on his BC, but listed as a female named Monte on his driver's license.

[readmoreoften]

25. Yes, he's born in Texas. WTF. Is he going to be denied a safe driver's license and passport?

If his BC isn't changed, then will his SS card and passport be changeable? What sort of dark hell is this?

[sgsmith]

26. Why worry about changing birth certificate?

A US passport serves as a primary identification document for nearly all purposes. And the nice thing is, you can change the gender marker on a passport without changing a birth certificate. All it takes (she says sarcastically) is a surgeon's letter!

But remember, because of DOMA, and strangeness in how Texas applies laws, a gender marker change may not be enough to provide for marriage rights.

http:/policy.ssa.gov/poms.nsf/links/0100203215

Sex-Change Operation: The surgeon or attending physician must provide a letter verifying the sex change surgery has been completed. All documents must clearly identify the NH.

[XOEnterprises]

27. I don't know that much about it.

I just know that birth certificates are by state/county of birth, and driver's license is by residence. I don't know about passports. It really, really sucks, because all the laws are different in the states. For a driver's license change in Washington, all you need is a letter of intent and I think a letter from a doctor.

I can find the websites a friend sent to me for you, if you'd like.

[devinkay]

9. Tranny in da house

I was considered legally male until after my orchiectomy (castration), at which time I received letters from my surgeon, my endocrinologist, and my therapist declaring my intentions. At that point I was able to apply for a new state of Maine driver's license with F as my gender marker. I had to wait until after sex reassignment surgery before I could apply for a passport with the appropriate gender. Once that was done -- legal recognition at both state and federal levels -- it was merely a matter of paperwork to correct social security, insurance, etc. Florida, my birth state, won't amend gender on the birth certificate but will only attach an addendum.

My insurance didn't cover a cent of my transition costs, no labs, no hormones, no surgery. It was all out-of-pocket.

http://devinkay.com

[Duncan Grant]

10. Hi Devin, welcome to DU!

:hi:

[FreeState]

11. Hi and welcome!

Good to see you here - hope to see you around more!

Edit to add:

Thanks for the link to your site! Your a beautiful woman inside and out. This quote from you is very moving "You know how in your dreams you can levitate, or fly, or swim like a dolphin, how that feels? Every day feels like that to me now." I wish everyone could feel like that! :)

[devinkay]

16. Thanks!

Thanks, Duncan and FreeState! I don't post very often but I'm a long-time fan of DU. It's nice to be welcomed so kindly into the fold. Peace.

[readmoreoften]

18. Welcome! Please stick around! /nt

[ayeshahaqqiqa]

20. Welcome!

thanks for this information. It is very useful. :hi:

[queerart]

23. I Very Much Enjoyed Your Website, & Photos....

Many Thanks For Posting The Link........

[Duncan Grant]

12. I was going to suggest the Transgender Law Center.

The Transgender Law Center would probably be happy to work with your agency. They have great healthcare resources (actually, they have great resources - period).

:hi:

[Hepburn]

13. Good link for medical providers on issues and others on legal issues...

... welcome to the DU. :hi:

Thanks for posting!

[ayeshahaqqiqa]

21. VERY good link!

Thanks for sharing!

[sgsmith]

14. This is what I do

I'm transitioning. Right now I have not changed my legal male name, and needless to say, the gender marker is still male. Since the employer and their agents (ie insurance) has all this information in the damn computers, I'm not going to go confuse the databases.

However, I do ask the offices to refer to me in my female name. Which without exception, everyone has been happy to do. Many of the medical offices has offered to change my name, but until that's a legal change, I graciously decline their offer.

And really, the gender marker isn't as important as you think it might be. I've been to my primary doctor a couple of times over the last few months with various sleep and fatigue type issues. Blood was drawn a few days ago for regular screens (sugar, HDL, thyroid) and I asked them to include estrogen levels. When I saw my doctor yesterday, the nurse started running down the standard health questions like do you smoke or drink.

Then she asked me if I've ever been pregnant. I can honestly answer that one as "No". Then she asked me when I last had a Pap Exam. Errr - "never" was not an expected answer.

If she has good insurance, they should cover Estradiol. Patches and shots seems to be the safest method of administration. However, my insurance did catch the Rx and flagged it as inappropriate. A nice chat with an agent and the issue was resolved.

Some advice to your patient
1. Be the best woman you can be. Dress appropriately, act appropriately.
2. A smile and humor can go a long way to alleviate the concerns of others. Most people have never knowingly met a transgendered person. We're not all like the guests on Springer.
3. Start on electrolysis yesterday. You can always go through life as a beardless man. But going through life as a bearded woman is near impossible.

[bicentennial_baby]

15. Welcome to DU

:)

[ayeshahaqqiqa]

22. Good ideas

I haven't met her yet, but I know she has Suggestion 2 down pat.

[LeftHander]

24. Ask her....if she prefers female pronouns...

Make notes on records that patient is transitioning M2F...

Is named Frank but identifies as female and prefers Betsy..

Lab results can be tricky because test get run based on gender....make sure the instructions are clear. Tell docs and techs...YES you are testing this "male" patient for estrogen levels....

My docs basically ignore my requests. And I get no coverage from my insurance.

They say "Him" and "He" despite repeated requests otherwise...

(Hell I even trip up with that.)

Had a chest MRI and was called "Abnormal"...

Though the MRI techs upon exposing my chest figured it out...and used she and her...(that was nice...)

[Ian David]

28. Render unto Caesar that which is Caesar's.

Render unto thy insurance companie that which they needeth to process ye paperworke.