American Medical Association
The American Medical Association (AMA), founded in 1847 and incorporated 1897, is the largest association of physicians and medical students in the United States. The AMA's mission is to promote the art and science of medicine for the betterment of the public health, to advance the interests of physicians and their patients, to promote public health, to lobby for legislation favorable to physicians and patients, and to raise money for medical education.
- 1 2008
- 2 American Medical Association House of Delegates Resolution: 122 (A-08)
- 3 References
- 4 Relevant AMA policy
- 5 See also
- 6 Discuss
On June 1, 2008 the AMA passed a resolution affirming the medical necessity of treating gender identity disorders and supporting its coverage by health insurance plans. While this has no immediate or coercive effect on the coverage of transitional expenses by health insurance companies, the resolution will carry a great deal of weight in the future when legislative bodies deliberate whether to include the denial of coverage as part of the anti-discrimination laws protecting trans people. The entire text of the resolution is below.
American Medical Association House of Delegates Resolution: 122 (A-08)
|Introduced by:||Resident and Fellow Section, Massachusettes Medical Society, California Medical Association, Medical Society of the State of New York|
|Subject:||Removing Financial Barriers to Care for Transgender Patients|
|Referred to:||Reference Committee A|
1 Whereas, The American Medical Association opposes discrimination on the basis of
2 gender identity and
4 Whereas, Gender Identity Disorder (GID) is a serious medical condition recognized as
5 such in both the Diagnostic and Statistical Manual of Mental Disorders (4th Ed., Text
6 Revision) (DSM-IV-TR) and the International Classification of Diseases (10th Revision),
7 and is characterized in the DSM-IV-TR as a persistent discomfort with one's assigned
8 sex and with one's primary and secondary sex characteristics, which causes intense
9 emotional pain and suffering; and
11 Whereas, GID, if left untreated, can result in clinically significant psychological distress,
12 dysfunction, debilitating depression and, for some people without access to appropriate
13 medical care and treatment, suicidality and death; and
15 Whereas, The World Professional Association For Transgender Health, Inc. (â€œWPATHâ€)
16 is the leading international, interdisciplinary professional organization devoted to the
17 understanding and treatment of gender identity disorders, and has established
18 internationally accepted Standards of Care for providing medical treatment for people
19 with GID, including mental health care, hormone therapy and sex reassignment surgery,
20 which are designed to promote the health and welfare of persons with GID and are
21 recognized within the medical community to be the standard of care for treating people
22 with GID; and
24 Whereas, An established body of medical research demonstrates the effectiveness and
25 medical necessity of mental health care, hormone therapy and sex reassignment
26 surgery as forms of therapeutic treatment for many people diagnosed with GID; and
28 Whereas, Health experts in GID, including WPATH, have rejected the myth that such
29 treatments are â€œcosmeticâ€ or â€œexperimentalâ€ and have recognized that these treatments
30 can provide safe and effective treatment for a serious health condition; and
32 Whereas, Physicians treating persons with GID must be able to provide the correct
33 treatment necessary for a patient in order to achieve genuine and lasting comfort with
34 his or her gender, based on the person's individual needs and medical history; and
36 Whereas, The AMA opposes limitations placed on patient care by third-party payers
37 when such care is based upon sound scientific evidence and sound medical opinion;
1 Whereas, Many health insurance plans categorically exclude coverage of mental health,
2 medical, and surgical treatments for GID, even though many of these same treatments,
3 such as psychotherapy, hormone therapy, breast augmentation and removal,
4 hysterectomy, oophorectomy, orchiectomy, and salpingectomy, are often covered for
5 other medical conditions; and
7 Whereas, The denial of these otherwise covered benefits for patients suffering from GID
8 represents discrimination based solely on a patient's gender identity; and
10 Whereas, Delaying treatment for GID can cause and/or aggravate additional serious and
11 expensive health problems, such as stress-related physical illnesses, depression, and
12 substance abuse problems, which further endanger patients' health and strain the health
13 care system; therefore be it
15 RESOLVED, That the AMA support public and private health insurance coverage for
16 treatment of gender identity disorder (Directive to Take Action); and be it further
18 RESOLVED, That the AMA oppose categorical exclusions of coverage for treatment of
19 gender identity disorder when prescribed by a physician (Directive to Take Action).
Fiscal Note: No significant fiscal impact.
- AMA Policy H-65.983, H-65.992, and H-180.980
- Diagnostic and Statistical Manual of Mental Disorders (4th ed.. Text revision) (2000) (â€œDSM-IV-TRâ€), 576-82, American Psychiatric Association; International Classification of Diseases (10th Revision) (â€œICD-10â€), F64, World Health Organization. The ICD further defines transsexualism as â€œ[a] desire to live and be accepted as a member of the opposite sex, usually accompanied by a sense of discomfort with, or inappropriateness of, one's anatomic sex, and a wish to have surgery and hormonal treatment to make one's body as congruent as possible with one's preferred sex.â€ ICD-10, F64.0.
- DSM-IV-TR, 575-79
- Id. at 578-79.
- World Professional Association for Transgender Health: http://www.wpath.org. Formerly known as The Harry Benjamin International Gender Dysphoria Association.
- The Harry Benjamin International Gender Dysphoria Association's Standards of Care for Gender Identity Disorders, Sixth Version (February, 2001). Available at http://wpath.org/Documents2/socv6.pdf.
- Brown G R: A review of clinical approaches to gender dysphoria. J Clin Psychiatry. 51(2):57-64, 1990. Newfield E, Hart S, Dibble S, Kohler L. Female-to-maletransgender quality of life. Qual Life Res. 15(9):1447-57, 2006. Best L, and Stein K.(1998) â€œSurgical gender reassignment for male to female transsexual people.â€ Wessex Institute DEC report 88; Blanchard R, et al. â€œGender dysphoria, gender reorientation, and the clinical management of transsexualism.â€ J Consulting and Clinical Psychology. 53(3):295-304. 1985; Cole C, et al. â€œTreatment of gender dysphoria (transsexualism).â€ Texas Medicine. 90(5):68-72. 1994; Gordon E. â€œTranssexual healing: Medicaid funding of sex reassignment surgery.â€ Archives of Sexual Behavior. 20(1):61-74. 1991; Hunt D, and Hampton J. â€œFollow-up of 17 biologic male transsexuals after sex-reassignment surgery.â€ Am J Psychiatry. 137(4):432-428. 1980; Kockett G, and Fahrner E. â€œTranssexuals who have not undergone surgery: A follow-up study.â€ Arch of Sexual Behav. 16(6):511-522. 1987; Pfafflin F and Junge A. â€œSex Reassignment. Thirty Years of International Follow-Up Studies after Sex Reassignment Surgery: A Comprehensive Review, 1961-1991.â€ IJT Electronic Books, available at http://www.symposion.com/ijt/pfaefflin/1000.htm; Selvaggi G, et al. â€œGender Identity Disorder: General Overview and Surgical Treatment for Vaginoplasty in Male-to-Female Transsexuals.â€ Plast Reconstr Surg. 2005 Nov;116(6):135e-145e; Smith Y, et al. â€œSex reassignment: outcomes and predictors of treatment for adolescent and adult transsexuals.â€ Psychol Med. 2005 Jan; 35(1):89-99; Tangpricha V, et al. â€œEndocrinologic treatment of gender identity disorders. â€ Endocr Pract. 9(1):12-21. 2003; Tsoi W. â€œFollow-up study of transsexuals after sex reassignment surgery.â€ Singapore Med J. 34:515-517. 1993; van Kesteren P, et al. â€œMortality and morbidity in transsexual subjects treated with cross-sex hormones.â€ Clin Endocrinol (Oxf). 1997 Sep;47(3):337-42; World Professionals Association for Transgender Health Standards of Care for the Treatment of Gender Identity Disorders v.6 (2001).
- The Harry Benjamin International Gender Dysphoria Association's Standards of Care for Gender Identity Disorders, at 18.
- AMA Policy H-120.988
Relevant AMA policy
H-65.983 Nondiscrimination Policy
The AMA opposes the use of the practice of medicine to suppress political dissent wherever it may occur. (Res. 127, A-83; Reaffirmed: CLRPD Rep. 1, I-93; Reaffirmed: CEJA Rep. 2, A-05)
H-65.992 Continued Support of Human Rights and Freedom
Our AMA continues (1) to support the dignity of the individual, human rights and the sanctity of human life, and (2) to oppose any discrimination based on an individual's sex, sexual orientation, race, religion, disability, ethnic origin, national origin or age and any other such reprehensible policies. (Sub. Res. 107, A-85; Modified by CLRPD Rep. 2, I- 95; Reaffirmation A-00; Reaffirmation A-05)
H-180.980 Sexual Orientation as Health Insurance Criteria
The AMA opposes the denial of health insurance on the basis of sexual orientation. (Res. 178, A-88; Reaffirmed: Sub. Res. 101, I-97)
H-120.988 Patient Access to Treatments Prescribed by Their Physicians
The AMA confirms its strong support for the autonomous clinical decision-making authority of a physician and that a physician may lawfully use an FDA approved drug product or medical device for an unlabeled indication when such use is based upon Resolution: 122 (A-08) sound scientific evidence and sound medical opinion; and affirms the position that, when the prescription of a drug or use of a device represents safe and effective therapy, third party payers, including Medicare, should consider the intervention as reasonable and necessary medical care, irrespective of labeling, should fulfill their obligation to their beneficiaries by covering such therapy, and be required to cover appropriate â€œoff-labelâ€ uses of drugs on their formulary. (Res. 30, A-88; Reaffirmed: BOT Rep. 53, A-94; Reaffirmed and Modified by CSA Rep. 3, A-97; Reaffirmed and Modified by Res. 528, A- 99; Reaffirmed: CMS Rep. 8, A-02; Reaffirmed: CMS Rep. 6, A-03; Modified: Res. 517, A-04)
- World Professional Association for Transgender Health, the successor to HBIGDA
- Standards of Care for Gender Identity Disorders
- AMA Resolution 122 (A-08)
- Harry Benjamin International Gender Dysphoria Association
- The American Medical Association Homepage
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