The latest Standards of Care, issued in 2022 by the World Professional Association for Transgender Health, designate facial masculinization surgery (FMS) as beneficial for some people. Yet health insurance carriers have not adjusted coverage policies, despite growing public interest in FMS. We review the current state of insurance coverage and geographic availability of FMS in the United States. Efforts should be made to expand insurance coverage, alongside other measures to improve access. Designating FMS as a medically necessary intervention eligible for coverage by both public and private insurance carriers is likely to reduce inequities in access to transmasculine care.
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References
1.
ColemanE, RadixAE, BoumanWP, et al.Standards of care for the health of transgender and gender diverse people, version 8. Int J Transgend Health2022;23(Suppl 1):S1–S259; doi: 10.1080/26895269.2022.2100644
2.
MorrisonSD, SatterwhiteT. Lower jaw recontouring in facial gender-affirming surgery. Facial Plast Surg Clin North Am2019;27(2):233–242; doi: 10.1016/j.fsc.2019.01.001
3.
GuiL, HuangL, ZhangZ. Genioplasty and chin augmentation with Medpore implants: A report of 650 cases. Aesthetic Plast Surg2008;32(2):220–226; doi: 10.1007/s00266-007-9106-6
4.
DefreyneJ, MotmansJ, T’sjoenG. Healthcare costs and quality of life outcomes following gender affirming surgery in trans men: A review. Expert Rev Pharmacoecon Outcomes Res2017;17(6):543–556; doi: 10.1080/14737167.2017.1388164
5.
SwanJ, PhillipsTM, SandersT, et al.Mental health and quality of life outcomes of gender-affirming surgery: A systematic literature review. J Gay Lesbian Ment Health2023;27(1):2–45; doi: 10.1080/19359705.2021.2016537
6.
El-HadiH, StoneJ, Temple-OberleC, et al.Gender-affirming surgery for transgender individuals: Perceived satisfaction and barriers to care. Plast Surg (Oakv)2018;26(4):263–268; doi: 10.1177/2292550318767437
HoffmanAF, LasproM, VerzellaAN, et al.Facial masculinization surgery: An analysis of interest trends using search term analysis. Ann Plast Surg2024;92(1):5–8; doi: 10.1097/SAP.0000000000003707
9.
TebbensM, NotaNM, LibertonNPTJ, et al.Gender-affirming hormone treatment induces facial feminization in trans women and masculinization in trans men: Quantification by 3D scanning and patient-reported outcome measures. J Sex Med2019;16(5):746–754; doi: 10.1016/j.jsxm.2019.02.011
10.
MackenzieS, WilkinsonC. Morphological and morphometric changes in the faces of female-to-male (FtM) transsexual people. Int J Transgend2017;18(2):172–181; doi: 10.1080/15532739.2017.1279581
HarrisJ, PremaratneID, SpectorJA. Facial masculinization from procedures to payment: A review. LGBT Health2021;8(7):444–453; doi: 10.1089/lgbt.2020.0128
13.
DubovA, FraenkelL. Facial feminization surgery: The ethics of gatekeeping in transgender health. Am J Bioeth2018;18(12):3–9; doi: 10.1080/15265161.2018.1531159
14.
AzevedoRT, Diaz-SisoJR, AlfonsoA, et al.Re-cognizing the new self: The neurocognitive plasticity of self-processing following facial transplantation. Proc Natl Acad Sci U S A2023;120(14):e2211966120; doi: 10.1073/pnas.2211966120
15.
ZebrowitzLA, MontepareJM. Social psychological face perception: Why appearance matters. Soc Personal Psychol Compass2008;2(3):1497; doi: 10.1111/j.1751-9004.2008.00109.x
16.
SayeghF, LudwigD, AschaM, et al.Facial masculinization surgery and its role in the treatment of gender dysphoria. J Craniofac Surg2019;30(5):1339–1346; doi: 10.1097/scs.0000000000005101
17.
ChouDW, BrussD, TejaniN, et al.Quality of life outcomes after facial feminization surgery. Facial Plast Surg Aesthet Med2022;24(S2):S44–S46; doi: 10.1089/fpsam.2021.0373
18.
CapriniRM, OberoiM, DejamD, et al.Effect of gender-affirming facial feminization surgery on psychosocial outcomes. Ann Surg2023;277(5):e1184–e1190; doi: 10.1097/SLA.0000000000005472
19.
JamesJ, AmakiriUO, Contreras-CastroFG, et al.An evaluation of patient-reported appearance outcomes following facial feminization surgery in transgender women. Plast Reconstr Surg Glob Open2022;10(10S):122–123; doi: 10.1097/01.gox.0000898964.82428.cf
20.
Human Rights Campaign Foundation. An Epidemic of Violence 2022: Fatal Violence Against Transgender and Gender Non-Conforming People in the United States in 2022. Washington DC; 2022. Available from: https://reports.hrc.org/an-epidemic-of-violence-2022 [Last accessed: July11, 2024].
21.
ParkerAC, BrydgesHT, KimberlyLL, et al.Facing violence: The protective impact of facial gender-affirming surgery. Plast Reconstr Surg2022;150(4):934e–935e; doi: 10.1097/prs.0000000000009509
22.
HaucSC, MatejaK, LongA, et al.Limited access to facial feminization geographically despite nationwide expansion of other gender-affirming surgeries. Plast Reconstr Surg Glob Open2022;10(9):e4521; doi: 10.1097/gox.0000000000004521
23.
LaGuardiaJS, ChinMG, FadichS, et al.Medicaid coverage for gender-affirming surgery: A state-by-state review. Health Serv Res2024;59(6):e14338; doi: 10.1111/1475-6773.14338
24.
GorbeaE, GidumalS, KozatoA, et al.Insurance coverage of facial gender affirmation surgery: A review of Medicaid and commercial insurance. Otolaryngol Head Neck Surg2021;165(6):791–797; doi: 10.1177/0194599821997734
25.
AristizábalA, EscandónJM, CiudadP, et al.The limited coverage of facial feminization surgery in the United States: A literature review of policy constraints and implications. J Clin Med2023;12(16):5308; doi: 10.3390/jcm12165308
26.
PatelNN, GulatiA, KnottPD, et al.Facial masculinization surgery. Oper Tech Otolaryngol Head Neck Surg2023;34(1):69–73; doi: 10.1016/j.otot.2023.01.011
27.
KhouriAN, HaleyC, MacEachernM, et al.Current concepts in gender-affirming surgery postgraduate training. Indian J Plast Surg2022;55(2):129–138; doi: 10.1055/s-0042-1751021
28.
FinkelsteinE, HaM, NgaageL, et al.An overview of gender-affirming surgical fellowships in the United States. Plast Reconstr Surg Glob Open2022;10(10S):149–150; doi: 10.1097/01.GOX.0000899108.03250.1d
