Transgender ‘tweaks’ like hair removal and voice feminization should be funded by the taxpayer

Minor aesthetic procedures for transgender individuals should be publicly funded, according to health officials in Canada. An editorial by doctors from the Canadian Medical Association (CMA) suggests treatments like hair removal and facial injectables should be paid for by the country’s Medicare, a publicly funded healthcare system.

‘Minimally invasive procedures such as facial injectables and hair removal warrant consideration for public health care funding across Canadian jurisdictions,’ wrote Dr Katie Ross and Dr Sarah Fraser, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia.

‘Public funding for such procedures, which are currently funded in only two jurisdictions in Canada, warrants serious consideration in all provinces and territories,’ the authors concluded.

Canada’s Medicare is funded and administered primarily by each of the country’s provinces and the programs receive assistance from the federal government.

Transgender influencer Dylan Mulvaney, 26, revealed the results of her facial feminization surgery after undergoing the procedure in December 2022 (pictured)

Transgender influencer Dylan Mulvaney, 26, revealed the results of her facial feminization surgery after undergoing the procedure in December 2022 (pictured)

‘I’m so happy, and it’s still me. It’s just a little bit softer of a version,’ Mulvaney said of her transformation. She is pictured here a few weeks before the procedure

'I'm so happy, and it's still me. It's just a little bit softer of a version,' Mulvaney said of her transformation. She is pictured here a few weeks before the procedure

The doctors from the article, published in the journal CMA, noted the added benefit of minimally invasive procedures being ‘relatively low risk and reversible’ compared to hormonal and surgical routes.

They can also be performed by a wide range of physicians.

Unlike Canada, the US does not provide universal healthcare to all of its citizens. Instead, most people are insured by private insurance companies or a combination of private and federal or state programs.

Policies concerning healthcare coverage of gender-affirming care or more minor feminizing procedures, sometimes called facial feminization surgery (FFS), vary from policy to policy. However, if the US were to follow the guidelines suggested in the CMA article, people enrolled in America’s government health insurance programs would have their FFS procedures covered and would not have to pay for it themselves.

Government-funded health insurance includes Medicare, Medicaid, TRICARE, Veterans Health Administration and State Children’s Health Insurance Program.

Waiting lists for more invasive procedures such as chest surgeries and genital reconstruction are, on average, around four years in the US, but minimally invasive procedures could ‘help compensate for delays,’ the CMA article authors argue.

Currently in the US, a self-pay patient can expect to pay between $8,500 and  $49,500 for FFS, depending on how much treatment is done.

For trans women, voice feminization and facial feminization surgery include operations such as forehead and brow bone reshaping, jaw and chin contouring, nose reshaping (rhinoplasty), hairline advancement, and tracheal shave — a procedure to reduce the size of the Adam’s apple.

Hair removal, for example removing facial hair on a biological male wishing to transition to a woman, or hair transplantation through electrolysis or hairplasty, is another option to bring an individual closer to their desired gender.

Whether or not these procedures are medically necessary for transgender individuals remains open to debate.

Some health insurers in the US may cover minor procedures to facilitate the gender transition process as part of treatment for gender dysphoria.

The CMA doctors cited a 2021 study of transgender people who said they had higher levels of self-esteem, a more positive body image, felt more aligned with their gender and faced less discrimination after getting nonsurgical facial injectables, compared to transgender individuals who did not undergo the procedures.

A larger study in the same year also found transgender women who received hair removal to make them appear more like a woman had better mental health status than those who did not have any hair removed.

The editorial authors argue that while members of the public might say aesthetic procedures should be paid for privately, surgery to change the shape, position or proportion of the ear has been publicly funded for years for children.

Those who have had the procedure, known as an otoplasty, have reported improvements in self-esteem and a decrease in anxiety to do with how they look.

Currently, only Manitoba and Yukon in Canada offer coverage for hair removal. Yukon also covers facial feminization surgeries.

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