Medicare and Sex Reassignment Surgery.

Abstract

To the Editor: The recent Medicare Review Panel's decision1 not to summarily reject requests from Medicare recipients for approval of sex reassignment surgery brings to the fore issues of transgender medicine in older persons. There are scant data to guide us. The Institute of Medicine's report on the health status of lesbian, gay, bisexual, transgender (LGBT) individuals2 indicates that there are few organized observations on medical problems of transgender persons in general and even fewer for older transgender persons. It is likely that there is a cohort effect according to date of birth for transgender persons. Today's society is more open to helping transgender persons from childhood onward, but the climate was much different for transgender persons who are old now.3 Family rejection and unsympathetic medical management were among the barriers to transitioning in the past. For the currently old transgender persons, good health care was marked by access to sex hormones and sex reassignment surgery. Both permitted physical congruence with the innate gender. Transgender aspects of geriatric medicine will receive further attention in the future. Older persons are beginning to be included in published series of individuals undergoing sex reassignment surgery.4 There are case reports of disease in transgender persons whose retention of natal organs (prostates in trans women5 and ovaries in trans men6) has been overlooked in the differential diagnosis. Systematic studies of the effects of long-term sex hormone ingestion on bone, hemoglobin level, thrombotic diathesis, cardiovascular disease, incidence of malignancies, longevity, and cognition may be undertaken in the future. The question of what transgender bodies should be as they age also asks the question of how long to take sex hormones, as diminution of these hormone levels is normal with aging. For further reading, a comprehensive review of transgender issues has recently been published.7 The Association of American Medical Colleges has recently published a seminal online monograph on curricular implementation of LGBT health concerns in medical education.8 Helping older transgender persons live through the arc of their old age is a vital part of current and future geriatric medicine. Conflict of Interest: The author has no competing interests. Author Contributions: DOS is the sole author of this paper. Sponsor's Role: None.