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this post was submitted on 26 Oct 2026
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While I 1000% agree that people should have access to gender affirming care, I don't know that this argument is as much of a slam dunk as it's presenting itself to be.
While there's certainly a contingent of people who want to ban or restrict access to gender affirming care to adults, a plurality of the debate is around access for minors. And minors aren't allowed to get full body tattoos, even with parental consent.
And second, one big distinction is that your insurance company isn't going to pay for you to get a full body tattoo. That's coming out of your own pocket. My understanding is that most of the checks like getting therapist notes are to prove that it's a "medically necessary" procedure. Not defending insurance companies, but when a third party is paying for something there should be some expectation of increased scrutiny on it.
Again, none of that should be interpreted as me saying anything close to "gender affirming care bad." I think people should have access to the care that they need. I'm just pointing out the argument in the OP is a a bit of a straw man.
I think that getting hrt in general should be open to anyone (after a very thorough explanation of what will, won't, and might happen), but it'd not be unreasonable to require a diagnosis for it to not be funded out of pocket.
Though I also feel like the argument falls apart when looked at more broadly, tattoos are accepted by most of society as something adults can do, other body modifications not so much (my first thought is always this guy i read about that allegedly had his nose sawed off because he wanted to look like a fallout ghoul). Modifications like that share more in common with HRT than tattoos do imo, they have permanent consequences that go beyond just looks (not having a nose to filter things should be obvious, and iirc it's not great to go on hrt for a long time and then just... stop, for availability reasons or anything else). Cosmetic surgery in general varies wildly in acceptance and legality worldwide depending on what is done precisely, and some can be dangerous while some isn't.
I am of the opinion that anything you want to do to your own body should be legal, but tattoos are a handpicked example that does not reflect a general social attitude towards body modification.
Guess what also permanently changes a body's appearance - natal puberty
HRT just changes it in the other direction, a preferred direction, that doesn't cause dysphoria, and blockers (which are demonstrated to be safe enough that cis kids with precocious puberty can use them) just prevent any changes until they're stopped/HRT is started
Ok so ethically the whole thing puts doctors in a situation where it’s tough.
A doctor worth their oath will have a hard time ethically, for the same reason your GP should refer you to a psychiatrist for psychiatric meds. The appropriate medical professional needs to be looped in for ethical reasons.
Simply because they are unable to quantify the harm being done, but a therapist can. So in order to uphold their oath they must have proof from a medical professional who can affirm harm is being caused.
Yes, there are assholes who are pushing their transphobia or hatred. But also the other thing.
Now whether or not gender affirming care should be considered “medical” care is another story altogether BUT this is the reality.
It absolutely is medical care. Here for the 'other story'. What are the counterarguments?
(Context: am transsexual, HRT did for me what 7 years of antidepressants could only dream of and quite literally saved my life.)
I meant insomuch as I’ve heard people say it ought not be kept behind the gate of a medical professional, not that it isn’t medical in nature or somehow unnecessary
I think there is some nuance to that, and IMHO it largely depends on the model of healthcare we are talking about.
In the case of paying out of pocket for treatment, all that's needed is informed consent. E.g. you see an endo, they inform you of the process and all effects, desirable or otherwise. They cannot bar you from treatment, nor are they responsible if the treatment turns out not to be right for you. Once consent is provided, they are responsible for monitoring your hormone levels and adjusting the dosing if needed.
When it comes to socialised medicine, gatekeeping is inevitable. This is for the same reason that someone whose teeth are ever so slightly crooked, to an extent that is only noticeable under close inspection and has no oral/jaw problems, would not be entitled to braces/invisalign. It isn't a medical need, and that person is free to pursue that privately. Attitudes towards gender and transitioning have changed over the years, and there are people these days for whom HRT is an aesthetic choice/body mod (and is partly why I distinguish by describing myself as 'transsexual'). Power to them, but I would not claim that cases like this are the best use of tax revenue. This is where the tattoo analogy has a bit of weight to it.
tl;dr medically necessary for some, and just a form of self-expression for others. That difference can matter to the taxpayer.