Dental dysphoria: Transgender medical procedures trump essential dental care across the US

by Worriedmom

Tax time rolls around again, all too soon, and as I tally up the itemized deductions for my 2016 return, I realize, to my sadness but not my shock, that once again this year, our dental expenses are close to $13,000. Between four adult children needing a variety of dental services, and the fact that my husband and I are beset with age-related dental woes, some months I think I pay our dentist’s office rent all by myself. Although my husband has a generous medical plan through his employer, it does not cover dental expenses, other than those incurred in an accident, and this is typical of many employer-provided benefits packages. So, we pay.

And when I pay, I take a moment to think about the people who can’t pay – but they still have teeth. What do they do? What happens to them?

First, if you’ve ever had an untreated cavity or, worse, an infection or abscessed tooth, you know that the pain involved can be incredibly intense: you can’t think, focus, or do virtually anything, until the situation is addressed. The drugstore has shelves filled with ointments and gels for treating dental pain, not all of which are for teething babies! Second, poor dental health affects nutrition. Ability to eat and appetite are adversely affected by painful or missing teeth.

According to the Kaiser Family Foundation’s “Access to Dental Care in Medicaid” report, “Research has also identified associations between chronic oral infections and diabetes, heart and lung disease, stroke, and poor birth outcomes.”

A serious side effect of poor dental health in adults is its adverse impact on employment. People whose teeth are unsightly or missing are often deterred from seeking employment, or better jobs, and can suffer discrimination in hiring. Poor dental health is not a “protected class” for the purposes of anti-discrimination law, so employers are free to decline to hire a candidate on that basis.

cletusAs a final but not at all minimal side effect, consider the psychic distress and embarrassment experienced by people with unattractive teeth. In the United States in particular, missing, crooked, or discolored teeth are associated by many people with ignorance, lower class status, poverty and other negative social qualities.

At 4thWaveNow, we do understand that the plural of anecdote isn’t evidence, but two quick stories might shed some light on the magnitude of the problem:

  • A 28 year old man from my church, who lacks dental insurance, is living with persistent tooth pain. One week it becomes acute. He leaves work and seeks care in the emergency room, where it is found that an infection has spread to his entire jaw, and he will now (after spending four days in the hospital), lose all of the teeth on one side of his mouth. He has also lost his job. Eighteen months later, he is unable to afford to replace his missing teeth and is still unemployed.
  • Another friend has a failed root canal which wakes her up with screaming pain in the wee hours of the morning. By the time she receives emergency care from an endodontist at 3 AM, the infection is already so aggressive it is invading her soft palate. The endodontist tells her if she’d waited until the next day to seek care, the infection could have potentially gone septic, and/or reached her brain.

Yet, we all treat dental care as if teeth and gums are not even connected to the rest of the body…

How widespread is lack of access to dental care in the United States? According to the Centers for Disease Control, in the period 2011-12, 17.5% of children between the ages of 5 and 17 and 27.4% of adults between the ages of 20 and 44 had untreated cavities. In 2014, 62% of adults between the ages of 18 and 64 had a single dental visit within the previous year; more than one-third of adults had not. Put another way, a 2012 Kellogg Foundation report estimated that some 83 million Americans faced barriers to dental care.

Medicaid, as our non-United States readers may not be aware, is the US health insurance program that provides health care for low-income people from birth until approximately age 65; it also pays for nursing home care for destitute adults of any age. Medicaid is the primary way for low-income or disabled people to access health care (and access to Medicaid was expanded in states which opted in via the implementation of the Affordable Care Act in 2010). Medicaid is administered through the states, and although there are some things that the federal government says that states must cover, dental care is not one of them, except for people under the age of 21. While some states have decided to provide dental care as part of Medicaid, fewer than half provide comprehensive dental care for adults and some do not even cover dental care that is required due to an accident.

The map below of dental coverage availability under Medicaid shows that 15 states provide “extensive” dental benefits (defined as benefits that can be chosen from a list of over 100 dental procedures); 19 states provide “limited” dental benefits (fewer than 100 covered procedures); and as to both of these classes, the annual benefit “cap” is $1,000. Several high-population states, including Florida and Texas, are among the 13 that cover only emergency dental care, and 4 states provide no dental coverage at all.

medicaid dental coverage map.jpg

Access to dental care is also inconsistent: in 2009, due to severe budget strain, the state of California eliminated adult dental care as a Medicaid benefit and did not restore it until 2014. Similarly, Illinois removed this Medicaid benefit in 2012 and restored it only in 2014.

How much does dental care cost in the United States? As might be expected in a country with such a large population and highly disparate financial circumstances, the answer is, it depends. In Connecticut, a high-income state, the average cost of a cleaning ranges from a high of $85 to a low of $66. In Mississippi, a low-income state, the same cleaning cost range is $60 (high end) to $45. For full mouth X-rays, the Connecticut range is $132-$87 – and the Mississippi range is $102-$63. For a filling, the Connecticut range is $139-$84 (for a non-front tooth that hasn’t been filled before) and in Mississippi the range is $105-$65. Finally, in Connecticut the range for a root canal (ouch) is $1,258-$1,046, and in Mississippi, it’s $918-$738. (All prices sourced via Dental Optimizer, an online dental cost calculation tool.)

With prices like these (notice that the cost of a root canal would likely exhaust an entire year’s dental benefit even in a state that provided comprehensive dental benefits through Medicaid), it’s probably no wonder that so many adults in the United States go without adequate dental care. In fact, kind-hearted and generous dentists actually provide “Missions of Mercy” to underserved populations in the United States, similar to medical missions that visit places like Rwanda and Zaire. A free dental clinic recently offered in Hartford, the capitol of Connecticut, attracted over 2,000 people, including one man who waited in line for over 15 hours to see a dentist (and recall that Connecticut is a state that provides “extensive” dental benefits under Medicaid).  For another recent example, a free dental clinic held in South Carolina attracted people who waited in line for over two days for dental care.

Dental charity clinic.jpg

Well, that’s enough of those unsexy teeth. Although there have been several articles and studies decrying the lack of dental care provided to adults, and detailing the negative overall health impact of that deficit, it is safe to say that this subject does not begin to arouse the passion and outcry comparable to that surrounding the demands that transgender people’s transition-related expenses ought to be paid for (by somebody else). There are no groups that have formed to advocate for access to dental care. Research has not disclosed a single demonstration or protest or letter-writing campaign or organized action on behalf of adults who lack access to dental care.

By contrast, there has been tremendous activism in the United States centered on compelling private insurance companies and the Medicaid program to provide transition-related health care. Similar activist pressure for guaranteed nationwide coverage of transition services was also placed on the Medicare program, which serves seniors and disabled people, but an extensive review by CMS resulted in no national change in policy, because

Overall, the quality and strength of evidence were low due to mostly observational study designs with no comparison groups, subjective endpoints, potential confounding (a situation where the association between the intervention and outcome is influenced by another factor such as a co-intervention), small sample sizes, lack of validated assessment tools, and considerable lost to follow-up.

But putting Medicare aside, between court rulings and legislation, access to payment for transition-related medical expenses has greatly expanded in recent years. And, of even greater significance, many states have passed “non-discrimination” laws, which typically provide that public and private health insurers may not refuse to cover (“exclude”) coverage for transition-related health expenses.

trans healthcarenow

The map below shows that as of 2016, 14 states had determined to provide transition-related health care as a covered benefit under Medicaid, and had also mandated that all private insurers cover transition-related health care. An additional 5 states either provide Medicaid coverage for transition-related health care or a private insurance mandate, but not both. The remaining 31 states did not, as of 2016, have legislation or rules covering transition-related care and Medicaid and/or private health insurance. By contrast, it does not appear that there is a single state that requires private health insurers to provide dental coverage.

trans healthcare map.jpg

Let us consider the case of California in more detail. Due to “intensive advocacy,” in 2012 and 2013, the state of California issued directives requiring private health insurance companies to provide transgender services. In addition, since it was ordered to do so by a court in 2001, the state’s Medicaid program has covered transition-related health care. Regular readers of 4thWave Now will not be surprised to find that the standards set by WPATH govern the criteria for “medical necessity” regarding the provision of transition services.

Recall, as noted above, that in the 6-year period from 2009 to 2014, when California was in the midst of a persistent budget crisis, the state eliminated all dental care for adults from its Medicaid program. And now, let’s run the numbers:

Going back to Dental Optimizer, the mid-range cost of a checkup in California is almost exactly $200 ($89 for the cleaning and $108 for the x-rays). Mid-range for a filling is $130 and mid-range for a root canal is $1,030.

Looking at some typical transition-related health care costs, the first case of sticker shock pops up with Lupron:

How Much Do They Cost and Are They Covered by Insurance?

These agents (medicines) are expensive. Typically, Depot-Lupron costs range from around $700 (online) to $800 (Portland area) to $1,500 dollars a month elsewhere for the monthly preparation. The 3 month preparation is equivalent in price. The histrelin implant is approximately $15,000 total for the device and the cost of surgically implanting it.

A histrelin implant would typically be used to provide the GnRH agonist medication in place of monthly Lupron shots. Estimating the cost of monthly Lupron shots at $1,000, which seems reasonable if not conservative based on the article, it appears that a year’s supply of Lupron, used to suppress puberty in a potentially transgender child, would cost $12,000, exclusive of the cost of monthly lab tests. In dental terms, 60 people could have a dental checkup, or almost 100 cavities could be filled, or almost 12 root canals could be performed. It is difficult to estimate the “average” amount of time that a child might spend taking Lupron; some providers argue that starting Lupron at age 9 or 10 is appropriate, while others wait until age 12 or 13. Assuming five years of Lupron shots, this translates into 300 dental checkups, almost 500 cavities filled, and nearly 60 root canals.

Moving on to hormones, as pretty much all puberty-suppressed children do, the price tag drops. The cost of hormone treatment is estimated at approximately $100 per month, or dental checkups for 6 lucky people, about 9 cavities, and a bit more than one root canal.

It’s when the “re-assignment surgeries” enter the picture that things really escalate.

According to multiple sources, the price of basic genital reassignment surgery or genital reconstruction surgery) for a man transitioning to a woman ranges from $7,000 for a simple orchiectomy and vaginoplasty to $25,000 for orchiectomy and the more complicated colovaginoplasty. This is often, but not always, followed up by breast augmentation, which can run anywhere from $5,000 to $10,000. That’s a total average high of $35,000, but estimates for the two procedures combined have ranged from $10,000 to upwards of $50,000. [Source.]

Taking the $35,000 number as our benchmark, and recalling that this does not include any other procedures also frequently deemed medically necessary, the dental cost of surgical transition for one male to female patient equates to 175 checkups, or about 270 cavities, or almost exactly 34 root canals. Note also that many transitioning men do not plan to “settle” for these $35,000 “half-measures:”

Some of Grey’s medical expenses are covered by her insurance, Kaiser Permanente, including her hormone therapy, a portion of her gender reassignment surgery and preparatory genital electrolysis that has to be done before the surgery. The insurance does not cover facial electrolysis (beard removal), laser body hair reduction, breast augmentation or facial feminization surgery, all of which Grey considers vital to her survival as a transgender woman.

No one sees me as physically female, just obviously transgender. This makes me an outcast and puts me at an extremely elevated risk for discrimination and harassment,” Grey said. ‘Just covering hormones and gender reassignment surgery is a half measure that still leaves us exposed to great risks and complications in our everyday lives.

The sky’s the limit, apparently.

How about women transitioning to male?

For women transitioning to men, the initial costs can be higher, and the choices more complicated. Some estimates lower-end cost of a metoidioplasty—a procedure that “frees” a hormone therapy-enlarged clitoris from the body for use as a phallus—at $2,000. That said, there are estimates of more complex metoidioplasties, as well as procedures that add testicles and involve full phalloplasties that top $100,000. Often double mastectomies, ranging in cost from $15,000 to $25,000, and sometimes hysterectomies, which run from $7,500 to $11,500, are performed. [Source.]

Although it’s clear that most women who hope to transition to male do not currently opt for the full-on phalloplasty procedure (see this recent 4thWave article for some great reasons why), the fact remains that, as a matter of California law, should a woman wish to pursue this option, private and public insurance must cover the $100,000+ cost. The dental equivalent of one phalloplasty is checkups for 500 people, or 769 cavities filled, or 97 root canals.

To further extend the analysis, prompt and competent dental care, as illustrated by the story at the beginning of the article, can often ward off much more serious and expensive dental problems. Simple cavities turn into abscessed, infected emergencies that often lead to the loss of the tooth and even body-wide illness and disability.

ignore your teeth they go away

By contrast, we see that “reassignment” surgeries themselves can lead to serious complications and the need for multiple follow-up or repair surgeries. To take one example that has been extensively documented online, one person has to date undergone more than 20 major surgeries to attempt to repair the effects of a failed phalloplasty.

Another, unexplored, aspect of providing transition-related medical care is the long-term effects of these interventions on healthy human bodies. Will the administration of puberty-blocking drugs and massive hormonal tampering lead to long-term medical consequences (and expenses)? This is unknown at present, but some early indicators aren’t looking particularly good.

Of course, we could evaluate any medical cost trade-off relative to transgender care, not just dental care. For one poignant example, fertility treatment generally is not covered under Medicaid. The dental analysis is striking because millions of people are profoundly affected, but it is only one of many choices made in the hotly contested world of health care spending.

Every society, outside of college economics classrooms, has limited resources, and must make tough decisions about how to allocate them. In a world of scarce resources, constituencies compete for their share, and more powerful, vocal and well-financed groups, in a system such as ours, will be better competitors. This is why lobbying, according to one source, was a $3.12 billion industry in the United States last year. It must be acknowledged, however, that distributing healthcare resources in one direction automatically preferences that group at the expense of others that do not receive those resources.

I would submit that the decision to direct health care spending towards transgender people, who by all accounts comprise a tiny fraction of the population (albeit one with potentially astronomical medical costs), and not towards dental care for adults, proves the extraordinary advocacy power and reach of the transgender movement. It also demonstrates that, contrary to activists’ efforts to characterize transgendered individuals as marginalized and under-privileged, as a whole this group is remarkably privileged. When the numbers show us that phalloplasty for one person is the equivalent of dental checkups for 500 people, and we choose the phalloplasty, we cannot conclude anything other than that we have decided the needs and concerns of one person take priority over those of the 500 people who go without dental care. Are the pain and suffering experienced by the natal woman who desires an artificial penis, more important than the pain and suffering of 500 people going without dental care? It seems that the answer to this question, at least in many places in the United States, is yes. We should ask ourselves why, and we should also ask ourselves whether that is fair.

64 thoughts on “Dental dysphoria: Transgender medical procedures trump essential dental care across the US

  1. I do note that you are apparently not founding any activist group to push for mandatory private, or Medicare where it is absent, dental coverage.

    As for the numbers, you list absolute numbers for a case, but this is not relevant without prevalence data.

    According to a study referenced in the WPATH SoC v7 chapter IV, the number of people in need of treatment is estimated as under 1 in 10000. Other estimates are higher, the very highest I am aware of (specifically for people requiring medical treatment) is 1:500 and that was guesswork based on number of births: . However, let us go with 1:500, and this is a once in a lifetime treatment.

    As for root canal treatment, its prevalence is higher than one in a lifetime per person:

    Therefore, a provider can expect to finance at least 500 root canal treatments to every transition treatment for the same population. 500 root canal treatments are at least $500k, while the cost of existing coverage for the vast variety transgender persons is probably under $50k per person (the very rare case of a full phalloplasty excluded).


    • This is disingenuous. Puberty blockers are very expensive and are being prescribed more and more. Hormone treatment is lifelong. “Top surgery” is more and more common, including for “non-binary” patients. Which I think you are aware of. This isn’t just about SRS. It’s about therapists and doctors that children and then adults go to for the rest of their lives when they are transgender; they become permanent medical patients. I am letting this one comment through, though regular readers are pretty aware that you come here to troll. So I’m unlikely to approve your next one.

      Liked by 9 people

    • But the point is that the resources are being directed to transition medical care and NOT to dental care, and resources are finite. Or is it your argument that because the need for transition medical care is comparatively less likely than the need for adult dental care, that somehow makes it appropriate to devote resources to the former? I understand that, per capita, it would cost the medical system less to provide transition care than it would to provide dental care – that’s because there are so many people who need dental care, and even giving them “a little bit” of dental care would probably far out-price giving a very few people a ton of expensive transition care. But your post intentionally avoids addressing the “allocation of resources” point of the article. You also fail to address the inherent moral choice being made when a healthcare system prioritizes medical spending for a tiny, fortunate few, over the needs of the many.

      I’ll assume your other comment slamming me for not forming a dental health advocacy group was facetious.

      Liked by 3 people

      • And, you did link to dental charities.

        And, dental care has been proved to result in substantial savings re. long-term chronic illness. Anything related to a sex “transition” is hypothetical, unproven and compulsive. We’ve not seen any data anywhere that treating “sex changes” as if they were real or legitimate is any better for people than acknowledging this phenomenon as just another form of dysphoria, i.e. providing mental health treatment to help people recognize and accept reality. I’m not happy seeing badly needed public funds wasted on this bizarre set of experiments.

        Liked by 6 people

      • Insurance-any insurance, be it dental, medical, or auto-is a bet the insurance company is making with the client. The reason transition related expenses are more likely to be covered then dental is because the odds are so long-it’s like roulette, the house always wins.


      • Gary, I’m not sure I entirely agree with the roulette analogy because it’s not solely a market-driven event. It’s certainly true that transition expenses would be rare, but it’s also true the system can be distorted by law and rule-making, which in turn are driven by political considerations. A small pressure group can exert outsize influence and wind up with coverage for a particular procedure or therapy, it isn’t just a statistical exercise for the insurers.

        Liked by 1 person

    • “… the very highest I am aware of (specifically for people requiring medical treatment) is 1:500…

      The operative word here is requiring. No one needs sex-reassignment, no one requires it. So the expense at the public trough is unjustified and denies many people necessary procedures.

      Liked by 2 people

  2. Excellent work. Very scary but very good information. Thank you for all the research. The comparison to transition insurance coverge is shocking.
    By the way, maybe it should be referred to as “transition related medical treatment” as opposed to “transition related health care”. The second phrase is more of an oxymoron, don’t you think?

    Liked by 8 people

  3. Reblogged this on PetuniaCatLand and commented:
    Why does Medicaid pay for sex changes and not for dental care? Well-researched article looking at the costs of government funded transition medical services.
    Sidenote: I live in Canada on disability so my dental care is paid for. Which is good because as I get older I keep getting multiple cavities. 4 last month! 😫

    Liked by 2 people

    • Yes, this is exactly the point! Many people experience dental problems throughout their life spans. I myself have had extensive work done, as the fillings I received in the 1960’s and 1970’s have cracked, worn away, and fallen out, and in several instances I’ve had to have a root canal procedure to repair extremely painful decay. At least I can afford to keep my teeth, whereas you’d probably be shocked to know how many people in the U.S. just get theirs pulled and are done with it. When pulling a tooth costs 1/5 of the cost of a root canal and crown, it’s no wonder so many people just opt for the extraction.

      Liked by 4 people

      • And “dental dysphoria” is a very apt term for someone in this predicament. For financial reasons, they have teeth pulled. Then every time they go out in public, they must feel embarrassed about how they look. And the impact it has on all of their opportunities: employment, romance, you name it.

        Liked by 7 people

      • Yes! I loved that this post was using teeth, including middle-aged people teeth, problems to illustrate this disparity and the ridiculously coddled way trans is treated. 😍

        Liked by 3 people

  4. I also live in Canada, and for years have not been able to afford basic dental care. I also need prescription glasses to function at a basic level. Without them I cannot read street signs, or even see traffic lights clearly as a pedestrian. Optometrist appointments are not covered, and cost
    $ 100.00+ per visit. They will give you your prescription (by law they have to) but this won’t include your pupillary distance or other information like your optic center measurement.

    Prescription lenses are not covered by provincial health plans. The 2nd last optometrist I saw offered me the bargain basement “deal” of $ 500.00 for my first pair of lenses, with the second costing $ 270.00, not including frames or tax ! I have been ordering glasses online – buying frames on Ebay and lenses from a US business that charges 1/4 of the optometrist’s prices. The last lenses I got were defective. I had to take them to the optometrist to have the prescription verified (another $ 25.00) while being shamed for buying lenses online, what a terrible mistake that is, how none of them are any good, etc., etc. Between appointments, frames, and lenses a BASIC pair of glasses would cost me close to $ 1000.00, if I bought them locally. Canada has restrictive laws about optical dispensaries. If I order from the US I can expect to pay close to $ 200.00 CAN for an equivalent pair of glasses, not including the exam.

    It is disgraceful that dental care, eye care and things like hearing aids and mobility devices are not covered. Without them people are unsafe, unemployable, and often in chronic pain.

    I think that people who want to transition should have 12-24 months of mandatory psychological and psychiatric care, including social workers. I do not think that coverage for Lupron, or any of the SRS should be covered, as they are both experimental, without even good statistical data.

    People need to see, hear, chew, walk every day. A person who desires SRS already has functional genitals…

    Liked by 6 people

      • Unfortunately, for many of us, off-the-shelf reading glasses from the drug store won’t suffice. In addition to typical middle-age reading problems caused by “old eyes,” I also have a lifelong case of quite severe near-sightedness, with each eye at a slightly different vision level, each requiring its own prescription. My optician typically has to send my lenses to a special lab in another state in order to get them compressed, so they won’t be thicker than the bottom of a glass Coke bottle, and will fit properly into the frame.

        My glasses usually cost around $1000. I would love to have insurance cover this expense. I can’t see without my glasses.

        Hmmmm… I wonder if testosterone shots would improve my vision. If I claim to feel like I should have been born a man, insurance will cover those. Or maybe insurance would cover a pair of men’s glasses for me?

        Liked by 2 people

      • There is optical insurance, but it generally just pays for basic exams and basic eyeglass prescriptions. Otherwise, you just get a discount. My glasses cost about $450. Fortunately, I can afford to pay that.

        Liked by 1 person

      • Yeah, you can use the non-prescription ones if your vision is basically all right to begin with. Mine is about 20/600, which means I can see as well at 20 feet as I *should* see at 600; to put it in perspective, it’s the vision of a domestic rat, a species which hardly uses its vision at all. I’ve been losing my vision since I was 7, get the special compressed lenses, and can’t wear most brands of contacts because they don’t make them in my prescription. (I also have astigmatism, and a lot of contacts won’t fix that either.) I’ve tried on the drugstore ones just for fun, and it’s the same as wearing nothing, only slightly larger.

        Also, I didn’t have dental insurance for 5 years and when I finally went to the dentist they found 4 cavities, and now all my teeth hurt and I am a sad panda. OP is right, this should **really** be covered.

        Liked by 1 person

  5. I have a friend with a good job, a husband who works a second job, and has lived in near-constant pain for years from poor dental health. She didn’t have dental insurance, and until this past year couldn’t go for checkups. Isn’t physical pain comparable to gender dyphoria?- assuming they have that, given that so many people are now told ‘it isn’t necessary to be trans.’ This is chilling.

    Liked by 1 person

  6. The most painful part of this article is reading about children as young as 9 years old being given sex change hormones. I believe this is a criminal act! NO 9 year old knows that they are trapped in the body of the opposite sex yet! They just don’t. I decided I was a boy when I was about 2 or 3 years old and became a tomboy. I had no interest in boys until I got to be about 13, except that I wanted to play with boys and not girls. Thank GOD my mother and father had brains beyond that of a carrot and knew to leave well enough alone. Kids decide lots of things when they are immature. Why would anyone make it legal to abuse your own child by giving them sex hormones at 9? And where in heaven’s name did we get doctors willing to destroy a child with this utter nonsense? Grrrrrr!

    Liked by 4 people

      • Nobody is getting arrested. Providing care for a marginalized community is hardly immoral, and pretty damn far from criminal. If you think helping people afflicted with a condition which you could never understand is immoral, then you perhaps need to look the word up again.


      • @ teganwillow; if not arrested, they should be imvestigated from child services. Who in their right mind thinks it’s ethical to do medical procedures on those under 18?
        “Helping people afflicted with a condition”… what “condition” is being treated here? If anything it’s causing medical conditions that can’t be reversed – sterilization, stunted growth, osteoporosis, etc
        What makes confusion about *gender* more important than everyone else? People can’t afford basic health care & die EVERYDAY. Does not having cosmetic surgery KILL people? Maybe they have suicidal thoughts, but lots of things cause suicidal thoughts… including illnesses that are left untreated. One example is migraines; there’s a 50% more likelihood of suicide for sufferers, same statistics as trans people …. That’s just ONE medical problem.
        You’re right, I don’t understand why medical intervention is more important for body image issues than other serioys health issues that are REALLY killing people.
        To push children into it is wrong too. It’s forcing kids to be slaves to medical care their entire life. Nothing that can’t wait till adulthood. It’s abuse. Trans ideology is harmful and tells children it’s all about what you look like. A goal that is impossible to reach because most people are ever happy with their body.
        Wait till the lawsuits come rolling in. I hope people like you pay for the way you pushed children into this insanity.

        Liked by 2 people

  7. It’s so ridiculous how dental care and eye exams aren’t covered by insurance, yet unnecessary cross-sex hormones, puberty blockers, and irreversible surgeries are. Somehow I doubt insurance companies will be all that eager to cover later surgeries to try to reverse this, like breast implant removal, urethral unhooking, and natal men getting phalloplasties after their original organs were surgically inverted.

    Some people with bad teeth have saved up for years to get corrective dental work. Until then, they had to live with crooked teeth and large gaps, many times being loath to smile in pictures. I myself was supposed to get my right eye mapped to see the extent of the damage in my scarred cornea, but since I knew it’d be expensive, and require more follow-up visits, I decided it wasn’t something I needed immediately. I likewise never went to the ENT specialist my doctor referred me to for snoring, since that too probably wouldn’t have been covered. It really angers and frustrates me to see these trans-related procedures and drugs getting fully covered at the expense of more basic healthcare needs!

    Liked by 3 people

    • Someone very near and dear to me was accidentally shot in the mouth as a girl, and spent her entire life smiling with her mouth closed. Her parents couldn’t afford to have her teeth fixed at the time, which led to a life-time of pain, embarrassment and expensive treatments that failed, one after the other. I think this is one reason I feel so strongly about “dental disparity.” It is incredibly stigmatizing to have awful teeth and it makes me very angry when I think that the suffering of millions of people is essentially counted as nothing.

      Liked by 2 people

      • Something else to consider too is the extra impact that bad/missing teeth often have on women in particular. A lot of the “low level” “entry level” type jobs that women (and particularly marginalized women) do involve customer service or some other type of close contact with clients, in ways that some of the more “muscle power” jobs that entry level men tend to dominate do not.

        This isn’t to justify denying dental care to anyone (why on earth are our teeth and eyes not just insured with the rest of the body??) but a lot of the customer service type jobs can be very discriminatory on appearance, very much including missing teeth.

        All the “if I don’t look a certain way I’ll be shunned and that affects my employment” “companies won’t hire someone who looks like a ‘freak’ to work the front desk” type arguments that people bring up to lobby for the necessity of FFS applies far more fundamentally to teeth!

        Liked by 4 people

      • It seems to me that the US could definitely use a dental equality movement. Could focus on ‘teeth-shaming’ just as ‘fat-shaming’ has done. Have an “All smiles are beautiful’ thing to try and remove stigma. Marches. Shame celebs who are always flashing those teeth. I am being serious here.

        I am not American and I live in Hong Kong and let me just bow to the gods in thanks I got accepted at the dental hospital as a teaching patient. Dental isnt covered here, although there are Catholic charities that do good work, though they cant do things like tiny root canals.

        I dont know the UK situation now: as a child it was properly covered, and you could even get some cosmetic work done on the grounds of feeling bad about how it looks. I had mine veneered for free and what a difference it makes. I dont know why the British get shamed for our teeth because certainly people my age had check-ups every six months as kids. They MADE you do it.

        Liked by 1 person

  8. Predatory denture clinics have popped up in response to this crisis, eager to pull teeth, which is much cheaper than saving them via endodontics, and help patients “finance” their dentures (meaning, get in astronomical debt w unfair terms to the clinic). Whatever political position generates profits is what seems to prevail by default. Life long hrt for trans patients is much more lucrative than the other uses of the same drugs.

    Liked by 2 people

  9. It’s madness to remove dental care from people when lack of it is connected to so many other health issues including heart problems and madness to support the ‘gender reassignment’ surgery and cross sex hormones that also promotes life long poor health and reliance on medication. Crazy all round.

    Liked by 4 people

  10. Because I was in a hit and run as a pedestrian, and my insurance would not cover the dental issues, I spent about 20K to try and save my teeth. Unfortunately, at 40, I was laid off, and I have not been able to get a new job because of my teeth. I am finally covered with Medicaid, but I will have to have them all out and wear dentures, as implants would cost 80K. I could have 6 sets breast implants and have a fake penis created for less. Dental Colleges don’t do implants, nor do they do dentures for someone my age.

    I am seriously considering suicide, but because I am a woman who is not trying to be a man, my suicide will not matter.

    Liked by 3 people

    • I’m so terribly sorry this happened to you, CeeCan. Please do not hurt yourself! I really empathize with how awful it must be to be in your situation, but surely there must be some middle ground between dentures and ending things. I have experience in my family with suicide and it is just never the answer. Please call on a friend or a relative who can help!

      Liked by 3 people

    • Yes, please don’t commit suicide! Dentures suck, but they have really improved recently. If you can raise 20K, you might be able to have implants done in Mexico, btw.

      Liked by 3 people

    • Dentures are much better these days, as Mark says. A decent set will allow you to eat and speak normally, and may well allow you to get back into work. You could have implants later.
      My mum has dentures – she always said that if she had to have them, she wouldn’t leave the house again, but she is still working and no-one even notices that her teeth aren’t her original ones.

      Liked by 2 people

  11. “Denying trans access to healthcare” is a total red herring when it’s used in a mainstream news context, anyway. It sounds as if trans people are being denied access to treatments for illness or injury, perhaps due to “transphobia”. As this article states, “access to trans healthcare” means “publicly funded gender reassignment”.

    Liked by 5 people

    • Some trans people are being denied access to regular medical care by ignorant and intolerant medical practitioners. It happens all the time, really.

      Also, many people- trans included- are covered by their employer’s insurance. There’s nothing “publically-funded” about that; employer-provided insurance is part of a person’s earnings, and quite frankly none of your business.


      • Give me a break – health care is EVERYBODY’S business, or have you not noticed the current climate? We’re not talking about a country that has even basic health coverage for its citizens here.
        People are discriminated against all the time by doctors, esp women. Did you miss how birth control can be denied now? Hormones a lot of women use to treat medical conditions like endometriosis…? I don’t see activists caring about that as long as they get their hormones. All for cosmetic reasons – let’s be honest.
        No one here will buy what you’re selling. I’m guessing you are trans and think your doing a great job screeching your opinion. Just like you, we have a right to say what we think too.
        So knock it off, public funding is exactly what they’re asking for. Cosmetic surgery isn’t a right. Why don’t activists push for body acceptance? No one needs breasts to be a woman – plenty are living fine without them. Women live with bodies that aren’t “womanly” everyday. Trans ideology is harmful by pushing stereotypes & focusing on outside appearance. What a joke.

        Liked by 2 people

    • You’re welcome! The idea for this piece came to me (as they so often do) while I was out for a run and thinking about my finances. Like so many families, it always seems like, just when we’re getting a little bit ahead, some darn thing or another comes along to vacuum up all the extra cash that month… and dental expenses are right up there with car repairs as budget busters!

      Liked by 2 people

  12. Cosmetic surgery (except to fix a real medical problem or injury) should never be covered by either private insurance or the taxpayers. I don’t get a free nose job because I think my nose is a little too big. Nobody needs “gender reassignment” surgery. The surgery is also a lie because nothing can actually transform you into another sex.

    Liked by 3 people

    • All so-called “gender reassignment” surgery is cosmetic surgery, and it’s discriminatory against non-transgenders to make insurance or taxpayers pay for cosmetic procedures for transgenders while denying it to everyone else. (I personally would benefit greatly from a surgical procedure to repair the damage that four full-term pregnancies with rather large babies did to my body, but I sure as heck would never expect anyone else to pay for it.)

      Liked by 3 people

      • For you, surgery would be vanity. For a trans person, surgery would be possibly life-saving. Sorry, the two aren’t equivalent.

        As for a cis person crying out “discrimination!” because she can’t get her tummy tucked for free- well, that’s just preposterous.


      • Nonsense. Gender reassignment surgery is a cosmetic procedure, not a lifesaving procedure. No one opposes adults being allowed to have cosmetic procedures if they want them, but they ought to pay for it themselves.

        Liked by 3 people

      • This reply is for Tegan, but I don’t think the replies will nest correctly. Women are not allowed to have hysterectomies for vanity’s sake. I know plenty of people who have severe endometriosis whose insurance companies will not pay for a hysterectomy. These women suffer physically daily. They have tried everything with no relief. Many took Lupron for years, which has caused other severe health issues. They are told their cases are not severe enough for a hysterectomy.

        When I had my hysterectomy, my doctor had to prove to the insurance company that it was the only option. My case was pretty obvious, and I kept my ovaries, so there was not much argument from the insurance company. But I suffered for YEARS before that, and had 2 previous surgeries to save my uterus.

        I guess if a woman decides to have a hysterectomy because she doesn’t want more children (or doesn’t want any), she should say that she identifies as a man so her insurance company will have to pay for it.

        Liked by 3 people

      • Tegan, maybe I should just threaten to kill myself because I am so upset about my chubby tummy and flat chest? I must have stomach liposuction and a boob job to become the authentic person I was meant to be! It is also not authentic for me to have hairy legs and armpits or yellow, crooked teeth. On the inside I am a flawless beauty free of body hair, and I have felt this way in the essence of my heart all my life. When I was a kid my parents often caught me trying to pull the hair off my legs with my bare hands, and I always drew pictures of myself with perfectly straight white teeth, an hourglass figure and six-pack abs. If I don’t get plastic surgery, laser hair removal, orthodontia and teeth whitening treatments I will be driven to suicide. I am so very certain of and invested in this authentic version of myself. I must have these treatments or I will end my life. My insurance must pay for them or I will be driven to suicide.

        Liked by 3 people

  13. oh man. I’ve been reading this website a ton lately – I consider myself extremely liberal and pro-equality, and recently many many of my friends (in their 20s, so not kids) have been identifying as some flavor of trans to much applause and accolades, including from me. But lately there’s been this niggling feeling of something not quite right with some of it, and the fact that I know that if I said anything like what’s in this article to some of them, I’d be shouted down as transphobic and awful is part of it. I feel like it’s impossible to have a discussion about some of these things because of the level of rage and emotion coming from the trans community.

    If I posted a gofundme to raise money for teeth, it wouldn’t get nearly as much attention as if my friend did to raise money for their transition, and a lot of it does seem like it’s because of the amount of attention and noise raised lately, as well as dissent not being tolerated — makes me wonder why we can’t “not tolerate dissent” when it comes to getting people proper healthcare.

    Liked by 3 people

  14. Great post. Thank you for pulling the data together and making a great point. I’ve been pondering the fact that most insurance companies deny fertility coverage as it is not considered a necessary treatment and yet according to trans activists, someone with a perfectly healthy body body should be entitled to immense alteration. It defies ethics and logic.

    Liked by 2 people

    • Thank you! And here’s something interesting, too. As you may know, if parents follow the “Dutch protocol” of administering puberty-blocking drugs (i.e. Lupron) to a child entering puberty, which is then followed by cross-sex hormones, the fact that the child never went through normal puberty will render that child permanently sterile. Although some trans-activists blithely shrug this off, there is a push among some to preserve the child’s fertility in some way, by retrieving sperm or eggs and preserving them (tough but apparently not completely impossible for a pre-pubertal child). Needless to say, there is also the demand that insurance companies pay for THAT fertility treatment…

      Liked by 1 person

      • The technology is not yet there to preserve immature gametes that have not been subjected to natal puberty. It’s something these people talk about because they want to be able to do it. But they’re not there yet. Of course they just consider it an interesting challenge to be overcome, not a reason to consider being more cautious about tampering with the puberty and future fertility of these kids.

        Liked by 2 people

  15. I just cannot fathom how leading psychiatrists, physicians, pediatricians and psychologists with doubts are not joining together to make a unified statement as to how immoral it is to tinker with a child’s natural physical and emotional growth.

    Liked by 2 people

    • Yes, they should be, but they probably figure it isn’t worth the personal downside. Trans activists are particularly nasty, and make rape and death threats on the regular.

      Liked by 2 people

    • Medical professionals are mostly cowards who fear professional opprobrium and career suicide above all else. Doctors are usually in it for the money and the prestige. Hard to believe that line of work still commands respect.

      Liked by 1 person

      • Thanks for this article. You make an excellent point. I keep waiting for what JBRo mentions above. Where are all of the medical/surgical/psychiatric/psychological professionals out there with a conscience? Form a new organization– if you must!.

        Liked by 1 person

      • Hard to believe that people respect doctors?

        I for one don’t find it at all hard to believe that respect is afforded to people who spent a decade studying in their field, learning things that your average layperson can’t even pronounce, all in order to save lives. Seems pretty respectable to me.


  16. This piece is the height of false equivalency. Transgender medical care and dental care have nothing to do with each other, and they are not mutually exclusive when it comes to coverages that could be offered by insurance. You easily could have compared dental care to any other treatment for any other marginalized community that you disapprove of, and this would be the same nonsensical feature.

    I’m seeing a lot of ignorance being posted about transgender people and transgender medical care here, and most if not all of it comes from a very unscientific point of view. This isn’t about pragmatism and it isn’t about caring to promote positive social change and benefits for the public; this is about finding a weak reason to throw a marginalized group under the bus (not that you folks need a reason). Look, if you hate the LGBT community and want them to not be covered for the care that keeps them alive, then just SAY IT. Stop trying to pretend that this is about little Timmy’s toothache.


    • There is no such thing as the LGBT community – it is a political fiction. Stop trying to pretend that lesbians are some sort of subset of transgender people, or that our issues are the same.

      These days, most of the people I see behaving hatefully towards lesbians are transgender activists and their self-righteous ‘allies’.

      Liked by 4 people

      • Thank you Artemisia. The notion of the “LGBT community” is a lie. I accept myself as a lesbian and because my parents are not batshit insane (and the trans trend wasn’t a thing going up), my brother and I were never turned into life-long medical patients for playing with each other’s toys as kids.

        No one needs puberty blockers, hormones or SRS to stay alive. It’s just effective political framing to make it look like a generic “gay right’s” issue.

        Most of the people who behave hatefully to me nowadays are the trans loons and their allies.

        Liked by 1 person

    • Hmmmmm. It’s interesting that you use the term “false equivalence” to slam the piece. I had actually given the issue (which actually isn’t “false equivalence” although I think I know what you’re trying to get at) some thought when I was drafting it, and that’s why I tried to focus on the question of allocation of scarce resources. I added a paragraph to the effect that the analysis could be performed using any other comparison – dental care just struck me as something especially sad, since so very many people are affected, and their lives could be markedly improved at comparatively low cost. Poor people are actually also a “marginalized” group, although I guess their concerns are not quite as important.

      I thought the article was fairly clear that choosing to spend money on transgender procedures rather than dental care is something that’s informative in and of itself, and that in a world where we don’t have money for everything, it’s significant when money is spent for one thing and not another. While it’s true that law and policy makers aren’t making the conscious decision to trade off dental care (specifically) against transgender care (specifically), the “privileging” if you will of transgender care, against other necessary care for greatly more people, should be highlighted. I also felt it was ironic that a group whose stock in trade is that it is the most maligned and discriminated against in the history of human-kind, was actually preferenced, at least in the health care arena.

      The other comment (which is made in a different response) concerning it being “none of my business” and “irrelevant” that private health insurance pays for transgender care does betray a bit of ignorance about how health insurance works. Just like things that are paid for by “tax money,” unless there’s a health insurance company just for you, in fact everybody who’s in that pool pays for the care. The costs are indeed shared. When a state like California mandates inclusion of transgender procedures in private insurance, everybody who buys private insurance pays a little extra. And, that “extra” could be directed elsewhere, to covering – for instance – dental care.

      The rest of your remarks boil down to, “you’re a hater,” which isn’t actually an argument. And, specifically now, that I hate the “LGBT community.” I’d submit that people like myself who are opposed to pediatric gender “therapies” are the ones who actually love our gay and lesbian children. We would like to see them grow up to embrace their own healthy bodies and sexualities, and there’s nothing hateful about that. If the transgender lobby gets its way, there won’t be much of a “community” left to love OR hate.

      Liked by 4 people

    • In your opinion, why do you think dental care is not included as part of many state/govt issued insurances? In other words, insurance will pay for say, doctor visit & antibiotics for a sinus infection, but not for cavity fillings.


  17. So, none other than the Washington Post ( is now highlighting the damage done to our society by lack of access to dental care. While the article doesn’t connect the dots regarding choices in resource allocation, it does provide even more facts, figures and stories about this crisis.

    Liked by 1 person

  18. Tegan writes: “Look, if you hate the LGBT community and want them to not be covered for the care that keeps them alive, then just SAY IT.”

    Tegan, have the basic dignity to stop dribbling snot on the nice clean floor. It is unseemly. Also, don’t use the Ls and Gs and Bs as your human shields unless they’re gullible enough to VOLUNTEER.

    But Tegan’s line of attack is, sad to say, boilerplate rhetoric in gay media outlets when “religious exemptions to non-discrimination laws” come under discussion. The are plenty of logical reasons to be suspicious of such exemptions, but the logical reasons aren’t scary and sensationalist enough for a juicy headline.

    So instead you get “Catholic hospitals could deny essential life-saving treatment to LGBT patients!” You’re meant to think a religious-fanatic oncologist could refuse to continue therapy for a breast-cancer patient because it’s revealed that she’s a SINFUL LESBIAN. Or that Bible-thumping ER surgeons would “be allowed by law” to let a gay man like me bleed-out on the sidewalk if I happened to have been wearing a rainbow-flag T-shirt when the truck hit me. But in actual practice, what we’re talking about is not getting involved with physical transitioning procedures for people attempting to become the opposite sex.

    (Yes, I’ve heard of the case where a fertility specialist who assisted with third-party sperm donations for heterosexual couples refused, on religious grounds, to do exactly the same procedure for a lesbian couple. Whether one thinks the doctor’s refusal amounted to admirable integrity or shameful hypocrisy, such fertility assistance is clearly outside the category of “essential life-saving treatment.”)


  19. I was looking for some tax return information and this 4thWave post from Worried Mom from last year came up and I just reread it. It hit me as if if it were the first time I read it because since a year ago, the contrast in what is legal vital healthcare and what is not seems even sharper.

    Healthy young bodies receiving what is in truth elective gender reassignment surgery with tax payers’ money.Yet if basic healthcare of their mouths ,by and through which they breathe, eat, speak, kiss, drink, sing, scream, humm, etc…, is needed, NOPE, no can do. LOOK at the insanity of this.

    No Care for Mouths and Mental Health….and look at the progress we are making.


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