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IRS Agrees To Exempt Some Sex Reassignment Surgeries (Except For Boob Jobs)

From the time she was 10, Rhiannon O’Donnabhain felt uncomfortable with her biological gender. As an adolescent she secretly dressed up in women’s clothes and as an adult she tried marrying a woman. But though she fathered three children, something still didn’t feel right. So she eventually divorced and underwent about $5,000 worth of sex reassignment surgery.

But when she tried to deduct the surgery costs from her taxes, the IRS denied her, saying the procedure was entirely “cosmetic.” So in 2006 she sued. And this week a Tax Court found in her favor… well, mostly in her favor anyway.

O’Donnabhain’s 2006 lawsuit called her surgery necessary for “a serious medical condition.” And the U.S. Tax Court’s decision agreed with her. As a result, the IRS acquiesced to exempt such procedures from taxation henceforth.

And while that’s awesome news for the thousands of transgender people who opt to undergo reassignment surgery, two things stick out about the decision:

1) The court did not exempt O’Donnabhain’s breast augmentation surgery because, “it was directed at improving her appearance and not to treat disease as construed by the tax code.” Even though the court did not rule out the possibility of exempting chest surgeries in the future, it’s interesting that they don’t see the necessity of breast augmentation towards bringing one’s body in line with their perceived gender. Would they have considered a mastectomy for a FTM trans person “cosmetic” as well?

2) The decision still reeked of transphobia. University of Pittsburgh law professor Anthony Infanti called some of the wording in the court’s dissenting opinion “clearly hostile to the taxpayer.” Even Judge Mark V. Holmes’s decision in favor of O’Donnabhain said that the decision put tax courts “into culture wars in which tax lawyers have heretofore claimed noncombatant status.”

Whether you like the official medical diagnosis or not, O’Donnabhain was able to claim exemption because her surgeries helped treat “Gender Identification Disorder”, a psychological diagnosis that pathologizes transgender identity and seeks to “cure” it the same way some ex-gay therapies seek to “cure” homosexuality. While transgender people don’t see their identity as a mental pathology, they do want the medial community to recognize the necessity of reassignment surgeries for a trans person’s ability to live and function well in life.

It’s great though that the U.S. Tax Court’s decision brings the trans community one important step closer towards having corporate insurers, medical professionals and the greater government recognize that necessity of and eventually create a minimum basis of medical care that should be afforded for all trans citizens.

By:           Daniel Villarreal
On:           Nov 11, 2011
Tagged: , , , , , , ,

  • 16 Comments
    • Riker
      Riker

      THIS is why transpeople who want GID taken out of DSM-V are complete idiots. If it isn’t a medical problem, you can’t have medical insurance pay for it. GID means that your psychological gender doesn’t match your biological sex. The easiest way to treat it is to change the biology to match the psychology.

      Nov 12, 2011 at 1:57 am · @ReplyReply to this comment ·
    • the crustybastard
      the crustybastard

      @Riker:

      Never thought of that. Good point.

      Nov 12, 2011 at 11:54 am · @ReplyReply to this comment ·
    • QJ201
      QJ201

      @Riker: Yes, BUT, GID is the only “psychological” disorder that requires “surgical” treatment. However, the point is valid about getting insurance to pay for it.

      As for boob jobs, too many trans women are in a big rush for the boob job without waiting to see what effect taking hormones for a year will have. I mean no bio-girl’s boobs magically pop up overnight during puberty.

      Nov 12, 2011 at 1:48 pm · @ReplyReply to this comment ·
    • missanthrope
      missanthrope

      @Riker:

      I have been skeptical of taking GID out of the DSM and have been for quite some time (mostly for health insurance reasons).

      But there is merit to the argument that it should be strictly medicalized as much as having a broken leg is medicalized. Putting it in the DSM pathologicalizes it and indicates that my identified gender is disordered. But my gender is not disordered. However a society that makes a person jump through a bunch of psychological hoops just so a person can be themselves when they need no psychological help is clearly wrong. For too long I’ve watched fellow trans people dole out hard earned money to get therapy that they don’t need to psychologists who are inexperienced with trans people and unnecessarily put up barriers to the health care that they need.

      Hopefully the need to keep GID in DSM for medical coverage evaporates in 2014 if the Affordable Health Care Act is upheld and onerous exemptions, like exemptions on trans health care coverage, are eliminated.

      Without these horrible exemptions that affect everyone who seeks health care, there is barely any need to keep it in DSM. There are other alternatives to treating trans people without saddling us with the stigma of being mentally ill.

      Nov 12, 2011 at 6:55 pm · @ReplyReply to this comment ·
    • Riker
      Riker

      @QJ201: It is a psychological disorder because something is wrong with the person’s brain in that the person believes they are a different gender than the one they are born into. Clearly something is psychologically wrong with the person.

      Hormones likely also play a part in transgender identity, so GID could also be classed as a neurological disorder.

      As for the surgery, there is no known treatment using therapy alone. We simply don’t know how to change a person’s gender back into the one which corresponds to their biological sex. Even if we could, the ethics of such would be…questionable at best. Since we can’t change the psychology, but the biology is fairly easy to change, the person’s gender and sex are brought into line in that way.

      Nov 12, 2011 at 7:14 pm · @ReplyReply to this comment ·
    • G.I. Joe
      G.I. Joe

      @ Riker:

      No. A lot of research points to feminization of the brain (in case of trans women) and masculinization of the brain (for trans men) in utero. Meaning that it’s “psychological”.

      It isn’t because you can’t see it that is is any less legitimate than the feminization or masculinization of exterior body characteristics such as the sex.

      And you can have it covered and treated as a medical condition just like people who are born with a cleft lip get surgery instead of being told the surgery is only cosmetic.

      Nov 12, 2011 at 8:45 pm · @ReplyReply to this comment ·
    • G.I. Joe
      G.I. Joe

      @G.I. Joe:

      “Meaning that it’s “psychological”. > I meant NOT psychological, obviously. That’ll teach me not to preview before posting.

      Nov 12, 2011 at 8:46 pm · @ReplyReply to this comment ·
    • Shannon1981
      Shannon1981

      I am torn on this one. While I absolutely hate any LGBT identity being on the DSM, as it implies we are all mentally ill (remember, to the straight community, we are all the same group, no matter the individual letters), it would be foolish to remove transgender identity from it due to the medical costs. As for the breast augmentation- correct me if I am wrong, but don’t the hormones help them grow breasts? If so, why the augmentation?

      Nov 12, 2011 at 9:30 pm · @ReplyReply to this comment ·
    • Riker
      Riker

      @G.I. Joe: The entire notion of gender and gender identity is a social and psychological construct. Gender identity is, in 99% of people, the same as sex, which is biological. Man and Woman are terms referring to gender, while male and female refer to sex.

      While the cause may well be in utero (hasn’t been proven yet,, but it seems to be the most reasonable hypothesis), that means that the mother’s hormones or other environmental factors affect the development of certain neural pathways, which creates a fundamental inconsistency between the brain and the body. This causes tremendous distress to the person affected, and is not part of the normal development of a human, which is pretty much the textbook definition of a mental disorder.

      So here, we have a neurological disorder (altered brain circuits) causing a psychological one (internal inconsistency between body and brain). Since we don’t yet have the technology to fix those circuits, and won’t for quite some time, the easiest way to resolve this inconsistency is to change the body.

      Nov 13, 2011 at 2:02 am · @ReplyReply to this comment ·
    • Kevin
      Kevin

      @Riker: Of course the bigger question then becomes, should we have the technology to “fix” the circuits, should they even be fixed? I would argue that they’re not really broken, in the sense that the brain functions perfectly well, just not in the body attached to it. That is, the brain of a MTF transgendered individual would be totally normal were it within a genetic woman, and given that the brain is the seat of the personality, I would think the brain should be sacrosanct unless it has some internal malfunction, which a transgendered person’s brain doesn’t.

      Nov 13, 2011 at 2:29 am · @ReplyReply to this comment ·
    • Christine
      Christine

      It should be thought of as an intersex condition and the diagnosis requires hormone therapy and in most cases surgery to bring the body into line.

      It should be carefully regulated with the decisions ultimately being driven by the patients expressed needs as failure to do so puts the health of the patient at risk due to extreme mental anguish.

      If you are trans and don’t transition early it is extremely likely that by the time you do you are completely broken and beside yourself. The realization that I denied from age 5 to age 35 hit hard. It ended only after I realized how utterly stupid it was to continue denying it. That took a noose and about a dozen police officers

      It took my daughter telling me she wanted me to live because I felt like such an utter failure.

      How much better would it have been if all along I had understood and been encouraged to just accept myself?

      How much longer can we let politics put politics over people’s lives? We’re dying here. We kill ourselves, we are lit on fire and burned to death, we are teased and bullied mercilessly. People slander our reputations and tell lies that just aren’t even remotely true.

      That’s an outrage. It’s morally bankrupt.

      Nov 13, 2011 at 5:07 am · @ReplyReply to this comment ·
    • Riker
      Riker

      @Kevin: If I might direct you to post number 5, I already covered that with “Even if we could, the ethics of such would be…questionable at best.” That’s a problem for the philosophers, not the scientists. We won’t have that sort of technology for quite a while, so the question is moot for now.

      However, I would contend that the brain of, for example, a MTF transperson is biologically more similar to the male brain than female brain. It is generally about 4% larger by mass than a natural female brain, and has a higher ratio of grey to white matter. The individual things that identify GID we can’t test for yet medically, but much of the brain structure is dependent on chromosomes.

      Further, the brain of a transperson doesn’t function perfectly well. The brain and the body are inconsistent with each other about such a basic concept as sex and gender. As Christine says in post 11, “If you are trans and don’t transition early it is extremely likely that by the time you do you are completely broken and beside yourself.” This inconsistency causes major harm to the person affected, impairing their ability to function within society.

      Compare that to gay people for a moment. While my neurons also fire differently than “normal” men, they are entirely consistent with each other. Thoughts and feelings that most men have towards women, I have towards men. That part is similar enough with transpeople. The difference is, my body responds in the appropriate manner. When my brain is aroused by another man, my penis gets hard and all of those other wonderful things happen.My brain may work differently than the standard, but it and my body are on the same page.

      For a gay man, any psychological damage he may have comes from external sources, i.e. discrimination against him. Transmen have that too, but they also have the internal chaos Christine described. That is why homosexuality is not a mental disorder, but GID is.

      Nov 13, 2011 at 8:06 am · @ReplyReply to this comment ·
    • missanthrope
      missanthrope

      On a scientific level (ie. real peer-reviewed evidence), speculation about the etiology of being trans (I will not classify my gender identity as a “disorder”) is just that, pure speculation. Neurologists have some good leads and people have speculated to fill in the gaps, but so all we have is assumptions and those assumptions could be proven wrong tomorrow. That’s how real science works.

      I would speculate that being trans is probably a cluster of things all happening possibly at once, as we learn more about complex brain conditions the more scientists find out that there are no “smoking guns” or genes that “turn on and off” like a light switch. For all that we know, what the medical establishment refers to “Gender Identity Disorder” could be several conditions manifesting themselves in similar ways or visa versa.

      Like I’ve said before, except for the legitimate medical insurance reasons, there is absolutely no logical argument for “G.I.D” to be in the DSM.

      Without conclusive, peer-reviewed and proven evidence;

      “” This inconsistency causes major harm to the person affected, impairing their ability to function within society.”

      No, that’s anxiety and trauma disorders cause through dealing with a stigmatized medical condition that hasn’t been treated. Psychologists don’t declare that an abuse survivor suffering trauma through abuse has a “abuse survivor syndrome”, they are diagnosed with PTSD because of a traumatic event that was not pathological in and of itself. Not all trans people that I’ve known have had trauma caused through being trans, only discomfort and body dysphoria.

      Trauma caused through being trans can be covered through trauma therapy after the insurance exceptions are no longer present. “G.I.D” in and of itself could be treated as a medical condition with little or no psychological hurdles.

      Nov 13, 2011 at 7:39 pm · @ReplyReply to this comment ·
    • George
      George

      These comments are some of the most logical and respectful discussion I’ve seen on this forum.
      Way to go!

      Nov 13, 2011 at 10:55 pm · @ReplyReply to this comment ·
    • Transgender Law Center
      Transgender Law Center

      Correction: Although Rhiannon did not have her breast augmentation qualify as tax deductible, the ruling does not preclude others from claiming procedures like this. Each individual’s case will be subject to audit.

      Recognition from the federal government that transgender people deserve to be treated with fairness, dignity and respect is an important milestone in our efforts to achieve full equality!

      Nov 14, 2011 at 4:01 pm · @ReplyReply to this comment ·
    • toob30
      toob30

      Arabc

      Jul 26, 2013 at 2:44 pm · @ReplyReply to this comment ·

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