Sexuality and gender identity issues have had a long history in the fields of mental health and public policy. There has been much debate surrounding the inclusion of issues related to gender and sexual identity in the Diagnostic and Statistical Manual since its initial stages of development (Drescher, 2010). Debates in this field of interest have been fragmented between several stakeholders (Ehrbar, 2010). This fragmentation has created complications in the process of developing United States policies that are inclusive of individuals with gender identities that do not match the gender to which they were assigned at birth. Specifically, policies surrounding gender reassignment surgeries have been difficult to develop and pass on a federal level (Taylor, 2007). To date there appears to be no specific federal level policy regarding the mental health procedures and correlated documentation required to receive gender reassignment surgery. In addition, there are very few state level policies regarding insurance coverage of these procedures (Taylor, 2007). Much of these policy issues are closely tied to the lack of consensus on the ethical, professional, and social implications of the inclusion of Gender Dysphoria as a mental health diagnosis in the DSM-V (Ehrbar, 2010). Because there is little consensus across various stakeholders regarding the process of determining eligibility for gender reassignment surgeries many of these issues are extremely difficult to address. To those in the non-cis gender community this has created many layers of difficulty in accessing adequate care throughout the reassignment process including insurance coverage, mental health care, surgical procedures, and documentation accurately reflecting the individuals’ gender. Stakeholders share concerns about the inclusion of Gender Dysphoria in the DSM-V and the implications for the continued stigmatization of gender identity differences, access to healthcare (including surgical procedures and mental healthcare), and insurance coverage of medical care (Lev, 2013) (Ehrbar, 2010).
2. Historical Development
Discussion of issues related to non-normative sexual and gender identities as related to mental health began in the 19th century (Drescher, 2010). Initially medical and psychiatric providers viewed issues related to gender identity as resulting from delusional thought processes (Drescher, 2010). As a result the concept of surgery as a solution to gender identity differences was viewed as unnecessary and ultimately an incorrect form of treatment (Drescher, 2010). In 1952 the first gender reassignment surgery was performed in Denmark on an American citizen (Drescher, 2010). The publicity in the American media that followed this surgery brought the concept of gender identity to the public eye. During the 1960s research about gender identity started to develop and it was the work of Money, Stoller, Benjamin, and Green that ultimately change professional and public...