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Comment by bayesian_horse | Hacker News Reader

Any kind of health insurance or health system has to draw the line somewhere.

Not covering novel, risky and expensive "elective" surgeries is relatively easy to justify, compared to other stupidities in American health care.

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I spoke to several of my friends about this. People of both genders I discussed the surgery with have said they'd seriously consider suicide if their genitals were destroyed.

I'm not saying this to make light of the situation; my point is that I would expect the risk of suicide caused by this kind of injury to make such a surgery of medical importance. Compare, for example, that several governing bodies consider gender reassignment surgery to be of medical necessity for transgender individuals who want to transition because of the dramatic reduction in suicide.

I'd consider gender reassignment surgery to be less elective, less expensive and less risky. There is a condition called gender dysphoria, and for a lot of patients hormones and living their gender identity doesn't alleviate it. I'm "cis", so I can't fully understand the situation transgender people are in, but I would hope that we can get to a point where genitalia matter less for gender identity. Easier said than done, probably.

It also depends on how much of your sense of self worth or identity is entangled with your sexual "functioning". I believe I wouldn't opt for such a surgery. Of course, I'm not in this terrible situation. And I can imagine other people having enough of a problem with these parts missing.

Speaking just about the costs, intensive psychiatric and therapeutic care should be more cost effective, and it's necessary in most cases, anyway.

> self worth or identity

Wow, that's rich. Is it really beyond your comprehension that someone might be deeply hurt by losing the capability to engage in sexual relations with their significant other? I know you say you 'can imagine other people having enough of a problem' but I'm not sure you really do when you word it that way. I agree that it's more expensive and more risky than gender reassignment but I don't understand why someone trying to return to a fully functioning body is considered "elective".

From the emotion in your response I gather you interpreted my words to be derogatory. Far from it, I see self worth and identity as important, and I don't want to judge those who involve their sexual functioning or their appearance in their sense of self worth. I certainly do, to some extent... I just think (or hope) my sense of self worth would survive without it.

I think the big issue is that this is an experimental and previously unproven remedy.

Speaking of gender reassignment surgery, is there any reason a penis couldn’t be transplanted onto a trans man?

I'm not an expert. But in this case, I believe there was some part of the penis left, making things a lot easier.

As far as I understand it, "reconstructive" methods using the female organs/tissue to provide part of the function is easier and less prone to complications. Keep in mind: A trans man can have sex with a partner before reassignment surgery. He just can't perform it in one particular way.

Finding a suitable donor, high change of rejection, etc., are the main reasons.

Then there's the price of it and the issues of finding surgeons who would be able to.

Right now, the option is pretty much a (huge) cosmetic surgery, so you can get it done "easily". Doing a full transplant would mean a much more complicated operation.

As long as it is an experimental surgery, it may be quite simple to find a donor, considering no competition.

I don't know if the donor or his family has to consent specifically to donating an organ which is normally not donated and where the procedure has a much lower chance of succeeding.

If a country with the resources of the US or most other developed nations wants to send people off to war, the deal should be that those men and women will be made as whole as possible again when they come back.

There are serious shortcomings in veterans' care when returning from combat, and we shouldn't regard any of it as "elective". Spending significantly more resources on veteran care might also help some countries reconsider the costs of war before engaging in it.

For a good book on the subject, read "What It Is Like To Go To War", by Karl Marlantes.

This is what "support the troops" should mean.

It's not just about the resources, but also about the ethics of experimental surgery. You'd essentially have a state paying for someone to harm himself. That has to be debated thoroughly, at least.

In my opinion, this is not a matter of health insurance. This is more comparable to a workplace injury. If I worked as a construction worker for instance, and suffered a debilitating injury or Asbestos poisoning because of the work, in a just society I would expect compensation from the employer, that covered the costs of fixing or mitigating it to the best of medical capability.

That surgery seems to be just beyond the best of medical capability. Or a lot worse, considering that the risks must be rather high.

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