People on the hormone will also notice fat redistributing around their hips and thighs and their faces take on \u201ca more female appearance\u201d as fatty tissue changes there too, she says.<\/p>\n
Transgender men, on the other hand, can take testosterone to achieve the opposite effect: fat begins to move towards the gut, the arms become more muscular and the face becomes more angular.<\/p>\n
Because transgender men\u2019s bodies won\u2019t ever produce testosterone naturally \u2014 and vice versa for transgender women \u2014 HRT is a lifelong treatment.<\/p>\n
After her morning exercise session, Morris usually takes out her favourite mug and makes herself black coffee with a sweetener. She says she\u2019s trying to cut down her sugar intake. After coffee follows breakfast \u2014 almost always a Granny Smith apple. But before she takes a bite, she pops two tablets into her mouth \u2014 one blue, one white.<\/p>\n
It\u2019s her oestrogen. And, because she\u2019s transgender, she needs to pay for it herself.<\/p>\n
Morris has medical aid but most schemes don\u2019t cover gender-affirming treatments such as HRT.<\/p>\n
Bhekisisa surveyed six of the country\u2019s largest medical schemes: the Government Employees Medical Scheme (Gems), Fedhealth, Discovery Health, Momentum Health, Bonitas and Profmed. Together, these schemes are responsible for more than three-million people \u2014 or almost a third of all privately insured South Africans, according to the\u00a0Council for Medical Schemes\u2019 latest annual report.<\/a><\/p>\n Momentum Health and Bonitas declined to comment. But the survey found that Gems, Fedhealth and Profmed require members on HRT to pay for the chronic medication out of their medical savings and when that is exhausted, eventually, their pockets.<\/p>\n Discovery Health is running a pilot programme that pays for surgery as well as hormonal treatment. So far it has approved care for two out of the five patients who applied to be part of the programme.<\/p>\n She explains: \u201cNot everybody can afford R800 a month. I find it very difficult and that\u2019s just to maintain [my health] \u2014 it\u2019s a basis for living.\u201d<\/p>\n For decades, studies have\u00a0suggested that members of the LGBTI community face an increased risk of suicide, in part because of the stigma they face.<\/p>\n Research<\/a>\u00a0published in 2008 in the journal\u00a0BMC Psychiatry<\/em>\u00a0reviewed 25 different studies focusing on suicide and self-harm among LGBTI people and found that, overall, adolescents and adults were almost twice as likely as heterosexual people to report having attempted suicide in the past 12 months.<\/p>\n A\u00a02014 study<\/a>\u00a0conducted among 900 transgender people in the United Kingdom found that eight out of 10 of those surveyed had thought about ending their lives. Some reported that delays in getting gender-affirming surgery or HRT contributed to thoughts of self harm.<\/p>\n The research, published in the\u00a0Mental Health Review Journal<\/em>, found that almost seven out of 10 people surveyed said they thought about ending their lives before surgery, but just 3% said the same after receiving this type of care.<\/p>\n To try to ensure that people in need of chronic medication don\u2019t go without, the law prescribes that 25 lifelong conditions such as asthma, diabetes and hypertension must be covered in full by medical aids. Illnesses such as these form part of what is known asprescribed minimum benefits (PMBs)<\/a>, which also include emergency care, mental illnesses and heart disease.<\/p>\n On the road to a\u00a0National Health Insurance<\/a>, the recently released Medical Schemes Amendment Bill proposes scrapping PMBs in favour of a\u00a0more comprehensive package of conditions and services<\/a>. But it\u2019s unclear what conditions would be included.<\/p>\n Right now, however, gender-affirming treatment \u2014 vital and sometimes lifelong as it is \u2014 isn\u2019t a PMB.<\/p>\n Why not? The answer may say more about society than it does about medicine, University of Cape Town clinical social work lecturer, Ronald Addinall,\u00a0says.<\/p>\n \u201cHistorically, private medical aids classified gender-affirming interventions such as hormone-affirming treatment and gender-affirming surgeries as \u2018lifestyle choices’ and not as quality of life priorities,\u201d he explains.<\/p>\n But surgeon Kevin Adams argues that medical aids should be covering this type of care. Based in Cape Town, Adams specialises in gender-affirming surgery and says he advises patients to check whether procedures are covered by their medical aid before going ahead.<\/p>\n If doctors have cleared a patient for surgery and a medical aid refuses to pay, then patients should seek legal advice, he says.<\/p>\n Legally, medical aids that don\u2019t cover such treatment may be violating trans people\u2019s constitutional rights,\u00a0Legal Resource Centre<\/a>\u00a0attorney Mandy Mudarikwa argues.<\/p>\n \u201cSection 9 of the\u00a0Constitution<\/a>\u00a0prohibits discrimination, among others, on the grounds of gender. The blanket exclusion of all gender-affirming care in the PMBs is contrary to the Constitution, specifically the rights to equality, dignity and access to healthcare among others,\u201d she explains.<\/p>\n But, she says, the crux is that many medical aids continue to believe that gender-affirming treatment is a choice, rather than a health need.<\/p>\n \u201cSchemes often categorise surgeries as cosmetic. Yet equality is both a value and a right in South Africa.\u201d<\/p>\n But the fate of trans people could change.<\/p>\n The head of healthcare and life sciences at\u00a0Werkmans Attorneys<\/a>, Neil Kirby, says patient groups can lobby the\u00a0Council for Medical Schemes<\/a>\u00a0to amend the Medical Aids Act on socioeconomic grounds, arguing that the cost of gender-affirming treatment is too high and compromises the right to health enshrined in Section 27 of the Constitution.<\/p>\n Morris is hoping to collect the evidence needed to make such a demand.<\/p>\n For the past 16 months, she has been gathering information on what kind of transgender care medical aids cover and under what plans. She wants to use the data to show the Council for Medical Schemes just how far away South Africa is from upholding\u00a0international\u00a0guidelines<\/a>\u00a0\u2014 and hopefully change legislation to fix this.<\/p>\n Discovery Health is already rethinking its benefits. For more than a year the scheme has been piloting changes to the way it funds transgender care, providing both surgery and HRT to some members. But there\u2019s a catch.<\/p>\n To qualify for the pilot, people must have been a member of the scheme\u2019s executive or comprehensive plans \u2014 among Discovery\u2019s most expensive options \u2014 for at least three years, Noluthando Nematswerani, Discovery Health\u2019s head of clinical policy says.<\/p>\n But a member of the executive plan pays almost R6000 a month in premiums.<\/p>\n Morris argues that this is unaffordable for most people and that members of those schemes are already likely to be able to pay for treatment out of their own pockets.<\/p>\n Meanwhile, Morris is a step closer to reaching her goal. After negotiations with Discovery Health and threats to take them to the Council for Medical Schemes, they\u2019ve agreed to pay for her HRT.<\/p>\n \u201cBut they are going to have to process the claims manually because their system will reject it,\u201d she explains.<\/p>\n \u201cI want medical aids to play fair according to the Constitution, and implement fair support for trans surgery, which is life-affirming and often life-saving.\u201d<\/p>\n![](\"https:\/\/cs.mg.co.za\/content\/images\/2018\/10\/25\/gXK5OML5TYCuVWTkTOkG_TransgenderHealthWhatDoMedicalAidsOffer.jpg\"){kind=spacer}
In the past, Morris tried to use her medical aid savings to pay for her HRT \u2014 but her scheme wouldn\u2019t always pay up. Today, she spends about R800 a month from her own pocket for the daily tablets. If she lives as long as the average South African, she will have spent almost a quarter of a million rand on the medication.<\/p>\n![](\"https:\/\/cs.mg.co.za\/content\/images\/2018\/10\/25\/nY7KoiCTZmS2JbvYVLwR_medication_7953.jpg\")
\nAccess to gender-affirming surgery and treatment has been shown to help reduce thoughts of self harm\u00a0and suicide among transgender people in some studies. (Oupa Nkosi)<\/strong><\/em><\/p>\n