Two transgender women, Carol Ann Beal of northwest Iowa and EerieAnna Good of the Quad Cities along with the ACLU of Iowa have challenged the Iowa Medicaid ban on coverage for transition-related medical services as being a violation of equal protection under the law "as promised by the Iowa state constitution and the Iowa Civil Rights Act."

As the result of this sweeping exclusion, all surgical treatments for gender dysphoria are excluded from coverage, even though the same or substantially equivalent treatments are provided to non-transgender Iowans.

--Rita Bettis, Iowa ACLU

For example, mastectomies are covered when they are for treatment of cancer, but not for treatment of gender dysphoria.

Medicaid of Iowa specifically excludes "procedures related to transsexualism, hermaphroditism, gender identity disorders or body dysmorphic disorders."

Gender Identity and sexual orientation were added to the Iowa Civil Rights Act as protected classes in 2007.

Reading a prepared statement, Beal said she has known since she was 5 that she's female, despite being born with male genitalia. She said she started taking hormones at 14 and has lived as a woman since then. She is currently working toward a bachelor’s degree in public health and epidemiology, she said, and both her family and her spouse are supporting her through this litigation.

You go through so many years transitioning, and now I hit a brick wall with Iowa’s discriminatory ban on Medicaid coverage for transition-related care. It has caused me stress and depression and affects every aspect of my life.

But I remain determined to change this outdated law and move forward with my life.

--Ms. Beal

Dr. Joe Freund, who is one of the most sought transition doctors in the state, strongly believes that medical intervention, including surgeries, can be necessary for some transgender patients.

Without these surgeries, transgender patients can experience extreme depression and anxiety and may have suicidal thoughts.

There is a tremendous amount of damage that is done to someone when their body does not match who they are. People don’t understand how very important this is. … It is costing people their lives.

--Freund

Dr. Freund cautioned that not every transgender person wants surgery.

Transitioning is a spectrum, and some patients find alignment with their inner and outer selves simply by dressing in gender-specific clothing.

Where else are we asking any other group of people to prove that their medical need is necessary to get addressed. This should be something between a physician and a patient.

--Freund

When prescribed by a doctor, all forms of transition-care, including surgeries, are recommended by most professional medical organizations, including the American Medical Association, the American Psychological Association and the American Psychiatric Association.

It is estimated that Iowa has 9300 transgender residents.

I look forward to the day when someone needing to get the transition-related medical care they need isn’t in the news because they had to go to court to fight for this.

--Beal