Calif. Requires Insurers to Pay for Breast Mutilation for Gender-Confused Teens

AP Photo/Rich Pedroncelli

Just before the end of 2020, California Insurance Commissioner Ricardo Lara issued an order stating that insurance companies cannot refuse to pay for a minor girl’s mastectomy just because she isn’t 18 yet. He reached this conclusion by defining the surgical removal of healthy breasts and the “creation of a male chest” as medically “necessary” for girls suffering from gender dysphoria (the painful sense of identifying with the gender opposite their biological sex) rather than “cosmetic.” This means that a gender dysphoric girl’s healthy chest would be considered “abnormal” if she identifies as male.


“For far too long, individuals diagnosed with gender dysphoria have had to battle a host of challenges to get access to gender-affirming care in order to be their true selves,” Commissioner Lara said in a statement. He suggested that requiring girls to be 18 before they surgically remove their breasts is an example of “outdated medical criteria” that “create barriers to necessary medical care.”

Lara had his general counsel issue this order after the group Trans Family Support Services submitted a request to the California Department of Insurance asking whether it is legally permissible for insurance providers to deny transgender mastectomy coverage for girls under 18 due to their age. Lara ruled that “insurers may not deny coverage for a mastectomy and creation of a male chest (‘male chest reconstruction surgery’) for treating gender dysphoria in female-to-male patients based solely on the insured individual’s age.”

Note the Orwellian redefinition of terms. When an otherwise physically healthy gender-confused girl under 18 removes her breasts and has her chest reshaped to appear like that of a man, the insurance department terms this “male chest reconstruction surgery.” It uses the term “mastectomy” without acknowledging that this involves the removal of healthy tissue.

Yet the order proves far more explicit in redefining what is “normal.”

“Insurance Code section 10123.88 requires all health insurance policies to cover reconstructive surgery necessary to ‘improve function’ or ‘create a normal appearance, to the extent possible,'” The order notes. “Reconstructive surgery is defined as ‘surgery performed to correct or repair abnormal structures of the body caused by congenital defects, developmental abnormalities, trauma, infection, tumors, or disease to do either of the following: (A) To improve function. (B) To create a normal appearance, to the extent possible.'”

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Tellingly, the order admits that “The statute clarifies that the mandate in Section 10123.88 does not require coverage for ‘cosmetic surgery,’ which is defined as ‘surgery that is performed to alter or reshape normal structures of the body in order to improve the patient’s appearance.'”

Despite this, the order claims that “male chest reconstruction surgery… recommended by a health care provider for treating gender dysphoria in a patient transitioning from the female to male gender constitutes reconstructive surgery as defined in Insurance Code section 10123.88(c)(1)(B), as it creates a normal appearance, to the extent possible, as part of the treatment of gender dysphoria.”

Finally, the order insinuates that any refusal to remove healthy breast tissue from minors amounts to discrimination on the basis of “actual or perceived gender identity.”

In other words, healthy breasts are “abnormal” for girls who identify as boys. The removal of healthy breast tissue is considered “necessary” and not “cosmetic,” even though it removes the normal “function” of the healthy tissue. The Department of Insurance declares that removal of this tissue and its replacement with tissue to make the chest appear male counts as “surgery performed to correct or repair abnormal structures of the body.”

Nevermind the harrowing stories of women who identified as male in their teens and twenties only to reject that false identity later in life. Charlotte Evans, a woman who previously identified as male, says she has been contacted by “hundreds” of people in similar situations seeking help. She argued that the hormones of puberty can contribute to gender confusion, and suggested that most transgender people would detransition when their brains fully mature around age 25, so long as they did not take hormones or undergo surgery.

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“I am a real, live 22-year-old woman, with a scarred chest and a broken voice, and five o’clock shadow because I couldn’t face the idea of growing up to be a woman, that’s my reality,” admitted Cari Stella in a deeply personal YouTube video.

Michelle Cretella, executive director of the American College of Pediatricians, told PJ Media that “the surgical mutilation of healthy breasts which can never be replaced” does incalculable damage “to emotionally disturbed girls and women.”

“The commissioner is requiring insurance companies to pay surgeons to remove the healthy breasts of emotionally distraught girls and women and implying it is ‘necessary treatment’ – yet we already have multiple studies demonstrating that mutilation does not treat gender dysphoria,” Cretella added, noting that the American Journal of Psychiatry issued a “correction” — that, in practice, worked out to a retraction — to a study claiming that transgender surgery helps mental health. Follow-up analysis “demonstrated no advantage of surgery in relation to” anxiety.

“No one is ‘born in the wrong body,'” Cretella insisted. “Sex is determined at fertilization by genetics. Every nucleated cell of the human body reflects this sex. When girls believe they are something or someone they are not a psychological problem exists. Counseling and/or psychiatric medications to treat underlying traumas and causes are the answer; not physical mutilation at the hands of a so-called physician.”


“Orwellian newspeak does not change this fact. To insist on payment for the surgical mutilation of any patient, most especially an emotionally or psychologically troubled child, should be considered criminal for obvious reasons,” the pediatrician added.

Late last year, Britain’s High Court ruled that children under 16 could almost certainly not give consent to receive so-called “puberty-blocking” drugs because those drugs set them on a path to cross-sex hormones and irreversible surgery.

Even so, the mutilation of children’s bodies and the use of transgender drugs that essentially cause chemical castration in the name of transgender identity has become a partisan issue, with Democrats supporting experimental and dangerous treatments even at young ages.

Tyler O’Neil is the author of Making Hate Pay: The Corruption of the Southern Poverty Law Center. Follow him on Twitter at @Tyler2ONeil.

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