All major clinical specialties are represented. A low total testosterone level, below the normal range as defined by the laboratory performing the test; A total testosterone level near the lower limit of the normal range and a low free testosterone level which is less than normal based upon the laboratory reference range; Treatment of hypogonadotropic hypogonadism (congenital or acquired) due to Idiopathic gonadotropin or luteinizing hormone-releasing hormone (LHRH) deficiency, pituitary-hypothalamic injury from tumors, trauma, radiation and who have documented testosterone deficiency as defined by, Delayed puberty in males greater than 14 years of age with either physical or laboratory evidence of hypogonadism as defined by. A doctor may prescribe hormone therapy to relieve these symptoms. She first realized she was transgender in her 30s, but didnt approach an endocrinologist about hormone treatments until age 45. Transgender teens have a high risk of attempting suicide, according to the Centers for Disease Control and Prevention. She works in Leadville, CO and 3 other locations and specializes in Family Medicine. von Willebrand factor (Recombinant) [Vonvendi]. Dr. Kenneth Joseph Baker, MD. Enter the name of the drug you're looking for, select the drug and dose you want and click on Clinical Criteria under the Notes & Restrictions section. While clients may sometimes benefit from services rendered outside of the therapy office, such as a client with an eating disorder needing support in the grocery store, or a client with a phobia of driving needing support in the car, these services are not likely to be covered by insurance and must be paid for out-of-pocket. Select Your State Subcutaneous testosterone pellets may be considered medically necessary when there is documented failure or contraindication to other topical, oral, and injectable HRT andONEof the following conditions: Subcutaneous testosterone pellets not meeting the criteria as indicated in this policy are considered experimental/investigational. Kanjinti (trastuzumab-anns), Ogivri (trastuzumab-dkst), Hormone Replacement Therapy Cost The incorporation of transgender health reassignment benefits applies to all individual, family, small group and large group plans. The doctors response was, I cant help you, she said. Read Also: Does Melatonin Cancel Out Birth Control Implant. Precertification is required for certain Transgender Services . This guide outlines Blue Cross Blue Shields coverage of therapy services. The Blue Cross name and symbol are registered marks of the Blue Cross Association , Agents for Hemophilia A and von Willebrand Disease, Akynzeo (fosnetupitant and palonosetron) for Iinjection, Aristada Initio (aripiprazole lauroxil), Beta Interferons and Glatiramer Acetate for Treatment of Multiple Sclerosis, Bevacizumab for Non-ophthalmologic Indications, Cabenuva (cabotegravir extended-release; rilpivirine extended-release) injection, Darzalex (daratumumab), Darzalex Faspro (daratumumab and hyaluronidase-fihj), Drug dosage, frequency, and route of administration, Duopa (carbidopa and levodopa enteral suspension), Enhertu (fam-trastuzumab deruxtecan-nxki), Enzyme Replacement Therapy for Gaucher Disease, Gonadotropin Releasing Hormone Analogs for oncologic indications, Gonadotropin Releasing Hormone Analogs for the treatment of non-oncologic indications, Hyaluronan Injections - Step Therapy and Quantity Limit - MEDICARE ONLY, Implantable and ER Buprenorphine Containing Agents, Injectable Hydroxyprogesterone for prevention of preterm birth, Lemtrada (alemtuzumab) for Treatment of Multiple Sclerosis, Monoclonal Antibodies to Interleukin-5, Off Label Drug and Approved Orphan Drug Use, Pepaxto (melphalan flufenamide; melflufen), Phesgo (pertuzumab/trastuzumab/hyaluronidase-zzxf), Proprotein Convertase Subtilisin Kexin 9 (PCSK9) Inhibitors, Prostacyclin Infusion and Inhalation Therapy, Radioimmunotherapy and Somatostatin Receptor Targeted Radiotherapy, Rituximab agents for Non-Oncologic Indications, Rituximab agents for Oncologic Indications, Selected Injectable 5HT3 Antiemetic Agents, Selected Injectable NK-1 Antiemetic Agents, Vascular Endothelial Growth Factor (VEGF) Inhibitors, Select Clotting Agents for Bleeding Disorders, Xiaflex (clostridial collagenase histolyticum) injection, Zilretta (triamcinolone acetonide extended-release), Xipere (triamcinolone acetonide injectable suspension). 29 Years Experience. Men, you listen up, and the reason Im saying that is because we dont go through this. Dr. Gov. This page provides the clinical criteria documents for all injectable, infused, or implanted prescription drugs and therapies covered under the medical benefit.The effective dates for using these documents for clinical reviews are communicated through the provider notification process. If you dont want your insurance company to have access to this information about your mental health, consider out-of-network options instead. Many Anthem Blue Cross behavioral health services plans require the client to pay a copayment that may be between $15-30 each session. Also Check: Does Blue Cross Blue Shield Cover Testosterone Therapy. Consequently, I dont have all the EOCs for all the individual and family plans offered in California. To relieve the symptoms associated with menopause, conventional HRT includes an estrogen and progesterone component to mimic hormones created by the human ovary. At the time, there was little public acknowledgment of transgender people, and they had scant options for medical care. Benefits are provided according to the terms and conditions of this Agreement that apply to all other medical conditions, including Medical Necessity requirements, Precertification and exclusions for Cosmetic Services. It can make you moody, tense, or depressed. Common symptoms include hot flashes, mood changes,sleep disruption and altered tissue linings of the vagina and urinary tract.Loss of ovary function and estrogen production are responsible for thesechanges. All clinical criteria are developed to help guide clinically appropriate use of drugs and therapies and are reviewed and approved by the CarelonRx* Pharmacy and Therapeutics (P&T) Committee. Your policy may cover traditional hormone therapy but not bioidentical hormones. Data on the number of transgender or gender nonconforming adolescents and adults in the United States are limited. The average age for women entering menopause is 51. Choose your plan for a complete list of drugs requiring site of care review. If you notice something unusual, start a conversation. Benefits are provided for services and supplies in connection with Gender Transition when a Physician has diagnosed You with Gender Identity Disorder or Gender Dysphoria. While it depends on your specific plan, it is unlikely that Blue Cross Blue Shield will cover couples counseling. Men go through andropause as they age, just like women go through menopause when they age. But the most contentious parts of the new standards among clinicians are the mental health requirements. Or, you can add a stand-alone Part D Prescription Drug Plan to your original Medicare. Im really not a believer in requiring that for people, said Dr. Alex Keuroghlian, a clinical psychiatrist at Fenway Health in Boston and the director of the Massachusetts General Hospital Psychiatry Gender Identity Program. Considering those data, some clinicians are opposed to any mental health requirements. Doctors prescribe Hormone Replacement Therapy to treat hormone imbalances, such as menopause and thyroid. Anthem noted that all requests for services must be manually entered as they update their system to handle the procedures and codes. Takhzyro (lanadelumab-flyo), Expect similar issues with the other insurance carriers. With our Site of Care program, certain specialty drugs when covered under the medical benefit require additional clinical review under Anthem's clinical utilization management guidelines. Most HMO groups and standard products plans include this program. Other doctors say they havent seen evidence to suggest that clinics are hastily providing medical treatments, or that many patients are experiencing regret about taking hormones. Blue Cross Blue Shield of North Dakota is an independent licensee of the Blue . It can weaken your immune system, so that you have a harder time fighting off disease. Notice shifts in sleeping and eating habits in your teen, as well as any issues he or she might be having, If you notice something unusual, start a conversation. You can also perform a search by entering any of the information from the table into the Search box. Somapacitan-beco: Sogroya; If you are considering using these new health insurance benefits to transition, contact your health plan first and see exactly how they are going to handle the benefits. Because this is a California state law that pertains to plans managed by the California Department of Managed Health Care and the California Department of Insurance, all health insurance plans will need to cover the transgender benefits. We've provided the following resources to help you understand Anthem's prior authorization process and obtain authorization for your patients when it's required. Dr. Zwerdlinger graduated from the University of Colorado School of Medicine in 1995. Antihemophilic Factor/von Willebrand Factor Complex (Human) [Alphanate, Humate-P, Wilate]. In one approach, clinicians in the Netherlands suggested that parents wait for puberty to make decisions about their children transitioning to another gender, pioneering the use of drugs that suppress the production of hormones like testosterone and estrogen. On average, menopause occurs in women at 51 years of age. Also, most insurance carriers dont cover testosterone when prescribed for women. Even men are helped when they use bioidentical hormone pellets. Recommended Reading: Does Blue Cross Blue Shield Cover Testosterone Therapy. Dont Miss: Does Blue Cross Blue Shield Cover Testosterone Therapy. Sinai. Likewise, if your practitioner is a preferred provider, youll pay your regular copay. Many well-studied Food and DrugAdministration approved options and routes of administration areavailable to help alleviate symptoms of menopause while minimizing risks. *CarelonRx, Inc. is an independent company providing pharmacy benefit management services on behalf of Anthem. A formulary is a list of covered medications. Recommended Reading: Can Having Your Tubes Tied Cause Hormonal Imbalance, 2021 HealthyHormonesClub.com On the other side of the debate are clinicians who say the guidelines are calling for unnecessary barriers to urgently needed care. Each non-covered drug has safe and effective, alternative covered drug options. Anthem noted that all requests for services must be manually entered as they update their system to handle the procedures and codes. $15 copay, deductible does not apply Your therapy sessions will cost $15 per session regardless of your deductible amount . Few studies have followed adolescents receiving puberty blockers or hormones into adulthood. Otherwise, call your insurance company directly to ask about the specific types of treatment youre considering. You can find a list of employers who offer coverage here. Most of us have periods of stress at various times in our lives. Bioidentical hormones are used to treat a number of menopause symptoms . Their plans allow patients to reduce final treatment costs only partially. This often raises the question of whether hormone replacement therapy is covered by insurance. Dont Miss: Does Blue Cross Blue Shield Cover Testosterone Therapy. For example, Cigna and Regence insurers offer the coverage of lab evaluation and clinic-based medical services but do not compensate expenses on injections and other oral medication prescribed. 4 0 obj I love him too much and Im not going anywhere.. Dont Miss: Does Nugenix Have An Estrogen Blocker. Original Medicare Part A and Part B will provide coverage for bioidentical hormone replacement. Subcutaneous testosterone pellets as a treatment for menopausal symptoms and/or reduced libido or any other indications not listed above are considered experimental/investigational and therefore non-covered. 2021 HealthyHormonesClub.com If you worry that your teen might be experiencing depression or suicidal thoughts, there are a few thingsyou can do to help. Pellets are implanted in the physician's office and release their contents over a period of months. But the guidelines take a more cautious stance on teens. The new standards state that clinicians should facilitate an open exploration of gender with adolescents and their families, without pushing them in one direction or another. You May Like: Does Nugenix Have An Estrogen Blocker. Recommended Reading: Unisom And Melatonin, Insurance coverage will vary based on your deductible, Scientific evidence of safety and efficacy has not been proven.Re: HRT or TRT with Blue Cross Blue Shield Everyone of you has said many true things here, Clomid, non biodegradable drug delivery Corporate Medical PolicyAn Independent Licensee of the Blue Cross and Blue Shield Association Testosterone Testing AHS G2013 Notification The Endocrine Society-Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons Testosterone levels monitoring is suggested atProprietary Information of Blue Cross and Blue Shield of Alabama Medical Policy #444 Effective for dates of service prior to December 29, In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, which outlines these special programs.Implantable Hormone Replacement PelletsSubcutaneous testosterone pellets as a treatment for menopausal symptoms and/or reduced libido or any other indications not listed above are considered experimental/investigational and therefore non-covered, All benefits are subject to the definitions, the Testosterone in Older Men with Mobility Limitations trial, and I was told by last Doc that alot of the times it depends on how the Doctors office gives the procedure code meaning it has to be a code that BCBS accepts in order for us to be qualified for coverage.Yes, Its only a matter of time before all follow suit, medications, Inc, co-pay, and anastrozole) Diagnosis of Erectile Dysfunction. 2 0 obj Icatibant (Firazyr, Sajazir), Kalbitor (ecallantide), J0593, J0596, J0597, J0598, J1290, J1744, J0599, Bonsity, (teriparatide), Forteo (teriparatide),Tymlos (abaloparatide), Durolane, Euflexxa, Gel-One, Gel-Syn, GenVisc, Hyalgan, Hymovis, Monovisc, Orthovisc, Supartz/FX, Synojoynt, Synvisc/-One, Triluron, TriVisc, Visco-3, J7318, J7320, J7321, J7322, J7323, J7324, J7325, J7326, J7327, J7328, J7329, J7331, J7332, Durolane, Euflexxa, Gel-One, Gen-Syn, GenVisc, Hyalgan, Hymovis, Monovisc, Orthovisc, Supartz/FX, Sodium hyaluronate, J7317, J7318, J7320, J7321, J7322, J7323, J7324, J7325, J7326, J7327, J7328, J7329, Immune Globulin: Asceniv, Bivigam, Carimune NF, Cutaquig, Cuvitru, Flebogamma DIF. Today there are more than 50 such specialty clinics in the United States, she said, up from just four in 2012. Lock up any potentially lethal objects. Children who are actively trying to harm themselvesshould be taken to the closest emergency room. Its common for traditional pharmaceuticalhormone replacement therapies to create synthetic estrogen using the urine of a pregnant horse. The Crisis Text Line: Text TALK to 741741 3. Depending on the insurance company, these conditions can include the following: Other conditions, like having had a prostatectomy, may also preclude you from needing tests to prove low testosterone. Also, most insurance carriers dont cover testosterone when prescribed for women. The National Suicide Prevention Lifeline: Text or call 9882. But your child, If you have immediate concern for your childs safety, do not leave him or her alone. Because this is a California state law that pertains to plans managed by the California Department of Managed Health Care and the California Department of Insurance, all health insurance plans will need to cover the transgender benefits. In short, the answer is, it depends. Are you concerned for your teen? It does not apply to self-funded plans where Anthem Blue Cross is the Administrative Services Organization. Recommended Reading: Nugenix Estro Regulator Review. That said, even if your insurance doesnt directly cover it, you still have options for getting affordable couples counseling. Some insurance companies consider only levels of testosterone in a blood test and the endocrinologists conclusion. In an emergency: If you have immediate concern for your childs safety, do not leave him or her alone. Traditional hormone replacement therapies use synthetic, lab-made hormones. Safer of Mt. Connections to home, land, language and heritage are powerful, said Knutson: People have specific reasons for living in rural areas., Lange certainly does. Watch for angry outbursts, mood swings and a loss of interest in activities they used to love. You can read more about what to expect in perimenopause in our recent article. Hormone replacement therapy (HRT) is supplementing women with hormones that are lost during the menopausal transition. As awesome as the info may be, it is not intended to diagnose, cure, treat, or prevent any disease. Yoga, meditation and other relaxation techniques can relieve stress, which can bring clarity and counter menopausal mood swings. American women have seen anincrease in expected lifespan, from less than 50 years of age in 1900, to 80years in 2000. The first version of the guidelines, called the Standards of Care, was released by a small group of doctors at a San Diego meeting in 1979. This page provides the clinical criteria documents for all injectable, infused, or implanted prescription drugs and therapies covered under the medical benefit.The effective dates for using these documents for clinical reviews are communicated through the provider notification process. The public is invited to comment on the guidelines until Sunday, with a final version expected by spring. a free consultation or with a simple call to your insurance carrier. Here are some reasons why folks choose Medicare Advantage or Part C plans for coverage: This is just the tip of the iceberg on the different benefits Plan C has. A. Given these risks, as well as the increasing number of adolescents seeking these treatments, some clinicians say that teens need more psychological assessment than adults do. So far, two have passed into law, in Tennessee and Arkansas, though the latter has temporarily been blocked because of legal appeals. Contact us: contact@healthyhormonesclub.com, HRT Day : Starting Transgender Hormone Replacement Therapy, WellPoint sued an ENTIRE STATE to increase profits, Orgovyx: New FDA Approved Hormone Therapy | 2020: The Year In Review | Mark Scholz, MD, What Is The Best Over The Counter Hormone Replacement, How Long Does It Take For Testosterone Gel To Work, Where Can I Buy Estrogen Over The Counter, What Supplements To Take To Lower Estrogen. Like most insurances, it is not typical for Blue Cross Blue Shield to cover services unrelated to a diagnosable mental health condition, such as: Blue Cross Blue Shield is also unlikely to cover therapy sessions occurring outside the therapy office, because of the greater potential for risk involved. I dont want any young person to go without the care that they need, Dr. Anderson said. Factor IX (Recombinant) [Benefix, Ixinity, Rixubis]. Others dont get their first period until theyre 15 or even 16. So what is the identified risk of utilizing these medications in the elderly population and what data is it based on? ;{+(f6yzYRUP2~>k_?|%vT: LVYY|l6heJQi/>Z7]Lvrlxvy;G#d:J '/''-WG^-'R`,_0h/f.+ wpq8ujgBHAJ@P(')M@ F#/M2K&E U7'O.{qO'br\60G?LtDi1)I Anthem Blue Cross of California has included a section called Transgender Services in their Evidence of Coverage (EOC) documents for individual and family plans offered in California for 2015. Dr. Ehrensaft and others are now working on large, long-term studies of patients in the United States. To learn more about Medicare coverage and other Medicare supplement options, give us a call at 800-208-4974 for a free consultation. Factor IX (Recombinant [Fc Fusion Protein]) [Alprolix]. Select a State Policies, Guidelines & Manuals We're committed to supporting you in providing quality care and services to the members in our network. % If youre worried about someone in your life and dont know how to help, these resources can offer guidance:1. We are inching our way toward full disclosure and transparency in the contracts between the insurers and the members so that consumers can finally see what is truly covered in their health plans. A Medicare Advantage plan may help you cover the cost of hormone replacement therapy. Generally, individuals in the U.S. secure health insurance coverage through one of the following channels: Many large private sector employers have taken steps to actively remove exclusions on transgender healthcare from their employer provided plans. A doctor may prescribe hormone therapy to relieve these symptoms. Now let me just explain here that as you get older, estrogen comes down, progesterone comes down, normal. Get timely provider information including policy, benefits, coding or billing updates, education, and moredelivered directly to your email. Some services are subject to prior authorization in order for coverage to be provided. HRCs Corporate Equality Index surveys employers on this important benefit. And preliminary studies have suggested that adolescents who receive drug treatments to affirm their gender identity have improved mental health and well-being. No health plan is created equal. xko{~g=`;^\&E?\bZGrz%fe.(>xrz_M/VwVe?O^|8yaEM/g8O~y,K3N,? Currently it is recommendedthat women approaching menopause discuss the risks and benefits of hormonereplacement therapy with their physician. These risks depend on the type of hormone therapy, the dose . Notice shifts in sleeping and eating habits in your teen, as well as any issues he or she might be having at school, such as slipping grades. Hormone therapy was once the most commonly prescribed treatment in the United States, but in 2002, a major study raised serious concerns about its health risks, causing many doctors and patients . She also has no intention of leaving law enforcement. Women now live for decades after the onset of menopause. Recommended Reading: Does Nugenix Have An Estrogen Blocker. The same coverage guidelines apply here as they do for men. 3 0 obj Easy access to exceptional care for a wide range of conditions in a secure, discreet, and convenient online process. FEP members can also obtain the list through thewww.fepblue.orgwebsite. Factor IX (Recombinant [Glycopegylated]) [Rebinyn]. Xkj8 H=_sJ@. Certain travel expenses incurred by the Member, up to a maximum $10,000 Anthem payment pertransgender surgery or series of surgeries , will be covered. Most HMO groups and standard products plans include this program. Some girls have their first period as early as 10 or 11. Cetrotide (cetrorelix), Ganirelix, Does the price for testosterone treatment include other aspects of your testosterone therapy beyond just the cost of your testosterone prescription, such as blood tests, follow-up doctors visits, and perhaps some additional nutritional supplements? Your health insurance plan was created before 2014, when the ACAs requirement that health insurance plans cover mental health services was enacted.There are other situations in which your Blue Cross Blue Shield plan may not cover the. Anthem Blue Cross doesnt make the EOCs easily available, but as an agent I can download Blue Cross EOCs attached to an existing client. Lange hangs out at home with friends Balducci and Buchanon-Romano, who came over for a cookout. Transgender Surgery Travel Expense. If your periods are becoming heavier, more frequent, prolonged, or with spotting between periods, you should mention this to your doctor. . When women approach their mid- to late-40s, their cycles may become irregular as they enter the perimenopausal stage. FEP Blue Focus members can apply for coverage of a drug not covered on their formulary with the Non-Formulary Exception Process form. a free consultation or with a simple call to your insurance carrier. Some of the drug regimens bring long-term risks, such as irreversible fertility loss. The quality rating system outlines quality rating metrics and corresponding bonus payments. Another import consideration when evaluating the costs of your low testosterone treatment, is that you must take into account exactly what is included in a price that you may have been quoted for testosterone replacement. Men have a little bit, maybe, of an andropause, but nah, we dont get to comment too much. Anthem Blue Cross includes transgender services language in new Evidence of Coverage documents. An Independent Licensee of the Blue Cross and Blue Shield Association Gender Affirmation Surgery and Hormone Therapy File Name: gender_affirmation_surgery_and_hormone_therapy 7/2011 4/2022 Origination: Last Review: Description of Procedure or Service Gender Dysphoria (GD) is the formal diagnosis used by professionals to describe persons who . Antihemophilic Factor (bispecific) [Hemlibra (emicizumab-kxwh)]. 2157 Main St Fl 1, Buffalo, NY 14214 2.76 miles. These are the top 10 symptoms on a survey of menopausal, pre-menopausal symptoms. Professional medical groups and transgender health specialists have overwhelmingly condemned these legal attempts as dangerous. <> Please Select Your State The resources on this page are specific to your state. , Rylaze (asparaginase erwinia chrysanthemi (recombinant)-rywn), Avonex (interferon beta-1a), Plegridy (peginterferon beta-1a), Rebif (interferon beta-1a), Betaseron (interferon beta-1b), Extavia (interferon beta-1b), Copaxone (glatiramer acetate), Glatopa (glatiramer acetate), C9399, J1595, J1826, J1830, J3490, Q3027, Q3028, S9559, Avastin, Alymsys, Mvasi, Vegzelma, Zirabev, Botox (OnabotulinumtoxinA), Xeomin (IncobotulinumtoxinA), Dysport (AbobotulinumtoxinA), Myobloc (RimabotulinumtoxinB). Q5114, Q5112, Q5116, Adalimumab agents (Humira, Abrilada, Amjevita, Cyltezo, Hadlima, Hulio, Hyrimoz, Yusimry), Hormone imbalance may also be caused by toxins or living an unbalanced lifestyle. FEP Blue Focus members can apply for coverage of a drug not covered on their formulary with the Non-Formulary Exception Process form. A common concern among individuals who seek hormone replacement therapy is how theyre going to pay for it. You May Like: Can Having Your Tubes Tied Cause Hormonal Imbalance. A child who expresses suicidal thoughtsmay benefit from a mental health evaluation and treatment. Hormones including bioidentical hormones are used to replace these hormones in your body to help provide relief. Choose your location to get started. How much bioidentical hormones cost depends on your insurance coverage. Medicare provides for transgender healthcare such as routine medically necessary care, hormone replacement therapy and gender reassignment surgeries. And some doctors have also argued that waiting several years to initiate medical treatments could itself be harmful. Of course, the amount that your insurance covers varies from provider to provider, and it also varies based on your specific health plan and other variables, like your deductible. Factor IX (Recombinant [Albumin Fusion Protein]) [Idelvion]. An Independent Licensee of the Blue Cross and Blue Shield Association Hormone Pellet Implantation for Treatment of Menopause Related Symptoms dosage of the drug, and increased risk of non-compliance with safety measures such as the addition of progestin." Estrogen compounded with testosterone for subcutaneous HT is not FDA approved. Before discussing any medical treatment, they say, adolescents must get a comprehensive assessment led by mental health providers, and must have consistently questioned their gender identity for several years.. These seemingly abrupt changes as well as other mental health issues or a history of trauma should be flags for providers to slow down, she said. Transgender people in rural areas often face particularly acute challenges when it comes to finding competent providers and obtaining health insurance. Some price lists include special offers for regular procedures that are not covered by the insurance. If your doctor prescribes a drug thats not on the formulary, you can request a substitute. Around the late 2000s, clinicians in the United States introduced the gender affirming approach, which has since been endorsed by several major medical groups. Experts in transgender health are divided on these adolescent recommendations, reflecting a fraught debate over how to weigh conflicting risks for young people, who typically cant give full legal consent until they are 18 and who may be in emotional distress or more vulnerable to peer influence than adults are. Dr. Ehrensaft is one of the key early proponents of the gender-affirming model and helped write a new chapter on prepubescent children in the draft guidelines. If you are transgender, you may be under a lot of extra stress because of discrimination in the community. Menopause begins after a woman has her last menstrual cycle. Some clinicians worry that public disagreement over the best way to care for transgender adolescents will add fuel to this simmering political movement. They stated that transgender people could be delusional or unreliable, and required two letters from psychiatrists before adults could access surgeries. Call a suicide prevention lifeline. Even before that last cycle, menopause changes the hormone balance in a womans body. While reviewing one of the 2015 Blue Cross EOCs about another issue I tripped across the transgender language for their Gold PPO Multi-State plan. Hormone replacement therapy (HRT) using formulas in subcutaneously implantable pellet form is an alternative to hormone therapy by injection or oral ingestion. To find out your actual out-of-pocket expense for therapy, search your Summary and Benefits document for your plan .