Battle of the sexes

There are more than 5,000 people living in Britain who have changed their gender. Transsexuals are slowly being given access to medical and support services that are enabling them to integrate almost invisibly into society.

Although public attitudes are changing ' transsexual people still have to tread a legal minefield in order to get simple financial products ' in the eyes of the law, a person's gender remains that printed on their birth certificate, even if successful gender reassignment has taken place.

Critical illness and life cover fall onto more complicated grounds for transsexuals. Regardless of legal gender, cover is underwritten and rated according to medical history. In fact, much of the data underwriters rely on is based purely on gender. So how easy is it for transsexual people to get cover that is based on their reassigned gender?

The simple answer is that it is extremely difficult. In fact, according to transsexual political lobbying and educational organisation Press For Change (PFC), there is only one known case of an insurer granting life cover based on a reassigned gender, rather than a birth gender.

The policy in question involves a female transsexual and was issued by Virgin Direct Care in 1996. According to PFC, Virgin confirmed it would treat other transsexuals in the same way ' however there have been no similar cases reported since.

Gordon Maw, marketing manager for Virgin Direct Life, said: 'We can confirm a case was written on that basis in 1996, but we cannot comment on the particular case, or our approach to underwriting in this area.'

So in order to get cover, most transsexuals have to disclose their birth gender, or claims are almost certainly turned down.

Gender disclosure

Chris Morgan, director of Compass Independent Financial Advisers, specialises in finding cover for gay clients, but has only had one transsexual client due to the emotive issues attached to gender disclosure.

'Although the transsexual community and gay community are separate, transsexuals may be treated with more respect and more of a sympathetic ear if they go to an IFA who specialises in gay cover. However, my only transsexual client decided not to go through with an application due to disclosure issues,' he says.

Claire McNab, editor of PFC's website, says the fact that transsexuals are unable to alter the gender recorded on their birth certificate under UK law means they have no choice but to disclose private information about treatment which they should have the right to keep to themselves.

'If a transsexual person told an insurer their reassigned gender, it would be fine for writing the policy, but when it came to claim they could be turned down and accused of giving the wrong information. Every country in Europe apart from Albania recognises the legal status for change of sex, but in the UK it remains a problem. When dealing with any kind of insurance, transsexuals have to out themselves and reveal very private bits of their history to brokers and underwriters. In our view this information is not treated with due confidentiality,' she says.

Lobby groups such as PFC continue to campaign for a change in legislation and headway is slowly being made.

The Home Secretary set up the Interdepartmental Working Group on Transsexual People in April 1999 and according to Jane Bransby, spokesperson for the Lord Chancellor's department, the Lord Chancellor is considering recommendations that transsexuals should be able to change the gender on their birth certificates.

However, even if transsexuals are allowed to change the gender recorded on their birth certificate, they would still need to disclose their medical history to life and health insurers, otherwise it would be impossible to underwrite with accuracy.

'The reason why we have to rate on birth gender is because different genders will always be more prone to certain conditions, regardless of a transsexual operation,' says Paul Casey, marketing analyst at GE Frankona Re.

Facing facts

The hard truth is that apart from side effects directly related to gender reassignment, being transsexual does not affect mortality or the kind of diseases you are prone to. A transsexual man will still be more prone to cancer, a transsexual woman will remain more prone to a heart attack.

Nick Kirwan, head of product development at Scottish Provident, says: 'The shape of rates and the incidence of illnesses is quite different for men and women. Here are some examples: 83% of all female claims are for cancer ' compare that with males where it is only 49%. A total of 24% of male claims are heart attacks, whereas with women it is just 2%. These things do not change through surgery ' we are what we are made of. Those figures speak volumes about just how influential our genetic make up is.'

Indeed, it is commonplace for insurers to offer standard rates for transsexuals one or two years after gender reassignment surgery has taken place ' as long as they are rated on their birth gender.

'Transsexuality is very emotive. If you have felt for your whole life that you are the wrong sex and receive treatment, once surgery has taken place there is no reason why standard rates should not be given ' post-operation medication and hormone treatment should not affect life expectancy,' says Casey.

Side effects from the long-term use of hormone treatment have yet to come to light, but underwriters tend to see the side effects from transsexual surgery as minimal, like extensive cosmetic surgery.

However, male transsexuals can be more prone to complications. 'Creating a man is much more difficult than creating a woman. There can be problems with the adhesion of tissues and issues with urinary tract infections as pipework has to be re-routed,' says Ross Campbell, chief underwriter at General Cologne Re.

Mental health

The main issue underwriters are concerned with is the psychological state of clients. Gender identity disorder is a recognised medical condition, with gender reassignment seen as the appropriate and successful treatment. How-ever, transsexuals are often prone to depression and high levels of stress pre-surgery.

Casey says: 'Lifestyle apart, the bigger concern of any insurer is the mental state of the client. Transsexuals often have a period of depression before they undergo surgery -' so this will be taken into account when rating individuals.'

Simon Taylor, senior underwriter at Scottish Equitable, says although mental history needs to be assessed, clients would not have been allowed surgery in the first place if they were unstable.

'We would require a full assessment of any psychological problems they may have had previously and how their state of mind is now. However, people are made to have a full psychological assessment before going ahead with gender reassignment,' he says.

The fact transsexual clients will have been subjected to more psychological testing than the average client means ratings based on risk of the mental instability could be seen as discriminative.

'These days gender reassignment is more accepted and people have access to advanced clinics, counselling and advice. It is therefore unfair to suggest mental illness is definitely a risk,' says Campbell.

Lifestyle risks are also minimal. Despite the distorted image sometimes cast on the transsexual community, most people who have undergone gender reassignment live quiet, inconspicuous lives. Unlike gay men, a transsexual woman in a relationship with someone of her own birth gender would not be underwritten as gay, or be expected to take an HIV test.

'Most transsexuals are content to live in a monogamous relationship and do not tend to live a promiscuous lifestyle. The main exceptions may be cross-gendered people who have not had surgery working in the sex industry,' says Campbell.

Taylor says that people concerned with buying cover tend to live conventional lives. 'Those people who want to buy insurance are usually stable and have a decent occupation,' he says.

So as long as transsexuals are prepared to apply for cover under their birth gender, cover is readily available and the clients is happy. Right? Unfortunately not. Transsexuality runs much deeper than medical data and risk assessment. People who have been through relentless psychological testing, extreme surgery and undoubtedly some form of social prejudice in order to change their gender do not want to look back on the experience once surgery has been completed. Transsexuals want to put their past behind them and start afresh.

Moving on

Sarah Smith*, a transsexual woman, has found it impossible to keep her birth gender under wraps at work due to the rules applying to the employee benefits package offered by her employer.

'I want to be in an environment where I am simply accepted as just another female employee. But being transsexual I will not be able to do that because I will have to inform the insurance company on the basis of ultima fides. In fact, for the rest of my life I will never be able to get life insurance or private health insurance without disclosing that I am transsexual ' and can never put my past truly behind me,' she says.

In addition to proclaiming her transsexuality to her employer, gender reassignment and complications of gender reassignment are not covered by Smith's group employee benefits plan ' they are classed as a pre-existing condition.

'With regards to my hormones I am in the same position as a post-menopausal woman on HRT and so one might think I would be treated as such for insurance purposes. Except that if a post-menopausal woman on HRT had an embolic stroke that would be covered, but in my case it could be called a complication arising from gender reassignment (oestrogen therapy) and potentially excluded. You pay the premium, but you do not get the equal benefits,' she says.

Accepting that insurers would find it nigh on impossible to underwrite individuals without knowledge of their birth gender, perhaps looking to provide cover for the so-far recorded very minimal complications arising from gender reassignment is something that the industry can do to make cover more attractive to transsexual clients. As society slowly rids itself from prejudice and medical procedures advance, more people can successfully change their gender, live an ordinary life, get a professional job and acquire the same protection as anybody else. Insurers would be advised not to overlook this growing community.

Kirstie Redford is senior staff writer

* Sarah Smith's name has been changed for this article.