News for Gay, Lesbian, Bisexual and Transgender Physicians

ACA prohibits anti-transgender bias, HHS says

A provision of the Affordable Care Act (ACA) banning sex discrimination covers discrimination against transgender and gender-nonconforming people, the U.S. Department of Health and Human Services (HHS) stated in a July 12 letter.

Leon Rodriguez, the director of HHS's Office of Civil Rights, authored the letter, which unequivocally states that "gender identity or failure to conform to stereotypical notions of masculinity or femininity" in federal health programs or activities receiving funding under ACA-covered programs is illegal. Rodriguez pledged continued education outreach to help inform people of their rights and responsibilities under the anti-discrimination provision.

This is an important development for the transgendered community, which often has faced hurdles in obtaining care and health insurance coverage in the past.

Olympic Games highlights issues in gender testing

Every four years, Olympics viewers become better acquainted with the often-nuanced rules that regulate many sports. Perhaps the most controversial of these rules is the gender test. The rule is designed to prevent men from competing in women's events, but the line between man and woman isn't always clear.

As an example of ambiguity, the Los Angeles Times highlights Spanish hurdler Maria Jose Martinez-Patino. According to the newspaper, when Martinez-Patino submitted to gender testing, the results revealed that she had a Y chromosome, which usually designates male. However, the results also found that she had a syndrome that prevented her body from responding to testosterone and caused her to develop as a woman. She was declared ineligible to compete in the 1988 games in Seoul, South Korea, but appealed and was reinstated just a few months after the games.

The London games mark a shift from a focus on DNA to testosterone, which aids muscle development, endurance and speed. This test still would have knocked Martinez-Patino out of the competition, even though her body cannot utilize its testosterone, the Los Angeles Times reports.

Interestingly, it may doom more Olympic athletes than one might think. Although no one knows why, androgen insensitivity—like the syndrome affecting Martinez-Patino—has an incidence of one in 400 among Olympic female athletes, while the incidence in the general population is one in 20,000, the Los Angeles Times reports.

While the testosterone testing method is still controversial, it's better than no test, Eric Vilain, director of the Center for Gender-Based Biology at UCLA, told the Los Angeles Times.

"I have talked to many elite female athletes, and I haven't found one who is comfortable with the idea of having no testing," Vilain said.