Christina Ketcham is a 60-year-old transgender woman who started her transition over four years ago and continues to experience significant distress from the incongruence between her typically masculine facial features and her identity as a woman. To alleviate that distress, Christina’s treating healthcare providers determined that certain facial feminization procedures are medically necessary to treat her gender dysphoria. But, the health insurance offered by her employer has a categorical exclusion for all facial feminization procedures.

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