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Trans activists have drilled vulnerable children and their parents into believing there’s nothing wrong with being trans.

Children, they claim, were incorrectly “assigned” a sex at birth, or were simply born with the “wrong body” or go through the “wrong puberty.”

And any distress over birth sex experienced by young people, they assert, is due to the lack of “affirmation” of their true gender identity by their families.

The problem with that approach, the trans medical industry found, is that families can’t afford the costly drugs and surgeries required to have their children live out their delusion as the opposite sex.

An easy fix would be to have trans drugs and surgeries for minors covered by health insurance. But, how to get health insurance to pay for these expenses when a “diagnostic code” is required – all the while gender ideologues claim there is nothing at all to diagnose?

According to Leor Sapir, prominent expert in the field of pediatric gender medicine, the answer to gender medicine’s puzzle was health insurance fraud – a “widespread” practice, he says, and now one the Trump administration is addressing.

“A common form of potential billing fraud involves use of the diagnosis ‘Endocrine Disorder Not Otherwise Specified’ (E34.9 in the International Classification of Diseases handbook), instead of ‘Gender Identity Disorders’ (F64), for patients who do not have or are not being treated for endocrine disorders,” Sapir wrote Thursday in a column at City Journal.

The Trump administration launched its attack on so-called “gender-affirming care” for children and teens on January 28 with the executive order “Protecting Children from Chemical and Surgical Mutilation.”

The order directed the U.S. Department of Justice to “prioritize investigations and take appropriate action to end deception of consumers, fraud, and violations of the Food, Drug, and Cosmetic Act by any entity that may be misleading the public about long-term side effects of chemical and surgical mutilation.”

The U.S. Department of Justice announced in July it had sent more than 20 subpoenas to gender medicine doctors and clinics that perform so-called “gender-affirming care” procedures on children. The investigations include issues of “healthcare fraud, false statements, and more,” the announcement said.

“Medical professionals and organizations that mutilated children in the service of a warped ideology will be held accountable by this Department of Justice,” Attorney General Pamela Bondi said in a statement.

A senior fellow at the Manhattan Institute, Sapir highlighted the predicament for trans activists in medicine, i.e., how to get health insurers to foot the bill for their costly services while not “stigmatizing” young seekers of life-changing drugs and surgeries with a mental health “diagnosis.”

“In the 2010s, advocates of gender medicine in the United States recognized the dilemma for their field,” he explained. “Delisting gender identity disorder from the Diagnostic and Statistical Manual of Mental Disorders (DSM) would ‘destigmatize’ gender incongruence, but at the expense of losing insurance coverage, which requires a diagnostic code. Because people who wished to undergo medical transition had no physical pathology, it was not possible to adopt a physiological diagnosis.”

In other words, how to be paid for removing the healthy breasts of a 15-year-old girl who believes herself to be a boy?

The American Psychiatric Association came to the rescue in 2013 when it replaced “gender identity disorder” with “gender dysphoria” in DSM-5.

“Unlike gender identity disorder, the concept of gender dysphoria was not thought to imply that the mismatch between a person’s sex and self-conception of being a man or woman was itself a disorder,” Sapir explained, pointing out as well that the World Health Organization (WHO), which publishes the international classification of diseases known as ICD – now in its 11^th revision – plainly provided its reasons for making its changes:

Gender incongruence has been moved out of the “Mental and behavioural disorders” chapter and into the new “Conditions related to sexual health” chapter. This reflects current knowledge that trans-related and gender diverse identities are not conditions of mental ill-health, and that classifying them as such can cause enormous stigma.

Inclusion of gender incongruence in the ICD-11 should ensure transgender people’s access to gender-affirming health care, as well as adequate health insurance coverage for such services.

“Setting aside these criticisms, I will assume for the sake of argument that there is a non-fraudulent diagnostic code for transgender medical procedures (‘gender identity disorders,’ F64),” Sapir wrote. “The problem: plenty of evidence suggests that providers are not using it. Thus, a plausible case can be made that systematic insurance fraud exists.”

“It’s worth stating up front that transgender identity is not an endocrine disorder, and sex-trait modification (“gender-affirming care”) is not intended to treat any physical pathology,” he added.

The trans medical industry, Sapir continued, moved ahead with using ‘Endocrine Disorder Not Otherwise Specified’ over “gender identity disorder” as a diagnostic code in response to three events:

• Obama-era regulations that required the collection of data on sexual orientation and gender identity in electronic health records
• Pressures from transgender-identified patients and their advocates to reduce the stigma associated with “gender identity disorder” diagnoses
• An insurance landscape in which reimbursement claims for hormones or surgeries were not always fulfilled.

Sapir reported multiple examples showing that ample documentation exists by gender medicine leaders of the use of “endocrine disorder” diagnosis codes for patients who actually lack that disorder.

“Indeed, the openness, even pride, with which they discuss this practice shows their confidence that neither the medical establishment nor the insurance industry would dare challenge the field on this critical matter,” he observed. “It thus remains to be seen whether providers who offer gender transition and use inappropriate diagnostic codes will be held liable for their actions.”

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