Intermountain Health rethinks butt surgeries for adult transgender patients

Amber Chevrier has known something was wrong with her body since puberty. However, she didn’t have the words to describe how she felt until she met a transgender woman in her 20s while she was playing online.

I asked her if she would be comfortable talking to me and answering a few questions about what gender dysphoria was like. She explained it to me, and every word she said started hitting harder and harder, Chevrier said. Everything he described about her before she came out was how I felt all the time.

Those conversations changed his world. Depression and anxiety began to consume her, in part due to learning about the dysphoria. Chevrier is back home with her parents in Florida, but her feelings have not faded. Depression, she said, prompted her to begin the transition.

Chevrier publicly came out as transgender in 2021 and soon began taking hormones. Then came laser hair removal and voice training. And because she had a better support system in Utah, she moved back. Now in her thirties, Chevrier was ready to take another big step in her medical transition vaginoplasty surgery.

An important aspect of my dysphoria was the underlying dysphoria. It was something that was a struggle for me, she said. And I genuinely want to be able to get to a point where I can have that part of my transition, have that surgery, and feel more true to myself, more like who I am.

On February 27, Chevrier received a call from Salt Lake City Intermontane health that changed everything. She was no longer able to undergo the vaginoplasty surgery she was working on.

The best way to put it is that it was kind of overwhelming, like all that excitement I felt about them taking care of me, she said. And then it fell apart because they just made it clear that actually no, they [Intermountain] you don’t really care about us.

Nationwide and in Utah gender-affirming assistance is politically in focus. The uncertainty left in the wake of the bans radical Republican-led states is creating both a run to get treatment and a gray area for healthcare workers and doctors.

A change of plans

Intermountain’s decision not to offer phalloplasty, metoidioplasty or vaginoplasty (also known as butt surgery) to adult transgender patients diagnosed with gender dysphoria came after Dr. Nicholas Kim already began seeing patients as surgical director of the gender assistance.

Kim, a plastic surgeon by training, specializes in gender-affirming care, especially butt surgeries. His experience is discussed in a video from Intermountain Healths Project Echo uploaded February 14th. His license to practice medicine in Utah was issued in 2021.

Intermountain did not respond to KUER’s questions about why they prohibit butt surgeries for transgender adults diagnosed with gender dysphoria. In a statement, the healthcare nonprofit reaffirmed its commitment to LGBTQ patients, but noted that lower back surgeries have never been performed at Intermountain’s gender-focused care facilities. They also said that the procedures in question are offered in the community by other providers.

Intermountain has always and continues to help patients navigate their gendered care journey and is committed to helping these patients connect with the care they need, both within Intermountain Health and through our community partners and the reference resources, concluded their statement.

In an Intermountains gender-affirming care policy FAQ internal sheet obtained by KUER, the answer to why the company hired a surgeon who could perform specific procedures if there was no plan to offer them to patients did not provided no clarity.

Intermountain aims to hire the best and most qualified surgeons. Some surgeons or providers have skills we don’t use in their current role, the sheet reads.

The FAQ also states that the decision not to offer butt surgeries was carefully reviewed and made by a team of Intermountain leaders, and that they have decided not to add these gender dysphoria surgeries at this time.

Chevrier’s journey began in October 2022. Since then Select Health insurance, which is accepted at Intermountain facilities, scheduled a consultation with Dr. Kim and his team.

The initial process was a little scary, but she was also excited about the opportunity to have the surgery. Lei chevrier said she was accompanied by the expectations of the surgery and what she needed to do to prepare. But most of all, Kim made her feel very comfortable about her throughout the whole process and made her trust him a lot because of it.

The medical team was in regular contact with Chevrier for up to six months before they could set a date for surgery, when they received the call from an Intermountain social worker about the policy change.

I didn’t expect that kind of news, Chevrier said. My mind went blank for the rest of the conversation because it was pretty crushing.

He didn’t get a reason why Intermountain decided to forgo butt surgeries only for transgender patients. In email correspondence with a member of the surgical team, Chevrier apologized to her for not being able to have the surgery and offered her options outside of Intermountain where she could continue her treatment. None were covered by her health insurance.

If Chevrier were to get the procedure at another facility, she would have to petition her insurance to pay for it. He would also have a completely new support team.

Chevrier isn’t sure Intermountain will ever offer butt surgeries at its facilities. And he’s not thrilled to start the process over just for someone in charge to say we won’t do it again.

Even if she’s putting her surgery on hold, that won’t stop her from getting it one day. It’s too important to her.

I was born and raised being told I was a boy. I’m not. I am a woman and I deserve to have the care that allows me to express it, she said. It’s what I want. It’s what I need to be able to feel like the person I really am, so that I can look in the mirror and truly appreciate what I see.

Communications interrupted

The confusion with Intermountain’s gender-affirming service policies didn’t end with Chevrier. While bottom surgeries are prohibited, full mastectomy procedures, or upper surgery, for adults, are performed at Intermountain facilities.

Orion Enceladus has been grappling with his gender identity for the past 30 years. When they came out as non-binary and started using the pronouns he/they, Enceladus said they felt elated. It was only earlier this year that they made the decision to seek gender-affirming medical treatment.

When I decided I needed major surgery, I thought, Wow, this can’t be happening soon enough. You know, this should have happened yesterday, they said with a slight chuckle.

They also have SelectHealth insurance and called Intermountain to set up a consultation appointment. Even if the appointment was far away, in August 2023 Enceladus said it was a step in the right direction towards authentic life.

Then Enceladus received a May call from the Intermountain staff.

They said we wanted to let you know that your appointment for higher surgical consultation has been cancelled. Dr. Kim will no longer provide that care through Intermountain, Enceladus said.

They added that no alternative options for treatment were provided and did not get an answer as to why top surgery would no longer be performed. They were surprised by the news, especially since the surgeon was one of the few operators able to perform the surgery within the Intermountain network.

I felt like I had a sense of control over my body just ripped away from me, they said, because my insurance wouldn’t cover anything else.

Since Enceladus determined that a top-notch surgery was absolutely vital to their mental and physical well-being, they decided to pay out-of-pocket and have the surgery performed at University of Utah Health. However, the higher off-grid cost is worth it for Enceladus, because they only need this care.

As summer approached, Enceladus received a stack of paperwork from Intermountain to fill out before the original August consultation. They were perplexed because they were under the impression that the operation through Intermountain was out of the question. When Enceladus called, it turned out that a mistake had been made by someone on the staff. Intermountain is still performing top-notch surgeries, the surgeon is taking on new patients and Enceladus should have been one of them.

In a shared telephone conversation with KUER, the Intermountain employee told Enceladus that it is very strange that they were told that Kim was no longer operating at the top and that their consultation was cancelled.

The employee told Enceladus that a new employee probably just cross-referenced her names and confused a social worker with the surgeon. Enceladus’ appointment with the social worker has been cancelled, not their surgical consult.

I’m so sorry the information was so butchered, the employee said. I apologize.

Now, Enceladus is torn on what to do. Stick to the scheduled surgery at University of Utah Health and pay out of pocket? Or stay on track through Intermountain and wait nearly a year to get the best surgery on the net?

Either way, Enceladus is about to have surgery and it’s a day that couldn’t come soon enough.

Being queer and trans and when you feel dissociated from your body for about 38 years of your life and then you have this tangible hope that you might actually connect with your body for once, they said. It’s like, oh wow, this is how most people go through life, and I’ve never had that. So yeah, that’s great.