When UNC School of Government employee Max Kadel goes to CVS to pick up his testosterone prescription, he pays seven times what a cisgender man would for the same drug because of the state’s decision to exclude transgender medical coverage from its health care plan.

Kadel, who is transgender, testified before the state treasury board Monday with other state and local advocates, including a transgender teen and parents of transgender children, urging the restoration of gender dysphoria treatment—which can be considered a life-saving measure for transgender individuals—in the state health plan.

Treasurer Dale Folwell did not respond directly to the group’s request but commented broadly on the unsustainable cost of supplying health care coverage.

“The fact is that this plan is on an unsustainable financial course, and it’s coming to a head,” Folwell said.

“This is not about cost. It’s about discrimination,” said Noah E. Lewis, of Transcend Legal, representing the employees. “In a plan this size, there’s so few transgender members the cost is incidental.”

Less than 1 percent of adults identify as transgender in the United States, according to research from The Williams Institute. More than 720,000 state employees and their families are covered by the state plan. Previous estimates showed the cost of covering gender dysphoria treatment running between $350,000 and $850,000 annually, less than 0.03 percent of the state’s total  $3.3 billion in health care costs. In other words, it’s a rounding error. 

The testimonies came the day after The New York Times reported that the Trump administration is considering effectively writing the term “transgender” out of existence by defining gender on a strictly biological basis, a sweeping move to aimed at gutting legal protections for transgender individuals. In response, the LGBTQ Center of Raleigh organized a rally Monday afternoon in support of transgender, nonbinary, and non-gender-conforming community.

North Carolina included transgender treatments in its 2017 health care plan, but the coverage was removed for the 2018 fiscal year and is not currently included in the 2019 plan. The state originally included the coverage to avoid violating federal nondiscrimination laws.

Continuing to exclude gender dysphoria treatment from the health care plan makes the state vulnerable to discrimination lawsuits, which the group testifying Monday said will be avoided if coverage is restored.

At least fourteen members in the health care plan are affected by the exclusion. All submitted written testimony to the board and nine spoke, including Kadel.

“For me, the biggest impact of the health coverage exclusion is the message that it sends me, as a transgender employee of UNC and the state of North Carolina: that I am not wanted as part of the Carolina community,” Kadel said. “That I, and my health and well-being, are less valuable than the health and well-being of my cisgender colleagues.”

Transgender teenager Connor Thonen-Fleck’s parents are state employees, but without changes to the health care plan, he will not be able to afford $9,000 chest-reassignment surgery necessary for his transition. Prior to beginning testosterone treatment, which his family pays for out of pocket, Thonen-Fleck was suicidal and self-harmed.

Mental health issues are not uncommon among those suffering gender dysphoria, Lewis said. Whatever the state saves by excluding transgender coverage, it will pay more in the costs associated with treating the mental health needs of those with gender dysphoria who do not have affordable access to treatment, he predicted. More than 40 percent of transgender individuals have attempted suicide, according to The Williams Institute, more than ten times the rate of suicide among the general population.

“We worry every day that our son will become part of that statistic,” East Carolina University employee Deborah Thomson testified. “Transgender health care is truly a matter of life and death.”

“My friends would tell you that testosterone has made me a completely new person. They have watched me struggle with gender dysphoria, watched me finally come out, and see the burden lifted from me,” Thonen-Fleck said. “Those close to me can attest to the months of suicidal ideation, self-harm, and self-hatred because of the possibility that I could not start hormones or have surgery due to financial struggles. They would all tell you that medical intervention is absolutely necessary, that it has helped me in ways I could never imagine.”

The Board of Trustees adjourned without amending the health care plan. Folwell declined to say if it was discussed in the executive session after the meeting.