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Experts hit back at claim transgender voice therapies aren’t lifesaving

After treatments added to state-subsidized ‘health basket,’ vocal cord surgeon Dr. Hagit Shoffel-Havakuk says the ‘life-changing’ remedies are ‘a medical matter and not cosmetic’

Amy Spiro is a reporter and writer with The Times of Israel.

Illustrative: LGBT activists denounce violence against Israel's transgender community in Tel Aviv, on July 28, 2019. (Flash90)
Illustrative: LGBT activists denounce violence against Israel's transgender community in Tel Aviv, on July 28, 2019. (Flash90)

When the Health Ministry committee tasked with expanding the list of state-subsidized treatments published its recommendations last week, one of the dozens of approved items gained the most media attention: vocal therapies for transgender Israelis.

Among the total NIS 550 million ($173.4 million) in procedures and medications added to the state-funded “health basket” for 2022, NIS 1.9 million was allotted for “treatments for gender adjustment of the voice.”

The allocated cost for those treatments amounts to less than half a percent of all the newly approved coverage, while about half of the overall funding – NIS 274 million – went toward fighting various forms of cancer.

“Transgender women who feel that their voice doesn’t match their gender — usually they’re afraid to speak in a crowd, and sometimes they won’t be able to express themselves,” said vocal cord surgeon Dr. Hagit Shoffel-Havakuk.

Gender reassignment surgery has been part of the state-funded health basket for several decades, and “voice feminization surgery is part of a group of surgeries called gender affirmation” procedures, said Shoffel-Havakuk.

But news of the inclusion of such treatments raised eyebrows among some. The Srugim religious news site headlined its article: “The medical basket: Cancer treatments – out; transgender voice changing – in,” similar to a story on the right-wing Channel 14’s website titled “At the expense of medications: The state will fund voice-changing surgery for transgender people.”

Even the Kan public broadcaster ran a chyron during its nightly news broadcast stating that voice-changing surgeries were approved “at the expense of life-saving medications.”

Dr. Hagit Shoffel-Havakuk (Efrat Saban Ben Yossef)

Prof. Jonathan Halevy, chairman of the committee and the president of Jerusalem’s Shaare Zedek Medical Center, reacted to some of the criticism during a Knesset hearing on Monday.

Halevy reiterated that the treatments in question make up 0.3% of the cost of the overall authorized health basket: “If that’s not a worthy proportion that combines correct medicine, social awareness and compassion, then I don’t know what would be,” he said.

Halevy criticized media outlets that “brought on cancer patients that say ‘I’m not getting treatment’ – they got NIS 250 million here.”

Writing in Haaretz, Ofer Erez, the first transgender IDF officer and the former CEO of the Jerusalem Open House for Pride and Tolerance, railed against the argument that voice-changing surgery is not lifesaving.

“Gender reassignment – of which voice change is an integral part – saves lives,” wrote Erez. “It saves us from transphobic violence in the street, it saves us from indescribable mental anguish, family and social exclusion, discrimination in employment and housing, and the depression and anxiety that come with life in a state of perpetual survival. Gender reassignment treatments have saved my life.”

The new approval includes a range of different treatments for transgender patients seeking to match their voice patterns to their gender identity. Surgery to do so – which involves either stretching or shortening of the vocal cords – tends to be a last resort.

Prof. Jonathan Halevy, chairman of the Health Basket Committee, speaks during a committee meeting at the Sheba Medical Center in Ramat Gan on October 24, 2021. (Avshalom Sassoni/Flash90)

Shoffel-Havakuk, who specializes in the larynx and vocal cords, and is affiliated with the A.R.M Medical Center at Assuta Hospital, said she believes she is the only surgeon in the country who performs transgender vocal reassignment operations, and that they are relatively rare.

“Most of the girls that come to me for surgery, I first send them to voice therapy,” she said. “Even if they’re interested in surgery, I tell them, ‘What do you have to lose [by trying voice therapy]?’ Many of those girls don’t need to do surgery eventually.”

Generally, she said, such intervention is only required for transgender women, since the vocal chords of transgender men are thickened by testosterone, which deepens the pitch of their voice – an irreversible change.

Various estimates indicate that around 20 people in Israel undergo gender reassignment surgery per year, and a smaller number seek out vocal therapies. Shoffel-Havakuk, who completed a laryngology fellowship at the USC Voice Center in Los Angeles, said that within Israel she has only carried out a handful of such surgeries.

“It’s not that common, but I think it’s not that common because transgender women are not aware of it, and doctors are not that aware that this is an option,” she said. “I hope that now, when the Health Ministry committee recognizes this as something that is needed, required, that it’s a medical matter and not cosmetic… the surgery will be more available to those who need it.”

Shoffel-Havakuk said she understands that members of the Health Ministry committee take a wide range of considerations into their decisions on which treatments to fund – and that she believes no patients are more deserving than others.

“This surgery and these treatments are life-changing for those patients that suffer through their whole lives from discrimination,” she said. “Transgender women who are afraid to speak, to laugh, or to do anything in public, because of their voice — this kind of treatment and surgery can change their life.”

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