“I wrote that because I was very angry, actually, at the editor putting all the papers of gender affirmation in the cosmetic section. And I said if you keep doing that, what’s going to happen is that someday some insurer, especially now, you know, seeing what happens in the U.S. with a lot of fight-backs, some insurer’s gonna say ‘Well if it’s cosmetic, we’re not … we’re just going to stop covering it’ and that’s a huge danger,” said Laungani.

Haim disagreed that phalloplasty should be considered reconstructive surgery.

“The key distinction between the two is whether the procedure is directed at fixing a physiological abnormality that negatively affects normal function,” Haim said.

Haim referenced the United Healthcare Guidelines, which state that “reconstructive procedures treat a physical and/or physiological abnormality related to an injury, illness, development abnormality, or congenital anomaly to improve or restore physiologic function.” The guidelines further note that “cosmetic procedures are performed to change or improve appearance without improving physiological function.”