Diagnosis: Gender dysphoria.
Treatment: Estradiol valerate.

The insurer denied coverage for estradiol valerate. The denial is overturned.

This is a transgender female (male - to - female) patient with a history of gender dysphoria. The patient has been taking feminizing hormones. She has tried and failed Estradiol oral tablets and estradiol transdermal patch. With both of these modalities she experienced insufficient feminization and headaches. She is requesting the use of injectable estradiol.

Estrogens, finasteride, spironolactone, and gonadotropin-releasing hormone (GnRH) analogs are used to achieve feminization that will induce physical changes that are more congruent with a patient's gender identity (Lakhiani, C., Somenek, M.T.).

The patient has a diagnosis of gender dysphoria. She has tried and failed the formulary alternative and is requesting the use of injectable estradiol for feminization.

The carrier's denial of Formulary Exception for estradiol valerate is overturned.