Court orders the Bas-Rhin CPAM to cover mastectomy costs as part of gender transition

A trans man, who was challenging in court the refusal of the Bas-Rhin Primary Health Insurance Fund (CPAM) to cover his mastectomy, won his case on Wednesday, May 14, at the Strasbourg court, a decision that was "unprecedented" in France, according to his lawyer.

The social division of the Strasbourg judicial court ordered the CPAM to cover the cost of bilateral mastectomy surgery and ordered it to pay the applicant 3,000 euros in damages.

The requirements imposed by the CPAM on the applicant – such as a prior medical certificate and a memorandum of understanding – “are contrary to the combined provisions of Articles 8 and 14 of the European Convention on Human Rights as likely to create inequality of access to health based on gender identity” , this judgment also underlines.

The CPAM was found guilty of having committed a "fault" which "caused direct and certain harm (to the applicant) who was subjected to significant and unjustified additional delays in a particularly long and complex treatment pathway, thus forcing him to undertake an unfinished transition which was in total contradiction with his new civil status" .

"This is the first time that a French judge has recognized the discriminatory nature of the CPAM's refusal and the invasion of privacy. This is unprecedented," said ^Laura Gandonou, the applicant's lawyer, to Agence France-Presse (AFP).

"I feel very relieved, grateful. This is a decision I've been waiting for a long time," the 31-year-old applicant, who wished to remain anonymous, told AFP. He hoped that "it will allow other trans people to suffer less discrimination."

Assigned female at birth, he began his transition in 2017. First a social transition, announcing it to his loved ones, then an administrative transition with a change of first name and civil status, and finally a medical transition, with the taking of hormone treatment in June 2022.

Due to his gender dysphoria, he applied for long-term care in order to receive full coverage for his care, including surgery. However, he was partially denied by the medical advisor. He appealed to the amicable appeals committee in November 2022, which rejected his application in January 2023. He then turned to the courts.

During the hearing on March 12 at the Strasbourg judicial court, the representative of the CPAM argued that the fund's decision was based on a "medical opinion" , while the young man's lawyer, ^Mr. Gandonou, described this refusal as "abusive and unfounded" .