Roughly a decade ago, a transwoman by the name of Rhiannon O'Donnabhain had genital reconstructive and breast augmentation surgery. These same procedures are done, every day, for transsexuals and others in the United States.

Come tax time, O'Donnabhain's story takes a turn. Like many others, she opted to deduct her surgeries as medical expenses. The Internal Revenue Service disagreed with her over the medical necessity of her surgery, even going so far as to cite an article by anti-transgender advocate Paul McHugh from a Catholic religious journal as part of its evidence against her.

The piece in question, titled "Surgical Sex," noted the closure of the Johns Hopkins Hospital's gender reassignment clinic way back in 1979. It did not, of course, include that the closure was, in part due to the machinations of one, you guessed it, Paul McHugh.

Nevertheless, this decision effectively stopped the long-time practice of claiming transsexual procedures and medications on one’s taxes, something I'd heard about -- and benefitted from -- for some time. Religions conservatives crowed about this victory, making it as big an issue as they could in a "culture war" dominated by their shrill cries against same-sex marriage.

The story did not end then, with O'Donnabhain taking her fight to the U.S. Tax Court in 2007. Now, three years later, and nearly a decade since O'Donnabhain was under the knife, the U.S. Tax Court has made its ruling: treatment for Gender Identity Disorder does indeed qualify as a medical necessity, and is therefore tax deductible.

This is the first time the U.S. Tax Court has ever made any rulings on transgender care and tax deductions -- and, quite frankly, one of very few Federal rulings ever dealing with transgender rights.

Those same religious conservatives are wailing at least as loud as they once crowed, with the "Americans For Truth" claiming that this ruling is nothing short of another step on America's "rapid descent into post-Christian chaos."
The Traditional Values Coalition also chimed in, pushing for a further reversal of this decision -- and citing again Paul McHugh from Surgical Sex. He also discusses, briefly, As Nature Made Him, missing the point that gender may indeed be an innate part of one’s being -- including the gender identities of transgender people.

The "Americans For Truth" statement, after spending most of their ink focusing on somewhat overly dramatic and offensive descriptions of transgender surgery, claim that this deduction will be an "incentive" for having surgery. I presume that these same people also buy in to the notion that legalizing same sex marriage will be an incentive to all their heterosexual friends to change their orientations?

This is where I and many others differ from the fear mongering being foisted on the public from the TVC and "Americans For Truth." There is only one "incentive" in seeking out such care and treatment, and it's not this "healthy tax break" they claim will cause people to start having "healthy breasts... surgically removed" or getting a "makeshift “vagina” from [a] surgically-dismantled, once-healthy penis."

The decision to seek any such care is rarely taken lightly. For many, it is accompanied with many years of crushing depression and inner turmoil. It is hardly the sort of thing one approaches as a tax dodge, let alone just how much one ends up having to invest in medical care far outweighing anything gained in tax deductions.

From my own experience and from talking with a great many transgender people -- certainly a lot more than I suspect the Paul McHugh’s, Lou Sheldon’s, and Peter LaBarbera’s of the world have -- few wish they would have to go down such a path in the first place. It's simply not something done on a lark. I certainly would not have sought out a life where I have to struggle for employment, where I may never have financial security, and where one can pay out a lot of money in medical care for a paltry tax deduction.

Many years ago, long before Mr. O'Donnabhain had her surgery, I had first heard from another transgender advocate about being able to claim a tax deduction for my hormone treatment and therapy. There was no court ruling on it then, simply an understanding that this care was considered medically necessary. Or, at least, no one had yet been challenged on it. Given the high cost of medical care, having such a deduction went at least some of the way in keeping many transgender people out of bankruptcy over much needed care.

This is what the opponents of this miss. They want to see this deduction as creating transgender people eager for a tax break, rather than seeing it as a tax break that will assist with the needs of already existing transgender people. It is the same argument used when the City and County of San Francisco sought and approved the coverage of transgender medical care in their own insurance policy amid conservative claims of hundreds of newly-minted transgender people swarming over the Oakland hills for a crack as treatment.

The thing is I don't expect that McHugh, Sheldon, or LaBarbera to understand that not everything in this world is fueled by greed, and that some people do have legitimate medical needs. They seem incapable of such compassion for others.

But what I do know is that -- by the letter of the law as determined by the U.S. Tax Court, the needs of transsexuals like Rhiannon O'Donnabhain are medical necessities. That is all that should matter.

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Gwen Smith hopes to actually get something back this year. You can find her on the web at www.gwensmith.com