Finally, employers are expanding trans-inclusive benefits

The “T” in LGBT is often overlooked in employers’ queer-friendly benefits packages. Some companies are working to change that, but progress is uneven.

Finally, employers are expanding trans-inclusive benefits
Michaela Demeter [Photo: Adam Bacher Photograhy, courtesy of Intel]

Michaela Demeter is something of a unicorn within tech’s white, male-dominated ranks. The security researcher is a 63-year-old trans woman who’s worked at Intel for the past 11 years. To hear her tell it, there couldn’t be a more inclusive place to work. “I work on one of the most diverse teams here,” says Demeter; her team counts three trans women among its 10 members. “Everyone treats everyone with respect.”


Demeter knows how unusual her experience at Intel is. According to recent research, unemployment among transgender and non-binary workers is higher (16%) than across LGBT people overall (13%), a rate that already dramatically outpaces the national one of around 4%. For many, being queer in the modern workplace invites harassment, discrimination, and worse, not to mention the widespread risk of getting fired with no legal recourse; the majority of U.S. states still lack employment protections for sexual orientation and gender identity, and the Trump Administration has argued that trans people are not covered by federal anti-discrimination law.

It’s in this environment that employers like Intel are working to attract and retain talent like Demeter, which in many cases means expanding LGBTQ-friendly practices to include more trans-inclusive policies and benefits. While many employers still lag behind, a few leaders are pointing the way.

Related: How companies are (and aren’t) supporting LGBTQ parents

A belated rise in trans-friendly benefits

Demeter tried to transition twice before arriving at Intel. The first time, in her 20s, Demeter was brutally assaulted around six months after beginning to shift her gender presentation. The two nights she spent in the hospital convinced her to go “back into boy mode.” Years later, after a divorce, Demeter briefly tried again, before halting the process once more. After joining Intel in 2007, she says, “I just did everything I could do to fit in and be like everyone else.”

After a year or two, though, she’d made a few friends through Intel’s LGBT employee resource group, and it was around this time that the company rolled out health benefits geared to trans employees. The announcement made an impact on Demeter. “The idea that someone was talking about trans people like they are really people, and they recognized we are part of their population–,” Demeter says, pausing before finishing the thought. “Other places never wanted to talk about it.”


Neither did she at first, Demeter admits. But around two years ago, she decided she was ready, and scheduled her first appointment with HR to discuss transitioning at work.

Her timing was fortuitous. Intel launched an aggressive investment in diversity in 2015, which included a focus on LGBT workers, including policy changes geared explicitly toward trans and non-binary employees. The company started covering all gender confirmation procedures according to standards set by the World Professional Association for Transgender Health, without a lifetime maximum benefit, in 2016.

Related: What it’s really like to be out at work in the Trump era

But trans-inclusive benefits like Intel’s have been slower to catch on than other queer-friendly business practices. In 2015 a group of Fortune 500 companies including Google and Coca-Cola formed a coalition to support their LGBT workforces through internal policies, corporate giving, and business partnerships, but these commitments didn’t necessarily extend to trans-friendly health benefits.


That’s begun to change in recent years. The Human Rights Campaign, a leading advocacy group, announced last year that over 450 major U.S. employers now have policies to support employees through the transitioning process. Separate research from the International Foundation of Employee Benefit Plans (IFEBP) found that these numbers are inching up throughout the U.S. workforce. Twenty-two percent of the nearly 600 HR professionals surveyed said their health plans cover gender confirmation procedures, up from 8% in 2016; a quarter provide mental-health counseling pre- and/or post-surgery, up from 11% two years ago; and 24% cover prescription drug therapy, up from 9% over the same period.

However, these benefits are more likely to be found at large employers like Intel, with workforces in the tens of thousands, than at smaller ones; IFEBP found that only 10% of companies with fewer than 50 employees offer trans-friendly health benefits, up from 4% in 2016.

Related: Here’s what it’s like to transition at work

Low investment in some, high reward for all

The “T” in LGBT has historically been overlooked, both within the gay rights movement itself and within employers’ reactions to the push for inclusion. That’s likely due to some combination of bias and demographics. Researchers estimate that 0.3–0.6% of people worldwide consider themselves transgender, a rate that’s thought to be similar within the U.S. as well, which puts the population of trans adults in America at around 1.4 million. This figure, of course, doesn’t include those who haven’t admitted to themselves or others that they are trans or gender-nonconforming, yet the community is still likely a minority within the roughly 10 million Americans overall who identify as LGBT.

Still, employers are finally realizing that trans-inclusive benefits aren’t all that expensive, and not only because a small sliver of their workforces are likely to require them. The Human Rights Campaign estimates the cost of trans-focused medical care at around $25,000–75,000 per employee, a fraction of the price-tags of more common procedures like treatments for cancer or heart conditions. “Offering transgender-inclusive health benefits is a way for employers to remain competitive in attracting talent without breaking the bank,” IFEBP’s VP of Content Julie Stich tells Fast Company.


Related: A brief (and depressing) history of LGBT workers’ rights

What’s more, the broad range of identities and experiences within the trans, intersex, and gender-nonconforming communities means that, for employers, being inclusive is frequently more about work culture than health coverage. What’s more, not everyone who identifies as transgender or non-binary medically transitions–in the same ways or even at all.

Gender confirmation surgeries for trans men and trans women, respectively, differ in scope and kind, giving patients a range of medical options to define transitioning on their own terms. For example, according to Drían Juarez, West Coast manager at Grindr/Grindr for Equality, recent advances in facial feminization are raising demand for those procedures among trans women, yet coverage for nonsurgical care “like hormone therapy [and] therapy in general” can still go a long way for many more. Grindr offers these benefits, as does Intel, whose plans also cover laser hair-removal, voice therapy, and tracheal shaving.

[Photo: Jordan Stead/Amazon]

Related: Can this platform keep frustrated LGBTQ workers from quitting?

The culture factor

While their particulars may vary, trans-friendly health plans can send a powerful signal. “Typically, this type of benefit is appreciated but not used frequently,” says Stich, and employers reap the rewards in numerous ways. According to the American Medical Association and American Psychiatric Association, trans people who receive adequate care are less likely to struggle with the emotional stress of gender dysphoria. Demeter recalls the psychological toll of staying closeted. “I did work very hard at maintaining multiple lives,” she admits. “I would just sleep a few hours a night.” After announcing the beginning of her transition to her team, the sleepless nights vanished. “I sleep eight to nine hours a night,” she says. “I’m absolutely more productive.”


Danielle Skysdottir [Photo: Jordan Stead/Amazon]
Danielle Skysdottir, a software engineer at Amazon Marketplace, was hired by the Seattle tech giant seven years ago, right out of college. While she’s decades younger than Demeter, their experiences as trans women in tech bear similarities. Amazon rolled out unlimited trans medical benefits in 2015, just as Intel was expanding its own policies, and Skysdottir also felt apprehensive about coming out to her colleagues. “My fears were completely unfounded,” she recalls, sounding relieved all over again.

Skysdottir was especially worried about her older, more conservative colleagues, but she claims Amazon’s inclusive work culture prevailed. “The vast majority were supportive, and the others are completely professional,” she says, adding that she continues to exchange 1,000-word emails with one coworker who’s made an effort to understand more about Skysdottir’s experience. “Day to day, it’s a positive affirming relationship,” she says.

Trans workers still face many challenges, though, hardly all of them limited to the transitioning experience. Before nailing down an advocate within Intel’s HR office and at her insurance company, Demeter says her personal information “got spread around to more people than I expected” before she was ready for others to know she was transitioning. Misgendering remains a common microaggression that trans and non-binary workers report experiencing regularly; bathroom access also remains a fraught issue. And while elite employers like Intel and Amazon may set an outsize standard for others to emulate, the fact is that the vast majority of trans Americans work at much lower-profile organizations that may have less inclusive values–and little public pressure to change them.

However, employers that lag behind are already paying the price in recruiting and retention, says Stich. “When searching for meaningful employment, individuals look for employers with cultures that resonate,” she explains. “Employers are seeking top talent, and offering an inclusive benefits package sets them apart from their competition.”

About the author

Lydia Dishman is a reporter writing about the intersection of tech, leadership, and innovation. She is a regular contributor to Fast Company and has written for CBS Moneywatch, Fortune, The Guardian, Popular Science, and the New York Times, among others.