Does Transgender Matter to Life Underwriters?

August 31, 2016| Von Ross Campbell | Life | English

European life insurers have had to offer the same premiums to both sexes since December 2012. While the European court decision that led to unisex premiums was aimed at promoting equality, it did not change the biological reality that being a woman or a man has an impact on how long we are likely to live.

For insurers the question is whether an individual can or should be treated differently from their birth sex. It’s a reasonable consideration for underwriters in the context of gender reassignment, especially in markets where gender-neutral rates are not mandated.

The latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a manual edited by the American Psychiatric Association, refers to "sex" and "sexual" as the biological indicators of the male and the female but that "gender" denotes the "public and often legally recognised role that is lived."1

The Equality and Human Rights Commission (EHRC) in the UK says trans people seek to match their gender expression or presentation with their gender identity rather than their sex at birth.2  According to the EHRC, gender can be defined by gender identity and gender role. Gender identity refers to a person’s self-perception and experience of their gender, and gender role is the way in which the person lives in society and interacts with others, based on their gender identity.

This shifts gender from a purely biological form into a behavioural construct. While the news has covered the topic of transgender people often in recent years, it’s not a first. In the 1970 divorce case Corbett vs. Corbett (otherwise Ashley), the court ruled a marriage depends on sex not gender and that “operative intervention” should be ignored.3  This changed the legal status of trans people in England and ended a right, which had existed from 1944, to an amended birth certificate after surgical reassignment. Legal status was restored across the UK with the Gender Recognition Act 2004 and the associated Gender Recognition Certificate (GRC). The GRC legally confers a person all the rights of his or her acquired gender from the date of recognition. After a successful application, a person’s birth register is amended and a new birth certificate is issued. It is unlawful to discriminate against a person with a GRC other than on grounds that would apply to anyone else of their acquired gender.

UK insurers accept the gender disclosed at point of application as that stated on a GRC. In the absence of a certificate, insurers will accept the acquired gender “in good faith.” The UK’s Equality Act (2010) further prohibits insurers discriminating against someone with a "protected characteristic" including gender reassignment. A review of the Gender Recognition Act (2004) announced in July 2016 will see the process for gender revision on official documents, such as passports, shift from a medicalised process towards self-declaration.

Asscheman et al. (2011) observed the total mortality of male-to-female transsexuals (males receiving cross-sex hormonal treatment to become females) was 51% higher than in the general population, mainly due to suicide.4 The significant strides made in the treatment of HIV since the mid-1990s is likely to nullify the other major cause of early mortality in this study, AIDS. Female-to-male transsexual total mortality was not significantly different from the general population. Self-harm and suicides are major feature of the transgender population, as reported by other sources as well:

  • One online support site reports over half of people on the transgender spectrum will have attempted suicide before the age of 20.5
  • Dhejne (2011) report increased suicide attempts and psychiatric in-patient care.6
  • Bailey (2014) found 48% lifetime prevalence of attempted suicide amongst trans people.7
  • Heylens (2014) found 40% have affective and anxiety disorders.8
  • Marshall (2015) reports trans men are at greater risk.9


To the initial question, it seems likely that different underwriting responses exist but that few are based in fact.10  The situation is clear in markets with gender neutral premiums. For the small numbers of applications in markets where this is not the case, offering the premium of a person's acquired or adopted gender would not seem to pose a significant problem. There is, however, evidence to suggest any given individual may not be a "standard rates" risk, depending on the presence of other risk factors.


  1. Diagnostic And Statistical Manual of Mental Disorders, Fifth Edition, page 451.
  3. Corbett -v- Corbett (otherwise Ashley); FD 1 Feb 1970 available at
  4. Assheman, H et al. A long-term follow-up study of mortality in transsexuals receiving treatment with cross-sex hormones, Eur J Endocrinol. 2011 Apr;164(4):635-42.
  6. Dhejne, C et al. Long-Term Follow-Up of Transsexual Persons Undergoing Sex Reassignment Surgery: Cohort Study in Sweden. PLoS ONE 6(2): e16885. doi:10.1371/journal.pone.0016885.
  7. Bailey, L et al. Suicide risk in the UK trans population and the role of gender transition in decreasing suicidal ideation and suicide attempt, Mental Heath Review Journal, Vol 9, No.4 2014, 209-220.
  8. Heylens, G. et al. Psychiatric characteristics in transsexual individuals: multicentre study in four European countries, The British Journal of Psychiatry (2014) 204, 151–156.
  9. Marshall, E. non-suicidal self-injury and suicidality in trans people: a systematic review of the literature, International Review of Psychiatry, 2015; Early Online: 1–12.


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