It took St. Paul resident Evan Thomas decades to realize that his birth gender was incongruous with the gender he identified with.

So two years ago, he began counseling and, last year, hormone therapy, to transition into a man. Thomas even legally changed his name, but then he hit a roadblock — a Minnesota law forbids state medical assistance programs from paying for the double mastectomy surgery he feels will complete his transition.

“It just feels like having a door slammed in my face,” Thomas said Thursday.

Now, the 63-year-old is suing Minnesota Department of Human Services (DHS) Commissioner Emily Johnson Piper for his right — and the right of all transgender Minnesotans — to gender reassignment surgeries under Minnesota’s Medical Assistance and MinnesotaCare programs, the state’s public insurance programs for low-income residents.

The suit, filed by the American Civil Liberties Union (ACLU) of Minnesota on behalf of Thomas and the advocacy group OutFront Minnesota, is asking a judge to stop DHS from enforcing the law.

“Transgender people all across the country have been making strides,” said Teresa Nelson, legal director for the ACLU of Minnesota. “Minnesota needs to … bring its laws into the 21st century.”

“We have received the lawsuit, which challenges current state law,” said a statement issued by DHS. “We are now reviewing the complaint.”

The medical assistance programs won’t pay for surgeries such as hysterectomies, mastectomies, vaginoplasty and phalloplasty, among others, if they’re related to gender reassignment. But they will cover the same surgeries for other medical needs.

Gender dysphoria, a “serious medical condition” of feeling incongruence between birth gender and gender identity, the suit said, is as legitimate a medical reason as any other.

“If left untreated, gender dysphoria can lead to serious medical problems, including clinically significant psychological distress, dysfunction, debilitating depression and, for some people without access to appropriate medical care and treatment, suicidality and death,” the suit said.

The suit alleges that the law discriminates against people who are transgender, infringes on a transgender person’s right to privacy and violates Minnesota’s Constitution.

Nelson said Thomas’ suit is the first one to challenge the state law, which has existed in some form since 1995. The programs used to cover transition-related surgeries, Nelson said, but changes to the law in 1998 began limiting coverage, and in 2005, stopped coverage of such operations altogether.

‘Something I needed to do’

It’s unclear how many Minnesotans are unable to pursue transition-related surgeries because of the law, but Phil Duran, legal director of OutFront Minnesota, said his organization has heard from “dozens” of people in the past several years.

However, Duran noted, striking the law from the books would have minimal impact on the state’s bottom line.

“The existence of the statute sends … a message that’s devastating to people,” he said.

Despite gains in transgender rights and increasing cultural acceptance, Minnesota’s stance on gender reassignment surgeries isn’t unusual. Dorsey Whitney attorney Kristina Carlson, who is also working on Thomas’ case, said that her research shows that only 10 states and the District of Columbia have state Medicaid programs that cover such surgeries.

But the momentum in the transgender rights movement made it the right time to challenge Minnesota’s law, said Thomas and his legal team.

“It was a very difficult decision,” Thomas said. “But it seemed important enough, not only for me, but for other people in Minnesota, that it just seemed like something I needed to do.”