Superior Court Judge Julian Houston in Middlesex, Massachusetts, has ordered Medicaid to pay for cosmetic surgery to remove the Adam's apple of a sex change patient. Houston ruled that an earlier decision to withhold Medicaid funds was "arbitrary and capricious," and declared that even though the operation would be cosmetic surgery, it was "medically necessary," as required by Massachusetts law. Houston was guided to this conclusion by the patient's psychologist, who contended that life with an Adam's apple would "lead to a deterioration" in the patient's mental and social well-being.

†