How Much Does it Cost? Financial Side of Gender-Affirming Surgery

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There are heartbreaking female-to-male and male-to-female anecdotes and stories detailing how painful and frustrating it is to transition. It's hard to imagine being in the wrong body with no way to immediately escape. Understanding what transgender people go through can prompt empathy, increase understanding, and spark change.

Institutions that Perform the Surgery

Not too long ago, there were only a handful of hospitals willing to perform gender-affirming surgery, and only then after prospective patients passed a battery of tests and regulations. Today, gender transition surgeries are more widely available than ever before. Men and women who are transgender don't have to risk traveling overseas, either. Hospitals in major cities, states, and even countries have opened their institutions to individuals who want to affirm their gender. This is mainly because people who are transgender are beginning to feel safer about opening up and revealing their truth. There's still a long way to go, but the recognition and acknowledgment that these surgeries are necessary marks a starting point. Better yet, as more hospitals begin performing them, they are also bringing in doctors, nurses, and other healthcare providers who have been educated and trained to take care of transgender men and women. Johns Hopkins is once again opening its doors to transgender patients. This comes after the hospital, once a groundbreaking institution and the first to provide gender-affirming surgery, stopped doing so due to faulty and flawed information and statistics. Other hospitals that are newly providing such operations include Mount Sinai in New York City, Oregon Health and Science University in Portland, Boston Medical Center, and the Cleveland Clinic.

Cost of Transitioning via Hormones

Most female-to-male and male-to-female stories include HRT, or hormone replacement therapy. Trans women who take estrogen and beta blockers are able to stop their body's testosterone production, while the estrogen allows for the development of more feminine features and details. Lines become softer, curls form, facial hair grows less dense, and breasts begin to take shape. Trans men take beta blockers and testosterone. The beta blockers block the production of too much estrogen. Thanks to the testosterone, the men lose fat around their stomachs and hips. Facial hair begins to grow. Their voices change and deepen. Beginning HRT is not unlike going through puberty, again. It gives transgender people the opportunity to officially begin transitioning into their true selves. However, HRT costs around $1,500 per month, and that's an average baseline. It can cost more. For individuals who do HRT for years, the cost adds up over time.

Cost of Surgery

Gender-affirming surgery encompasses several different surgeries. It isn't all about genitalia. For example, trans women often want facial feminization surgery to make their faces more feminine, while trans men may choose facial masculinization surgery to achieve more masculine features. The cost ranges from $25,000 to $60,000. Some trans women opt for breast augmentation if they aren't pleased with how much their breasts grow on HRT. That can cost anywhere from $5,000 to $10,000. Trans men may choose to have transmasculine top surgery, which results in the removal of breast tissue. The cost of that procedure is $3,500 to $9,000. Many female-to-male and male-to-female stories stop there because of the prohibitive cost of gender confirmation surgery. Bottom surgeries, the procedures that affirm a transgender person's genitalia, are even more expensive. On average, it costs more than $50,000 to transition from female to male. Trans women, who transition from male to female, spend between $7,000 and $24,000.

Insurance Question

Just as more hospitals perform gender confirmation surgery, more insurance companies are now willing to recognize these operations as medically necessary rather than elective. Thanks to the gradual shift toward acceptance and recognition of transgender people, the healthcare industry is beginning to realize that, for many, these surgeries are life-and-death issues. All the same, it's still difficult for people who are transgender to find suitable insurance and healthcare. The fact that they're thought to have a pre-existing condition doesn't help matters. Far too many people are forced to wait for years. They can't become their true selves until they manage to save enough money for surgery.

Surgical Process

Transitioning from male to female is primarily considered easier. It's not as expensive, and the results tend to be more successful. To transform a penis into a vagina, the testicles and majority of the penis are removed. The urethra is shortened. Surgeons use the skin from the sack and penis to create a vagina, which is typically functional for the most part. Surgeons also use nerve-laden pieces from the penis to craft a “neoclitoris,” which allows the trans woman to experience sensation. Trans men who transition from female to male have a more difficult time. Bottom surgery for trans men is far from perfect, and the results aren't always successful or satisfactory. These facts, combined with the cost, stop most trans men from going through with bottom surgery. Some men do opt for the surgery. In those cases, surgeons remove tissue from the patient's forearm or another area with skin to spare, which they use to construct a “neophallus.” The urethra is extended to allow the patient to urinate while standing. That's considered the hardest part of the surgery. Transgender individuals have to go through a long, difficult journey to become the people they were meant to be. Prohibitive expenses often prevent their ability to live authentically. Would you be able to afford such surgeries?