Why is gender affirming care so expensive?

I’ve written quite a bit about the costs that I have incurred along my journey of trying to inhabit a trans body. But even as I look forward to the upcoming revision surgery on my vulva, it is a harsh awakening to realize that I am going to have to spend yet another $6,000+ for housing simply because Seattle has no transgender vaginoplasty surgeons and most insurance refuses to pay for out of state surgery costs.

So how much have I paid out of pocket so far for gender affirming care?

  • $5,000+ for electrolysis and laser hair removal on my face and body (not considered “essential” by insurance)
  • $9,500 in travel costs for consults, surgical recovery housing, and post-op appointments
  • $6,000+ for housing for revision surgery recovery

All told, I can account for over $20,000 in costs that insurance refused to cover.

I am one of the lucky ones. I am privileged enough to have a good job with decent health insurance so my co-pays are minor and I can afford to save up for these procedures. And I have a large network of friends who have generously donated over $5,000 towards those costs.

But can we talk about why these costs exist in the first place? Why is it considered ok for transfeminine people to have to pay for face and body hair removal to deal with dysphoria? In a world that demands that we “pass” as women to use public facilities such as restrooms, that is incredibly classist and discriminatory. And why does insurance not have to pay for the costs of getting an out of town surgery when there are no local surgeons available? My insurance now pays for cancer patients to get out of town specialty care but despite my advocacy for the past several years, continues to deny trans people that same right.

Luckily, starting in 2022, insurers in Washington State are now going to be required to pay for all doctor-prescribed gender affirming treatments and will no longer be allowed to label them as “cosmetic”. This is thanks to the tireless work of many many advocates and organizations who fought for years against insurance denials. And I hear through the trans rumor grapevine that Seattle may FINALLY be getting a surgeon soon who can perform vaginoplasties locally. But while that helps people here in Seattle, that doesn’t change the fact that far too many trans people around the US aren’t given equal healthcare access. We need laws in place federally to mandate coverage of gender-affirming care.

So next time you think of asking someone if they have had “the surgery” or make any kinds of assumptions about what trans people should look like, think about how expensive it is to look like I do. How inaccessible it is to the vast majority of trans people in this country to achieve what Laverne Cox, Caitlyn Jenner, and Elliot Page have done. And if you have resources, I encourage you to donate generously to your local trans fundraisers and places like the Jim Collins Foundation to help more trans people get the care we so desperately need.

How much does surgery cost?

It is going to depend a lot on your insurance plan and where you decide to get surgery but let me share a bit about what my expenses were.

  • 2 Pre-Surgical Consults in San Francisco with flights for 2 people and 5 nights in a hotel – $1,000
  • Comfortable ground floor lodging for 1 month in San Francisco for the pre-op appointment and 3 weeks of recovery on AirBnb – $3,300
  • Lodging and gas to drive to San Francisco from Seattle and back – $400
  • Takeout food during recovery (we splurged a bit on comfort food) – $1,200
  • Medical supplies and copays – $200
  • Flight back to San Francisco for a 3 month recheck – $200

Total = $6,500

I am very lucky that I didn’t have any large deductibles and copays since I met my out of pocket max both years. This was obviously a much more comfortable recovery than most people can afford and I am extremely grateful to my friends who donated almost $4,000 to help make this happen. I also didn’t have to bear all the expenses myself since my spouse paid for a lot of the food.

The costs of being trans

Being trans is so damn expensive! Who in their right mind seriously thinks we do this just for kicks?

I just budgeted my out of pocket costs for bottom surgery and I’m looking at between $6,200 to $8,800 since there are no surgeons near Seattle and I have to travel to San Francisco to do it. I also just spent $400 on my name and gender change documents. And I’ve already spent $3,000 on hair removal with at least another $600 to go.

If you would like to help contribute, please donate to my transition fund: https://www.gofundme.com/f/haven-gender-confirmation-treatments