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.

What it takes to change your government gender

I received my new Drivers License today which means that I’m officially a doctor certified, government recognized woman! It also means I’m done with phase 1 of changing my name and gender marker. But you wouldn’t believe how complex the steps to get there can be. Here’s what it takes in Washington.

First I had to research the process and figure out which dependencies were built in so that I could get the necessary documents at the correct government office in the right order. Then  I had to go to my doctor to get the required letters and signatures.

Step one was going to the local County Courthouse and filing a Petition for Name Change which had to be submitted by 11 am if I wanted a same-day hearing and I had to pay $215 in cash to get the 4 certified copies I would need later on. Then I had to come back at 1:15 to have a judge have me attest on the record that I wasn’t changing my name to commit fraud or escape debt. Then I waited around in the lobby while my documents were processed.

Once I had the name change, I was able to submit my passport renewal in the same office but I nearly made the mistake of filling out the renewal form because that’s what the online steps indicate if you say you are changing your name. In order to find the correct steps you have to find the deeply hidden page on how to change your gender which tells you to submit the application for a NEW passport (Form DS11) in person and means you can’t use the online wizard completely (you have to tell it you don’t have a former passport and then correct it by hand after you print) or submit by mail. I also had to be prepared with a new passport photo which cost me $15, a letter from my physician certifying that I had medically transitioned, and pay $145 in the form of 2 checks to submit along with my previous passport which means I can’t fly abroad until the new one arrives.

Then I proceeded to the local Social Security office where I waited for an hour in a crowded lobby full of armed officers to submit my Application for a Social Security Card showing the correct gender which required me to show my court order along with another copy of the letter from my doctor certifying my medical transition. Luckily that process was free.

Then I proceeded to the Department of Licensing to update my Drivers License only to find out that to update an Enhanced ID (necessary for flying soon), I needed to wait for the new Social Security Card to arrive in the mail. So I came back a week later and waited in line a second time to submit yet another Change of Gender Designation Form with my physician’s signature along with another copy of the court order and a $10 fee.

Luckily for my Birth Certificate, I was able to mail in the Request to Change Sex Designation on a Birth Certificate for an Adult which had to be notarized but luckily doesn’t require a doctor to sign anything now in Washington. I did have to pay another $20 by check if I wanted to get a copy however.

All told, this is how much effort it took:

  • Research Time: 3 hours
  • Number of Offices: 4
  • Wait Time in Lobbies: 2 hours
  • Cost: $425

Now I get to move to phase 2 where I contact all the various places that have my old name such as banks, medical providers, online accounts, etc. to get them to update my name and gender as well. I’m exhausted just thinking about it!

If you would like to help support my transition costs, you can donate at https://www.gofundme.com/f/haven-gender-confirmation-treatments

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