Guide to paying for gender reassignment surgery

With queer and trans people constantly under attack from waves of legislation and discrimination directly targeting them, taking a direct stand against the hate is one of the most impactful actions.

Pride month isn’t the only time we should be learning how we can do our part to support people in the LGBTQIA+ community, including the estimated 1.4 million U.S. adults who identify as transgender, but it is an opportune moment to take stock and understand their experiences.

See related: Guide to LGBT finances: You can live a richer life

A few important things to understand about sex, gender and trans people

Sex and gender are not the same thing – and gender is often more personal and culturally constructed. While sex is someone’s biological and physiological characteristics, a person’s gender is the behaviors, roles, expectations and activities they relate to in society.

Not everyone identifies with the sex they were assigned at birth, and thanks to more exposure in pop culture and the amplifying of trans people’s voices, people are increasingly starting to explore their gender identity.

Another important thing to know and consider is transgender people exist everywhere and come from all kinds of backgrounds. They come from all walks of life and of all ethnicities and races. And what it means and looks like to be trans will be different for each person, which is why it’s so critical not to make blanket assumptions about transness.

In many places, it’s still dangerous to be openly trans, and not all trans people are even remotely safe to present as who they truly are inside. Wearing the clothing, makeup or other external accessories that make them feel most affirmed and like themselves is not always possible.

For this and many other reasons, it’s important to remember that you can’t tell someone’s gender just by looking at them.

Gender reassignment procedures

Those who want to transition physically or externally have many different options, from getting gender reassignment procedures and buying a new wardrobe and accessories that match their gender, to choosing against surgery.

Trans people can also transition without surgery or medical procedures by changing their clothing, pronouns, name and gender presentation. Either way, money can often be a barrier for trans folks, and getting accurate information about the costs of transitioning can be a hurdle in and of itself.

For those who do wish to get surgery to alleviate gender dysphoria and have a body that matches their gender (and are at least 18 years of age, in most cases), the costs vary significantly depending on details like insurance coverage and location.

Types of surgeries and their costs

The types of surgeries that trans people seek are more informally known as top surgery, which is a reconstructive surgery that alters the appearance of the chest, either taking breasts away for a more masculine/flat chest or adding breasts for those who want to appear more feminine. Top surgeries are performed by a plastic surgeon with training in transgender and gender-affirming medical procedures.

Bottom surgery refers to vaginoplasty, phalloplasty or metoidioplasty, all various procedures that change a person’s genitals to match their gender. Trans women might also opt for facial feminization surgery, so their facial features match how they want to see themselves.

Hormone replacement therapy (HRT) is also a popular mode of transitioning and involves using testosterone or estrogen to reach one’s desired gender presentation.

These methods are not just for binary trans people, or trans men and women, either. Non-binary people and genderqueer people might medically or hormonally transition as well.

The cost breakdown includes:

How to budget for the costs of transitioning

Transitioning isn’t limited to medical costs and procedures. Other things to budget for include post-surgery care or even buying new clothes that match your gender presentation and make you feel affirmed in your identity. It might also include makeup and accessories that help you feel like yourself. And of course, for trans women and transfemmes, much of this will include the pink tax.

Everyday costs

“So far, it’s all been relatively manageable. But I will say that trying to cultivate a wardrobe with gender-affirming looks and clothing has been the most expensive,” says Evelyn, a trans woman who began transitioning within the last half-year. “The biggest thing as a trans woman that has surprised me is shoes. Mainly women’s shoes usually only go up to about 11-12. I have a size 14-15, so most of the time, I would have to order from special stores, or places that custom-make shoes for drag queens.”

Buying new clothing and accessories is not the only option, though. You can do clothing swaps with other trans people, go thrifting or ask friends if they have old clothes they want to get rid of that match your new gender presentation.

Clothing and makeup, despite how expensive they can be, have brought the most joy to Evelyn. “My personality is very extra and outgoing and colorful, and my male-passing clothing always were dull and very narrow fitting. Now, I am buying all these flowy cardigans and scarves and really living my Stevie Nicks meets City girl dreams,” she says.

“I feel so powerful and so happy when I walk around, and the wind picks up my long cardigan and I move with a grace I didn’t think I would ever be able to have.” Despite how much costs can weigh you down, the people who spoke with us explain that transition feels freeing.

Sasha, a Latinx non-binary trans woman who began HRT in January 2020, says that her job in tech and excellent health insurance is what’s made it possible for her to afford transitioning. The most expensive part of her transition, she says, has been hair removal.

“I have spent thousands of dollars on both laser and electrolysis. I looked at my credit card history and to date, I’ve spent $5,003.25 on electrolysis (with probably another $1,500 or so before I’m totally clear of facial hair). As for laser for body hair, I have paid around $3,000 for it so far.”

In total, Sasha has spent about $8,000 just on hair removal, and she says she still has $2,000 or more to go. “This has been far and away the most expensive part of transition because insurance won’t cover it. They will only cover electrolysis for preparation for bottom surgery,” Sasha says.

There are some important things she wishes she’d been told earlier, like the costs and benefits of laser versus electrolysis. While electrolysis is more expensive and takes a longer time, it permanently removes hair. Laser is faster and cheaper but not permanent.

“I decided to go with laser early on in my transition because it was cheaper and seemed to be a good option at the time. For facial hair removal, I would’ve liked to have started out with electrolysis because although it is a slower process, the results are for life. So, I wasted some time and some money on laser for my face early on that I wish I hadn’t,” she says.

Although surgeries and other medical necessities have certainly helped Sasha transition, some of the most affirming purchases she has made in the last few years are accessories that help her feel gender euphoric.

“I bought these leather high-heeled boots that I absolutely love. Playing with makeup is something I always wanted to do and since allowing myself the pleasure, I’ve had so much fun trying different eyeshadows and lipsticks,” she says.

Alex, who has been out as a nonbinary trans woman since 2017, says she’s been most surprised by how quickly transition expenses add up. “They are wildly inaccessible to those without disposable income and require maintenance,” she says of things like budgeting for nail and hair appointments and medspa procedures (like laser hair removal, Botox and fillers).

Legal costs

When transitioning, some people choose to legally change their names and some don’t. The costs can vary depending on where you live. For Sasha, it cost $350 to get a court-ordered name change and publish her name change in a local paper, which is a legally required part of the process.

“I wouldn’t have had to pay that if I had had a legal counsel that guided me through the process of waiving those fees, which is totally possible, but I didn’t know how to navigate it,” she says. Once her name change is official, she’ll also have to pay for copies of the court order.

See related: Major issuers slow to adopt Mastercard True Name card

Social costs

The costs of transitioning are also not simply financial. Trans people who choose to live openly often face discrimination, rejection and even violence. Black trans women and trans women of color face these dangers the most. The risk of being fired from a job, bullied or harassed at work or having to move to an entirely new community because of transphobia is also high.

Some of the social costs of transitioning that Alex says she’s experienced include “ongoing stress and hypervigilance when in public, and exhaustion from being hyper-focused on how I’m being perceived by others.”

However, there are also positive, affirming social experiences that come with transition ­– and that joy is just as important to acknowledge and to be able to look forward to.

The pieces of clothing that Alex has invested in that have made her feel like her truest self include crop tops and big pants, neutral blushes and lipstick and skin tints. And the most affirming experience she’s had related to her transition has been relearning what sex and pleasure feels like in her changing body, she explains.

Options on how to pay

Crowdfunding, loans and credit cards are some of the main ways that trans women who spoke with us said they’ve been able to pay for medical bills.

Like Sasha explained, even if you have insurance or a well-paying job, some costs are just too great, and insurance doesn’t cover everything.

Other options to pay for the numerous costs listed above include:

• Personal loan from a credit union: Although credit unions provide virtually all of the same services and products as banks, their goal is to enable members to borrow at the lowest possible cost.
• Credit cards: A 0% APR credit card may be your best option as many offer introductory APR periods of usually 12 months or longer.
• Home equity line of credit: A HELOC is a variable-rate home equity product that works like a credit card – you have access to a credit line that you can draw from and pay back as needed.
• CareCredit: Instead of an open-ended date to pay off your debt (like with a regular credit card), a CareCredit credit card has fixed monthly payments over a set term ranging from six months to 60 months.
• Online personal loan: A personal loan is best for people who may need more time to pay down their balances. You’ll get a low fixed rate that can last for several years.
• Family loan: If a family member is willing to help, make sure to formalize the deal by writing up a contract that includes terms, dates and conditions.
• Crowdfunding: GoFundMe and Indiegogo are great examples of crowdfunding platforms.
• Surgery grants: Point of Pride, Genderbands and The Jim Collins Foundation are all great places to start when looking at this option.

See related: When should you use medical credit cards?

Allyship to trans people

“It is still a very dangerous thing to be trans in the world. I am extremely privileged and due to my job and the resources I have, I can shield myself from many of the hardships a lot of other trans people face. Most trans folks don’t have that luxury,” Sasha says.

The best way to support trans people is to give to them directly, she explains. Donating to transition funds is crucial. “If you see a way that directly supports a trans person’s housing, surgeries, HRT, food, etc., whether that be through a GoFundMe, Venmo, or whatever, if you have the resources, give! Especially to Black and Indigenous trans folks,” she says.

“For cis allies, I challenge you to really listen to trans people. I find that when I speak to cis allies, they do a lot of talking and not a lot of listening. Listen to what trans people tell you about what their experience is like living in this world. It will help you understand how to be a better ally.”

Speaking out against transphobia, sharing your own pronouns and respecting others’ pronouns is yet another important way to support trans people. Doing all these things even when you don’t think there are any trans people to hear it or see it is especially necessary. Because not everyone is able to be or wants to be openly trans, you never know what these actions might mean to someone.

Cis people as well as trans people can embrace their unique gender identities in many ways by “cultivating self-reflective practices that make space for you to think about your gender instead of taking it for granted,” says Alex.

“Everyone, cis or not, has their own relationships to gender. Not all cis people adhere to gender roles in the same way. We are all unique and it’s misleading to think that only trans people divert from gender expectations.”

Even if you’re cisgender, embracing your own unique gender identity and exploring your gender presentation can be eye-opening. Understanding your own gender could help you care more about understanding and respecting other people’s, and stands to give you deeper self-knowledge.