The Costs of Gender Transition 17 Jan, 2020

What is Gender Transition?

On the surface, the idea of a gender transition implies moving from one gender to another. Typically, this is thought of as a man “transitioning” to become a woman, or vice versa. “Transition”, in this case, means that a person aligns their appearance and behavior to the gender with which they identify.

But it’s not that simple.

For one, the above example represents the desires of only a small part of the community. Likewise, transition means different things to different people. For some trans folks, transition will be hormones and clothes. For others, it’ll mean getting various surgeries. Just like gender is a spectrum, so is transition.

For example, a transwoman will transition to a degree she feels necessary. It could be her way of speaking, which includes tone and pitch, her clothing, or it could include hormone therapy and reassignment surgery.

But if we were to analyze just the way of speaking: at what point does one’s manner of speaking become classified as feminine or masculine? Are there not women, who identify as women, with a pitch that is lower than the pitch of many men (who also identify as men)?

The answer is a categorical yes. There simply is no clear dividing line. We can get into discussions about sex, but that too gets blurred, as people can have both male and female organs, along with an androgynous appearance. Biology is an arbitrary factor that mistakenly dictates gender behavior.

With that said, when someone does identify with a specific gender that’s not the one assigned to them at birth, he or she is called a transgender person. Transgender people may not feel the need to carry out any sort of transition therapy — or they might. It’s a personal question with a personal answer.

Then you have genderfluid and genderqueer people, who are further testament to how terribly simplistic our traditional concepts of gender are. The first category refers to people whose gender identity is in perpetual flux, and the second refers to one that’s more static.

For our purposes, we will use the terms non-binary, gender diverse, or gender nonconforming people, which encompass anyone who doesn’t identify with being male or female, who identifies with a mixture of both, or who switches back and forth between the two.

What’s important to understand is that the ways in which someone chooses to change their appearance depends on how they feel inside about themselves, their own concept of gender in general, and the economic means they have at their disposal.

Gender Dysphoria

For many folks within the trans community, not having their appearance aligned with their internal gender identity can be the source of a lot of emotional distress, a problem known as gender dysphoria. The mismatch between how they feel and the identity assigned to them at birth gives rise to depression. On top of that, they suffer from harassment, rejection, and discrimination in society. It’s therefore not surprising that members of the community are more likely to harbor suicidal thoughts.

Aligning one’s appearance with their gender identity is often the solution. Most studies on the topic show that some form of gender transition does improve a transgender or gender nonconforming person’s mental health.

However, reassignment therapy is often a painful, time-consuming process that’s expensive. Through hormone treatments and surgery, people have alterations done to their chests, skin, muscles, the sound and pitch of their voice, genitalia, and more.

Of course, gender transition goes beyond one’s body. Further steps include making changes to one’s legal documents, hairstyle and clothing, to their name and the pronoun used to describe them. In the US, one’s legal transition can vary, but it may involve getting a court order to change one’s name, social security card, driver’s license, passport, the gender stated on their birth certificate, and even school transcripts and diplomas.

Let’s explore what one’s reassignment therapy can entail, including costs, and the ways in which gender diverse people cover the expenses.

Hormone Therapy

One of the most powerful tools for a physical gender transition is hormone therapy. It is useful to transgender men and women, as well as to non-binary people. Those who identify with the gender not assigned to them, or with no gender in particular, will undergo varying degrees of hormone treatments.

Male to Female (MtF) Hormone Therapy

Assigned male at birth people take estrogen and antiandrogen pills, patches, creams, or direct injections to help facilitate their gender transition. Estrogen makes their physical features appear more feminine, and reduces the natural production of testosterone, while antiandrogens inhibit the effects of testosterone.

Hormone therapy for transgender women can lead to breast development; alterations in the thickness of body hair; changes in muscle mass and body fat distribution; one’s testes and penis can exhibit some degrees of shrinkage; their skin can also become softer and more sensitive.

What MTF hormone therapy doesn’t change is a person’s beard or voice. Trans people can address facial hair with laser hair removal, but altering the pitch and modulation of their voice requires voice therapy or surgery.

Female to Male (FtM) Hormone Therapy

Transgender men, people assigned female at birth, take testosterone through patches, creams, or direct injections. It’s important to note that if someone starts masculinizing hormone therapy before female puberty kicks in, then they can avoid certain female characteristics, such as breast development.

When assigned at birth women do male hormone therapy, testosterone will decrease the production of estrogen and shut down their menstrual cycle (within two to six months of treatment).

FTM hormone therapy causes one’s skin to become thicker and oilier, while also giving rise to a certain degree of acne. One can expect to see the first effects within six months after treatment, and they can take up to two years to finalize.

FTM therapy also generates body mass redistribution with the maximum effect taking place within five years. While body mass redistribution doesn’t decrease breast size, it can make them less firm.

Non-binary Hormone Therapy

Gender diverse people, which includes both static and fluid identities that don’t conform to the binary categories of male and female, also may choose to undergo hormone therapy. Their transition goals highlight the complexity of gender in general.

Most would assume that by choosing to transition, a person wants to align themselves with the gender identity opposite to the one assigned to them at birth. For many non-binary people, this simply isn’t the case, making their transition goals all the more challenging, because their identity lies on the part of the gender spectrum that is non-binary.

Gender Affirmation Surgery

The common belief is that reassignment surgery mainly focuses on genital transformation. Nothing could be further from the truth. While the creation or removal of male or female genitals are important procedures for many trans people, the overall reassignment process entails much more.

Male to Female Surgery

Trans women may have their testicles and most of the penis removed. Surgeons use some of the remaining skin to create a vagina.

Facial feminization surgery alters the shape and size of a trans woman’s face. It modifies the bone and cartilage structures in a person’s jaw, brow, chin, forehead, nose and cheeks, to endow these features with a more feminine quality.

Breast augmentation, or mammoplasty, is a well-known type of plastic surgery which, through implants and/or fat-grafting, increases the size, shape and texture of a person’s chest.

Some trans women have a “tracheal shave,” which essentially makes the size of one’s Adam’s apple look smaller, and thereby, more feminine.

Voice surgery shortens and decreases the mass of one’s vocal cords, to raise their pitch range, giving trans women the capability of sounding more feminine. Voice surgery is dangerous because one runs the risk of having their vocal cords permanently damaged, which leads to a loss in tone quality and volume capacity, while causing an ongoing sore throat.

Female to Male Surgery

Transmen may opt to have a hysterectomy or mastectomy, along with a series of other surgeries designed to create a new penis and scrotum.

Trans men undergo surgery to remove tissue from inside of one’s breast, and any other unwanted skin in the area. The purpose is to construct a more masculine shaped chest. Masculinizing the chest entails altering the appearance and position of the nipples, as well as the areolae.

Finally, trans men and gender diverse people may undergo facial masculinization surgery, which helps add a masculine quality to the face. From the chin and cheeks to the forehead, and jaw, surgeons alter the bone structure, skin, and cartilage of the patient’s face to make it look larger and more pronounced.

Costs of Reassignment Therapy

It’s no surprise that one’s transition takes a lot of time and money. It’s hard to state the exact cost, because there are so many variables. It depends on each person’s particular case, and where they decide to undergo treatment. Some estimates for overall reassignment treatment, which includes hormone therapy and surgery, can easily surpass $100,000 and climb up to almost $200,000.

Laser hair removal alone can range between $75 to $100 dollars for every session, and some people have to go every week for up to 7 years. Estimates for body hair removal range between 200 and 400 dollars a session, while electrolysis costs between 30 to 100 dollars.

As usual, the price depends on where one does the sessions, and how long each one takes, which in turn depends on the amount of hair a person needs to remove. Some people won’t need as much as others, but either way, it’s a considerable cost.

Costs of Hormone Replacement Therapy

The cost of hormones can vary quite a bit. Often, it’s not the hormones that are the most expensive part, but instead the frequent doctor and therapists visits a trans person might have to make in order to receive regular hormones.

Hormone treatment can go on for years, or for the rest of one’s life, even after surgery. What is clear is that at least one year of hormone replacement therapy is required before undergoing gender affirmation surgery.

Bearing in mind that dosages depend on individual prescriptions, in the US, transgender and gender diverse people pay around $130 a month, or $1,500 dollars a year for hormone replacement therapy.

Costs of Gender Affirmation Surgery

It is even more difficult to calculate the costs for surgery, because there are so many parts to it. Based on estimates from The Philadelphia Center for Transgender Surgery, here’s how costs can be broken down.

Male to Female:

For each individual aspect of facial feminization, it’s about $3,400 – $14,500 per procedure. If one is going to pay for the full package, then the price can reach around $100,000!

Top and body surgery pricing varies, but is usually around at least $60,000.

Finally, for vaginoplasty, the price goes for about $30,000 dollars.

Female to Male:

For each individual aspect of facial masculinization, it’s about $5,400 – $14,500 per procedure. If one is going to pay for the full package, then the price can reach around $78,000.

Top and body surgery rounds out to around $45,000, while gender affirmation surgery, depending on the procedure (metoidioplasty vs. phalloplasty), ranges between $20,000 – $50,000.

Funding for Reassignment Therapy

It goes without saying that for most transgender and non-binary people, affording reassignment therapy is challenging, to say the least. Members of the trans community suffer some of the highest rates of unemployment, and most surgeries are out-of-pocket.

But things are changing. A growing percentage of companies in the US offer healthcare covering transgender care, while more public healthcare insurers cover hormone therapy and reassignment surgery, as they should. Over 17 states have Medicaid programs that cover gender-affirming surgery for people with low income.

We saw before that transition therapy improves one’s mental health and well-being. It literally saves lives; transitions protect the trans community from harassment and hate crimes, and also makes people feel more comfortable in their own bodies.

Nevertheless, most companies and private insurers don’t cover any costs for transgender care, and none of them cover all of the costs. People who can’t afford the treatment they need seek other options to get financial aid.

Some embark on medical tourism to find cheaper prices abroad, but then they run the risk of potentially getting surgeries of a lesser quality, or paying more money in plane tickets. Here are some ways people get financial aid when healthcare providers don’t cover the costs.

Founded by Ian Giles, a non-binary person, Genderbands is an international nonprofit lead by volunteers dedicated to the cause of helping people affirm their gender identity. The organization offers a variety of programs and services, receiving support through partnerships, donations, and direct sales, to provide grants for transition therapy and surgery.

This organization’s Annual Transgender Surgery Fund has a program to provide financial aid for surgery in the US, to transgender and non-binary people struggling to cover the costs of their transition.

To be eligible, applicants must be transgender or gender non-conforming, and be at least 18 years old (or have proof of consent from a legal guardian and healthcare insurer). Candidates need to show that they lack the means to pay for treatment and surgery. Once aid has been provided, candidates must complete surgery within 18 months.

A fundraising organization with many success stories of providing financial aid for gender-affirming surgeries.

Its aim is to fill in the gap of insurers that don’t cover the necessary expenses for transgender and non-binary care, and fully fund those who are denied any coverage. Through community-based initiatives, the organization has successfully raised money for a number of people to achieve a healthy gender transition.

We aren’t just a dating app.

For us, serving the trans community isn’t just about providing a social network for people to connect with each other. It’s also about supporting them where we can.

Once we reach the 15,000 trans user milestone, we will sponsor 5 trans users on our platform. Each sponsored user will receive $5,000 from Fiori, which they can spend at their convenience toward their personal transition goals. While we know that won’t cover everything, we do hope it helps five unique individuals find the treatment that they need to feel like who they really are.

To receive funding from Fiori, all you need to do is to submit an application form, follow our Instagram page, and become an active user on our platform by signing up on our iOS or Android app. All applicants will receive information about our decision with regards to 5 winners. You’re required to follow all the requirements to receive funding.

The Future of Gender Affirmation

The world has come a long way toward accepting that gender is a rich diverse spectrum of possibilities, and not a rigid binary category.

It’s inspiring to see that companies and insurers are finally considering transition therapy and surgeries as necessary medical costs to be covered, yet this just isn’t enough to support everyone. It is not uncommon for those needing assistance to turn to crowdfunding platforms like Indiegogo and GoFundMe, but they too have their limitations.

Hopefully, the future will see a society that fully embraces gender diversity and considers gender affirmation surgery a necessary medical cost for those that want it.