Between 1.4 million and 1.65 million adults in the U.S. identify as transgender, according to the Williams Institute at UCLA’s School of Law. For many transgender and gender-nonconforming individuals, medical transition is a significant and empowering part of their journey. Transitioning may include hormonal treatment and/or surgery known as gender confirmation surgery or gender affirmation surgery.
Many transgender individuals go through the process of transition — which includes legal, psychological, social and medical experiences — to resolve gender incongruence between their internal sense of self and external anatomy. Gender identity refers to an individual’s experienced gender and sense of self.
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Not all transgender people want to undergo gender confirmation surgery. But for those who do, the process can help to alleviate gender dysphoria. Gender confirmation surgery also doesn’t change or “reassign” one’s gender. Instead, it allows transgender and gender-nonconforming people to change their bodies to reflect their gender identity more accurately.
While hormonal treatment and/or surgery is a deeply important step for many trans and gender-nonconforming people, it can also be expensive. Learn more about the average costs of medical transition care options and find resources and ways to help fund procedures.
Medical Transition Care Options and Average Costs
Medical transition care options are diverse in terms of procedures, costs and outcomes. Each transgender person, along with their medical provider, should choose the options that make the most sense in terms of budget and desired results.
The main two medical transition care options are hormonal transition and gender confirmation surgery. Here’s a breakdown of the average costs of each kind of gender-confirming healthcare treatment.
1. Hormonal Transition
Average Cost: $20–350/month
The majority of transgender individuals who seek out medical transition choose to undergo hormonal transition, also known as hormone therapy. Because of its relative affordability and accessibility, hormone therapy can be a particularly effective option for those experiencing gender dysphoria or looking for an alternative to surgery. Hormone therapy can help trans men and women, as well as nonbinary and gender-nonconforming individuals, achieve significant physical changes.
Patients who undergo masculinizing hormone therapy often take testosterone. Testosterone therapy can affect a patient’s fat distribution, facial characteristics, vocal cords, hair growth patterns, libido, menstrual cycles and more. Testosterone typically comes in the form of injections (approximately $80 per month), patches ($300 per month) and gels ($300–350 per month).
Patients who go through feminizing hormone therapy often take estrogen or testosterone blockers, such as spironolactone and/or progesterone. Like testosterone therapy, this can affect a patient’s voice, facial appearance, libido, fertility, emotions and fat distribution. It can also promote breast development. On average, oral estrogen costs about $20 per month, while estrogen injections can cost up to $200 per month and spironolactone up to $20 per month.
2. Gender Confirmation Surgeries
Average Cost: $5,000–$50,000
Gender confirmation surgery for transgender patients refers to reconstructive surgeries to bring patients’ bodies into conformity with their experienced gender. Surgeries might include reconstruction of the chest and/or face. Depending on the type of surgery, patients may have a recovery period from about two weeks to several months after their initial hospitalization.
Like all surgeries, these procedures come with potential risks. But patients who seek out board-certified surgeons and follow all pre- and post-op guidelines are usually satisfied with their results. Here are some of the most common gender confirmation surgeries that transgender and gender-nonconforming patients seek out.
Types of surgeries for trans men
For trans patients, gender confirmation surgery might include removing breast tissue and reconstructing the chest, facial masculinization surgery (FMS) to make their facial features appear more masculine, removing and reconstructing the external genitalia and removing internal reproductive organs.
Here are the most common forms of gender confirmation surgery for trans men and nonbinary patients.
Average Cost: $5,000–$50,000
Surgery procedures could include:
- Facial masculinization surgery (FMS): FMS may include thyroid cartilage enhancement, cheek augmentation, forehead lengthening or augmentation, jaw and chin augmentation and nose reshaping.
- Periareolar procedure: The areolas and nipples are resized and repositioned during this surgery. Two circular incisions around the areolas allow the surgeon to remove the “ring” of chest tissue.
- Keyhole procedure: The keyhole procedure involves just one semi-circular incision below each of the nipples. Keyhole top surgery also allows most patients to keep the sensation in their nipple area.
- Double incision: In double incision top surgery, the surgeon makes two incisions at the top and bottom of the pectoral muscles. The nipples and areolas are removed and replaced with nipple grafts.
- Inverted-T top surgery: Inverted-T top surgery involves horizontal and vertical incisions and the removal of chest tissue but not nipples. Sensation is retained for most patients.
- Metoidioplasty: Metoidioplasty involves releasing the clitoris from the ligament attached to it and repositioning it to create a penis. With this procedure, patients can also choose to undergo urethral lengthening and remove vaginal tissue.
- Phalloplasty: Surgeons use skin grafts from other parts of the body (usually the thigh or forearm) to create a penis. A vaginectomy, or the closing of the opening in the front of the pelvis, as well as scrotoplasty, which creates a scrotum, can be included in some phalloplasty procedures. This is the most expensive of bottom surgery options for trans men, with price tags up to $150,000 in some cases.
- Hysterectomy: A hysterectomy includes the removal of the uterus and ovaries.
Facial masculinization surgery (FMS)
Average Cost: $10,000–$50,000
Here is what FMS surgery may include:
- Thyroid cartilage enhancement: An “Adam’s apple” is made using a small incision in the chin area and an implant in the throat region.
- Cheek augmentation: Small incisions inside the mouth allow the surgeon to place implants in the cheek to create a more angular appearance.
- Forehead lengthening or augmentation: Forehead lengthening and augmentation procedures involve lengthening the area between the eyes and scalp, and sometimes placing an implant, to create a more masculine, angular forehead.
- Jaw and chin augmentation: Jaw and chin reshaping and implants can help to widen the face and contour the jawline for more masculine facial proportions.
- Nose reshaping: Rhinoplasty can help to widen the nose and masculinize the facial proportions.
Types of surgeries for trans women
Around half of trans patients choose to undergo breast augmentation, facial feminization surgery (FFS) (which involves a variety of procedures that make facial features appear more feminine), and the removal or reconstruction of genitalia.
Average Cost: $5,000–$50,000
Here are some of the most common gender confirmation surgeries for trans women:
- Facial feminization surgery (FFS): This surgery may include genioplasty, cheek augmentation, brow lifts, tracheal shave and lip lift or augmentation.
- Breast augmentation/augmentation mammoplasty: Breast augmentation is one of the most common gender confirmation surgeries for trans women and nonbinary patients. It might involve saline or silicone implants or even fat transfers from other parts of the body.
- Vaginoplasty: In vaginoplasty, a surgeon uses skin grafts from another part of the body (usually the scrotum or abdomen) to create a vaginal canal. The surgeon also uses existing genital tissue to create a clitoris. This allows most patients to have penetrative intercourse.
- Orchiectomy: An orchiectomy is often a transfeminine patient’s first gender affirmation surgery. It involves the removal of the testicles.
- Vulvoplasty: A vulvoplasty involves the external part of the vagina rather than the vaginal canal. Skin from the patient’s genitalia is used to create a vaginal opening, the inner and outer labia, a clitoris, and an opening that allows the patient to urinate.
Some trans women undergo voice feminizing therapy to adapt their voice to their gender identity. In voice feminizing therapy, vocal cords are surgically altered to raise the patient’s vocal pitch.
Some trans patients might also choose to undergo gender confirmation surgery in the form of body contouring procedures. These might include liposuction or abdominoplasty as well as implants in the calves, buttocks or other areas.
What Health Insurance Can Cover
In the U.S., it is illegal for most public and private health insurance providers to discriminate against transgender patients or deny them transition-related care. However, trans patients may still face financial and logistical barriers. Here’s what you should know about health insurance coverage and gender confirmation surgery.
Type of Barriers
Transgender patients still sometimes face health disparities and barriers to medical care, including transition-related medical care. These are some of the obstacles that trans and gender-nonconforming people might face when trying to access healthcare and insurance coverage.
- Differences in state-by-state health insurance coverage: Each U.S. state has different policies regarding health insurance and trans-related care. Some U.S. states legally require health insurance providers to cover transition-related care while others do not.
- Difficulty accessing up-to-date and accurate insurance information: The language in health insurance plan summaries can be out-of-date or vague. This can lead to discriminatory denials of care.
- Discrimination and stigma: Discrimination against the LGBTQ community remains widespread, and transgender people may face health disparities and stigma in the context of medical care as a result, as well as other financial challenges. A 2015 study by the National Center for Transgender Equality revealed that about one-third of transgender patients said they were denied medical care or harassed by a medical provider.
- Lack of training and cultural competency among health providers: Some healthcare providers haven’t had adequate training in healthcare for transgender patients, which can lead them to make questionable decisions.
Additional Insurance Considerations
Transgender patients might also have questions about Medicaid coverage and Medicare coverage for gender confirmation surgery and other transition-related care. Both Medicare and Medicaid are prohibited from denying coverage of trans-related care if it is medically necessary.
The Veterans Health Administration (VHA) provides some coverage for transition-related medical care to transgender veterans. However, there is still an exclusion when it comes to coverage of gender confirmation surgery.
If you have insurance through your employer, you might be able to save up for your out-of-pocket surgery costs with a non-taxed Flexible Spending Account (FSA).
Ways to Navigate Health Insurance for Gender-Confirming Surgeries
It can be challenging to navigate health insurance coverage for gender confirmation surgery, but it’s not impossible. It’s important to know your rights as a patient when interacting with providers and finding the best health insurance plan for your needs. Here are some tips to keep in mind.
1. Stay informed
Remember that your health insurance plan should cover your transition-related care. Make sure that you read your insurance provider’s member handbook. Ask for the medical policy and any specific documents about eligibility for trans-related medical care to determine if you qualify.
2. Find a plan with no exclusions
Look for a health insurance plan that doesn’t have exclusions for either all transition-related care or specific kinds of treatments. You can often find this information in the medical policy.
3. Ask your current or potential employer about coverage
If you’re in the negotiation phase of a job interview, don’t be afraid to ask your potential employer about transition-related health coverage. If your current company or school doesn’t cover transition-related care, you might want to advocate for coverage.
4. Understand informed consent vs. WPATH standards
Before choosing a plan and care provider, find out about your potential provider’s ethical approach. An informed consent model of care allows you to make your own transition-related decisions after being informed of the risks by a physician. The WPATH standards of care might require additional steps, such as letters of support from therapists and other providers.
5. Look into pre-authorization
You’ll need to see your primary care physician before requesting pre-authorization for surgery. It is also known as prior authorization. You might need to gather documents such as letters from medical providers before applying. Depending on the plan you selected, your primary care physician can provide you with a referral.
Keep in mind that the referral or pre-authorization may not guarantee the surgery or other procedures will be authorized. National Center for Transgender Equality addresses common health coverage questions related to pre-authorization that may be helpful. It may be a good idea to speak with your health coverage provider directly.
6. Appeal denials
If you are denied coverage for a transition-related procedure, do not be afraid to appeal your insurance provider’s decision. Some exclusions might be prohibited or deemed discriminatory.
Financing Options and Support
Outside of partial or full health insurance coverage, there are several other options for financing gender confirmation surgery, such as loans, lines of credit, grants and scholarships, and fundraising.
There are several different personal loans you can use to fund your transition-related care.
- Bank or credit union loans: To qualify for a loan from a bank or credit union, you’ll need a good credit score and history.
- Family loans: If a family member can extend you a personal loan, consider creating a promissory note so that you have a repayment schedule in writing.
- Online loans: If your credit history is less than ideal, an online personal loan could be a good option.
Grants and Scholarships
Several organizations offer grants and scholarships to cover some or all of the costs associated with gender-confirming surgeries. These can help you avoid or offset any potential medical debt.
- The Jim Collins Foundation: The Jim Collins Foundation is dedicated to funding gender-confirming surgeries for trans people who need them. Grants are awarded on an annual basis.
- Genderbands Transition Grants: Genderbands offers transition grants to offset the expense of gender confirmation surgery for trans and nonbinary recipients.
- Rizi Xavier Timane Trans Surgery Grant: Rizi Xavier Timane, DSW, established a grant program to aid in the costs of gender-confirming surgeries for trans and nonbinary individuals.
- TransMission: The Loft LGBTQ+ Community Center’s TransMission is a small scholarship fund that helps trans and nonbinary recipients with medical, surgical and legal expenses.
- Stealth Bros & Co. Surgery Support Fund: The Stealth Bros & Co. Support Fund offers financial aid to trans men and transmasculine people for surgery, hormone therapy and related expenses.
- Black Transmen, Inc. Surgery Scholarship: Black trans men in the U.S. who have already been approved for surgery by a surgeon can apply for up to $1,000 in financial assistance.
- Point of Pride: Point of Pride offers scholarship-like funding for gender-confirming surgeries on an annual basis with a competitive application process each November.
Many people may raise funds for their gender confirmation surgery. For example, some throw parties with suggested donation amounts so friends, family and other supporters come together. Others raise money for their procedures by selling original art and letting would-be buyers know that they’re supporting a good cause.
Line of Credit
A home equity line of credit (HELOC) is one option if you own your home. With a HELOC, you can borrow against your home’s appraised value and repay it over time.
Certain surgeons partner with medical financing companies to help gender confirmation surgery patients make payments over time. You may want to check your credit score with a free report. Other surgeons allow patients to make smaller payments in installments.
Advocacy Organizations Making a Change
Many LGBTQ advocacy organizations are making a difference in the lives of transgender and gender-nonconforming people every day. Here are just a few of the LGBTQ charities, nonprofits and other organizations making positive changes.
- The Sylvia Rivera Law Project: In addition to impact litigation advocacy, the Sylvia Rivera Law Project offers legal services and resources to aid people in their journey toward gender self-determination.
- Transgender Legal Defense & Education Fund: The Transgender Legal Defense & Education Fund is a nonprofit that fights for trans rights and against discrimination. The organization’s Trans Health Project helps transgender people access trans-confirming health insurance.
- Transgender Law Center: The Transgender Law Center is a trans-led advocacy organization that offers educational materials and other resources around healthcare, immigration, incarceration and employment.
- National Center for Transgender Equality: The National Center for Transgender Equality offers educational materials, self-help guides and other resources for the trans community.
- SPARTA: SPARTA is a nonprofit organization dedicated to transgender, nonbinary and gender-nonconforming people serving in the U.S. military.
Additional Resources for Trans-Related Healthcare and Support
If you are a transgender or gender-nonconforming patient seeking funding or support for your gender confirmation surgery, various resources can help. Here are some of the best resources available for trans people, loved ones and allies who want to know more about gender confirmation surgery.
- National Center for Transgender Equality’s Know Your Rights: The National Center for Transgender Equality regularly updates its guide to existing and expanding legal protections for trans people in the U.S.
- HealthCare.gov’s Transgender Health Care: The website helps explain what to know about applying for Marketplace health insurance coverage as a trans or gender-nonconforming patient.
- HRC’s Corporate Equality Index: Human Rights Campaign (HRC) publishes an annual guide to workplace policies and benefits for LGBTQ employees, including a list of companies that offer trans-inclusive benefits.
- Transgender Law Center’s Transgender Health Benefits Guide: The Transgender Law Center offers a guide to healthcare advocacy for trans and gender-nonconforming patients, including advice on what to do if you face discriminatory denials of care.
- Out2Enroll: Out2Enroll helps members of the LGBTQ community find and enroll in health insurance plans.
- Trans-Health.com’s Trans Health Clinics: The clinics in this list specialize in transition-related and trans-confirming care and mental health support.
- Transbucket: Initially started in 2009, Transbucket is an online resource and peer-to-peer support group exclusively dedicated to trans participants, primarily discussing gender-confirming surgeries and medical transition.
- Gender Spectrum: Gender Spectrum hosts online support groups for trans, nonbinary and gender-nonconforming youth, as well as parents and educators.
- TransMentors International: TransMentors International connects members of the trans community with mentors who can offer emotional support and advice as well as referrals to resources, such as help with safe housing.
Mental Health Support
- The Trevor Project: The Trevor Project provides a number of resources, including suicide prevention and crisis intervention services, to LGBTQ people under 25.
- Trans Lifeline: The Trans Lifeline is a hotline offering peer-to-peer support services for trans callers, as well as their family, friends and allies.
- The Tribe, LGBTribe: The LGBTribe offers mental health support and wellness tools to LGBTQ participants.
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