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The Costs of Transitioning

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Last Updated on June 13, 2022 by Daniella

On an emotional level, the stress of transitioning is immense.

Even with good support, there are so many feelings, internal struggles, and logistical problems to overcome throughout almost every stage of gender affirmation.

We also need to talk about the financial costs of transitioning, and how that impacts decision making.

As a transgender person myself, I know firsthand how much transitioning can impact your wallet (and even your paycheck).

The Financial Costs of Transitioning

Wouldn’t it be nice if you realize you’re trans (also referred to as “cracking your egg”) and could magically wake up completely gender-affirmed? The media representation of a trans person “becoming the opposite gender” couldn’t be more from reality. 

The truth is, transitioning is a long and gruelling process that is further complicated by significant financial burdens and barriers.

In short, it’s expensive to transition.

A Whole New Wardrobe

Although some people never change the clothes they wear, the vast majority of trans people will want to swap out their wardrobe for clothes that better reflect themselves.

If you’ve ever needed to replace a lot of clothes at once (maybe your weight changed or you started a new career) then you know how quickly it adds up. It doesn’t stop at clothing, either; you’ll also need new shoes, jackets, and accessories to match.

We’re not talking about luxury items here, either. Many trans people offset the costs by shopping at discount stores and second hand, but that presents its own problem: sizing.

Many trans folks struggle to find clothes that fit their unique body shape right, which means it can be almost impossible to avoid paying full price. 

Money saving tip: Some LGBTQ+ and charity organizations have free clothing swaps specifically to help trans people find new clothing.

Gender-Affirming Accessories

These vary depending on the person, but can include a variety of transgender supports.

For trans masculine people, there’s binders to flatten the chest, proesthetic pensis (called “packers”), stand to pee devices, and special underwear to hold a prosthetic in place.

Trans feminine folks often turn to breast forms until they can either grow natural breast tissue or afford surgical augmentation, underwear to aid in “tucking” (hiding any unwanted genitals), and shapewear to enhance curves. 

Depending on the quality of the products, you’re looking at spending at least $100 just to cover the basics.

Money saving tip: Transgender clinics sometimes offer supports for these products, and some private and public insurances cover gender affirming items with a prescription.

Therapy

It goes without saying that access to therapy is already wrought with barriers that make it nearly impossible for low income people. For LGBTQ folks, especially the trans community, there’s an additional burden of finding a therapist who specialises in gender identity.

Although the requirements and coverage depends on your provider, almost all gender confirmation surgeries and sometimes hormone replacement therapy hinge on a diagnosis and/or referral from a licensed therapist.

Tools to check out when looking for a therapist:

Money saving tip: Look for free support groups or reach out to LGBTQ organizations to see if any help is available. 

Hormone Replacement Therapy

This is one of the biggest gender-affirming steps a transgender person can take. A lot of people think surgery is the “big change”, but really it’s the work of hormones that enable many trans folks to start living their lives authentically.

Not all trans people choose to take hormones, and the way they take them will depend on transition goals and their own body. Both binary and non-binary trans people may choose HRT.

But wanting to do it and being able to do it are two different things. In some jurisdictions, the issue comes down to medical gatekeeping, but other times it’s a question of affordability.

Like all medicine, HRT is expensive. And the price is going to vary depending on where you live and what kind of insurance you have. It’s not just the cost of medication, either. Since it’s hormonal you need medical supervision and frequent appointments.

In the US, Planned Parenthood does offer transgender healthcare on a sliding scale, but their locations are limited. For the poorest folks, even free appointments don’t help when they can’t afford to fill the prescription.

Even if you have insurance, you’ll still be on the hook for copays or spending until you meet your deductible.

Here in Canada our medical visits and lab work are all covered, but we have private insurance to fill our prescriptions. Most provinces also have a drug plan to help low-income people access their medication. 

Money saving tip: Try GoodRX to find coupons to make medications more affordable. 

Surgery

This is probably the biggest ticket item on the transgender balance sheet. There are two main types of gender affirming surgery: “top” surgery, which involves the chest, and “bottom” surgery, which involves the lower genitals.

There are also other surgeries to help trans folks alleviate other types of body dysphoria.

In the US there are federal laws protecting transgender people when it comes to health care discrimination, but unfortunately many states have contradictory laws that negatively affect LGBTQ people.

Top Surgery

Many trans masculine (and some nonbinary) people who are assigned female at birth will opt for top surgery, which is essentially a double mastectomy where they also masculinize the chest.

The price can range anywhere from $3000 to $10,000 or more depending on a variety of factors. Most US insurance companies cover it, but they may require a copay or for you to meet your deductible. 

In Canada, provincial healthcare covers this service. However, they often don’t pay for revisions, which means you’re stuck paying out of pocket if your unique body shape doesn’t leave you with desired results.

(By the way, this happened to me; I was quoted about $1500 for a revision 5 years ago but haven’t had the money to do it.)

Trans women are slightly luckier, since feminizing hormones actually stimulate breast growth. The results aren’t always ideal, though, so some trans women turn to breast augmentation.

Again, this can be covered depending on your insurance, but not always. The out of pocket cost is $5,000 – $10,000, although luckily access to a surgeon should be easier since the procedure is popular amongst cis women too. 

In Canada it’s only covered on a case-by-case basis in most provinces. 

Bottom Surgery

These surgeries are really intense. Not only do you have to (possibly) pay for the surgery, you’ll also need time off work and extra support at home while you recover. 

If you’ve ever had surgery you probably already know how quickly the little things like medical supplies and domestic help can add up.

On top of that, the clinics that offer gender affirmation surgery are limited in both the US and Canada, which means many people will have to travel. Sometimes that cost is covered fully or in part, or you may be responsible.

In the US, the cost of bottom surgery is immense. It averages around $25,000 but can be as high as $50,000. Insurance coverage varies. 

Here in Canada gender-affirmation surgery is covered by most of our provincial health plans. However, there can be long wait times since we only have two practising clinics in the entire country.

Other Surgeries

There are a few other surgeries that help trans people feel better in their bodies and face less discrimination.

The most common is facial and body feminizing surgery, which helps someone with a masculine face/body look more feminine. It can cost anywhere from $20,000 to over $50,000, and is often excluded from health coverage in both Canada and the United States.

Trans feminine people also sometimes undergo surgeries to reduce the size of their Adam’s Apple and voice feminization surgery. Trans mascs can also get body and face masculinization surgery.

All of these come with additional costs and, again, are rarely covered by insurance.

Financial Gatekeeping

Many trans people are forced to wait on, or even skip, gender affirming surgeries because they can’t afford the cost. 

Even when any or all procedures are covered, the average annual copay in the US for an individual is $4,364 (double for a family), so some people may still struggle to afford a “covered” service.

Money saving tip: Know your rights and be willing to advocate for yourself; in Canada provinces keep adding coverage when trans folks fight for it, and in the US insurance companies often use outdated rules or illegal practices to avoid paying for trans healthcare. 

Additional Gender-Affirming Care

Besides surgery and hormones, there are other “medical” interventions that can have a positive impact on trans people.

Trans feminine people who want to remove facial hair will often undergo electrolysis or laser hair removal, which may be covered by insurance. Private rates vary, but it’s around $60-$100 per hour. 

Vocal training is also common, and again the rates and coverage vary by insurance and location. 

Transgender hormones also cause acne, which can be severe. Acne medication pricing, and its coverage, varies. 

Finally, binary transgender people might need to “try harder” than cis folks on their looks, which means “vanity” services like gym memberships or hair extensions can be instrumental to avoiding discrimination. 

Money saving tip: Sometimes services can be insured if you have a referral from your medical provider.

Legal Name and Gender Changes

If you’ve ever been married then you’re probably aware of the hassle this can turn into. The process varies from state to state, but for the most part the costs and processes are similar across North America. 

Most of the time, you’ll need to fill out the name change paperwork, pay a processing fee, possibly pay for fingerprinting and/or an advertisement announcing the name change, and then pay to order your new birth certificate after it goes through.

In some states, they require a court petition for a name change which adds on more costs for legal fees. Changing your gender can be more difficult, some states (and most Canadian provinces) require no paperwork at all, others need a therapist letter or even confirmation of gender reassignment surgery.

Then you’ll need to fork over the cash to replace your driver’s licence and get a new passport.

All this will run you around $150 to $500+ depending on your location and what documents you need to order.

Financial Checklist After a Name Change

When you change your name, your credit history might be wiped if you didn’t change your name at all the institutions and banks you have money or loans at.

Use this financial checklist to go through your “financial scavenger hunt” for all the items you need to complete after a name change. The first step is bringing your legal name change paperwork to the Social Security office to get your social security information updated with your name. Then, your identification cards such as a drivers license and birth certificate.

Then proceed to these steps:

  • Call your bank to notify them of your name change and send through any of the requested paperwork
  • Call to update your name for any of the bills you have
  • Call any loan providers to notify them of the name change
  • Call for credit cards to notify them of the name change
  • Have a partner, friend, or family member who has good credit and pays off their credit cards in full every month add you as an authorized user on their card to jumpstart your credit report with some positive updates. This is for folks who need their credit updated a little quicker for a house purchase, care purchase, etc.
  • Check Experian to check your credit report for updates. If you don’t see your credit report to start to update to your new name within a few weeks to a month of changing your name with all of the banks and institutions, call Experian directly to see if there are any hangups. They may request similar paperwork that your bank requested to get the request expedited in the system and get the information to start updating.
  • Then check with the other 2 credit reporting bureaus: TransUnion and Equifax to see the status of your reports there, if they are updating accurately, and if you need to send them any specific paperwork
  • Read this tweet thread for more tips on getting your credit score to update quickly if you’re trying to buy a car or a house

If You Have a Kids/Spouse

On top of your own documents you’ll probably need to order new documents for your kids too. Depending on the fees in your area and how many kids you have, this can really add up. Likewise for replacing marriage documents with the new name.

Money saving tip: Make sure you leave a lot of time before needing this documentation (eg. upcoming travel) so you can avoid paying rush fees.

Social and Career Costs

The transgender community can be a supportive home for many trans people, but that doesn’t meant the rest of society doesn’t create barriers for us.

There are very literal long-term financial costs to transitioning: cisgender people are paid 32% more in the workplace than trans folks. 

Socially, a lack of network can also have a financial impact. Networking is huge in the corporate world, but it’s hard to do if you’re alienated by your peers. 

Real Transition Cost Stories

Case study one: Me, a Trans Man Living in Canada

I’m fortunate enough to live in Canada, so most of my gender transition has been covered so far. In Manitoba, there is a provincial pharmacare program that, after I meet my deductible of around $280 CAD, covers my medication.

I do have to pay for my injection supplies out of pocket, though, but I’d say they only cost about $50 a year or less. I also pay about $50 a month for face creams to help fight the acne caused by HRT.

To change my name, it will cost $120 plus the cost of fingerprinting, which is a minimum of $25. Once it’s changed I have to order a new birth certificate, which, thankfully, is only $30. The trouble is I don’t live in the province I was born in, so there’s an extra hassle there. 

I have 5 kids and will need to order new birth certificates for all of them, totalling at least $150.

Eventually I’ll look into top surgery revision, which I expect to cost around $1500.

When I needed a binder it cost about $60, and I’ve spent over $200 on various prosthetics. 

Without accounting for the cost of clothing or possible lost income, I spend over $900 per year and will/have already put out at least $2000 in one-time costs. 

Case Study Two: A Trans Woman Living in the US

I reached out to Lauren, a trans woman and mom of two who lives in DC. Her experience is similar to mine, with insurance covering hormone treatments and bottom surgery. 

While trans-masculine top surgery would be covered under her insurance, breast augmentation for herself is not. Neither is facial hair removal, which has already run her $5000 with the expectation of incurring additional costs as treatment continues.

Legal costs were minimal, only about $250 in total, and medication copays are about $30 a month.

Like many trans women, she’s also had to purchase a whole new wardrobe, transition supports like female shapewear, and pay for “cosmetic” appointments in line with the expectations cisgendered women face but that are, arguably, imperative to help “pass” as female and avoid transphobia. 

Luckily her family’s insurance doesn’t have an annual deductible, and caps at $1000 per year out of pocket as long as providers are in network. 

No other surgeries are covered so if she wanted to pursue, for example, facial feminizing surgery and breast implants the combined cost would be between $26,000 and $60,000 or more.

This is in line with the experiences of other trans women in the United States.

Coverage for Gender Transition in US and Canada

US:

  • Coverage is based on your insurance
  • You may be responsible for a co-pay or have to meet your deductible before receiving coverage
  • Federal laws protect trans people, but state laws contradict and supersede them in many cases
  • Monthly out of pocket costs for hormones: $50-$200
  • Top surgery cost: $3000 to $10,000
  • Bottom surgery cost: $10,000 to $60,000 or more, averaging at $25,000
  • Other surgeries: cost and coverage varies
  • Fees for name and gender changes range from state-to-state

Canada:

  • Prescription coverage varies depending on province, income, and private insurance
  • Transgender people are protected legally
  • Monthly out of pocket costs for hormones: $50-$200
  • Top surgery cost: covered by most provinces, revisions $1500-$3000
  • Bottom surgery cost: covered by most provinces, including travel
  • Other surgeries: cost and coverage varies
  • Fees for name and gender changes range from province-to-province

Get Help Paying for Transgender Care and Surgery

Some of these things you can plan and save for, but others such as surgeries are going to be a little harder to figure out how you’ll need to prepare financially. 

First, open up a savings account at your bank for your transition fund and name it whatever fun name that you can come up with that also makes you feel badass as your true self. Whatever amount you can put into this fund monthly, set up automated transfers into this fund of that amount every single month.

You can also use remote side hustles like freelancing out your skills, pet sitting on Rover, starting an online platform whether that is a blog or YouTube to document your journey, or opening an online store selling digital products or print-on-demand products, to earn extra money to help fund some of your transition, safely from wherever you are.

For additional financial aid, there are a couple of options available to you.

GoFundMe

Crowdfunding is a common way trans people raise enough money to complete gender affirming surgeries. Anyone can donate and the money goes directly to the individual. 

Planned Parenthood

They offer a sliding scale depending on income for a variety of trans healthcare services

Loans

Private bank or credit union loans can help you pay for surgery upfront and then pay it back slowly. If your credit rating isn’t very good, though, the interest rates can be as high as 35.99% APR (if that’s the case, I do not recommend it).

Supportive family members may also be able to help, either by giving you a private loan or cosigning on a bank loan.

Care Credit

Care Credit is a surgery financing company that could come in handy when planning your surgery. It acts just like a normal credit card, but specifically for healthcare and cosmetic surgeries that aren’t covered by insurance.

You can also use the card to fun appointments for those surgeries such as follow up appointments.

Read more about Care Credit and how it works on their website.

Hospital Payment Plan

Some hospitals and clinics offer financing options and payment plans so you can get the care you need upfront and pay it off over a period of time.

It’s a good idea to discuss billing and payment plans before undergoing any services so you find out whether the monthly payments can fit into your budget. 

For example, the Cleveland Clinic offers 0% financing for 24 months if your balance is over $4000, but if you had to pay for a $25k surgery out of pocket the payments would be over $1,000 per month. 

Grants/Organizations

  • Point of Pride – helps a variety of transgender folks based on financial need
  • Jim Collins Foundation – completely funds and helps fund gender-affirmation surgery
  • Genderbands – offers grants to support top surgery and HRT
  • CK Life – helps trans people access transition support, employment, and housing
  • BlackTrans – they offer free appointments and help navigate through insurance barriers to receive care
  • Stealth Bros – funding top surgery for trans masculine people

Talk to your doctor, therapist, or local LGBTQ groups about what might be available in your local area. 

The Cost of Not Transitioning

Transitioning can be a huge financial burden for trans folks and money is a huge barrier to access – but the costs of denying it can be even greater.

Trans people who are able to transition experience quality of life improvements including better mental health and job satisfaction. 

Those who wish to and are unable to access healthcare, including hormones, surgery, and other “passing” supports face increased levels of descrimation and personal violence. 90% of trans people report experiencing some kind of negative outcome related to being trans at work.

When people are forced to live inauthentically it will have an impact on their mental health, which in turn affects their ability to earn a living. So not transitioning can have a significant financial impact. 

It’s a catch-22, someone who’s struggling may need trans-affirming healthcare to be able to earn a good living, but unable to afford the care to get them there.

How Cis People Can Help

Being trans is expensive; to help, all gender-affirming services and medicine should be covered by insurance for those who wish to medically transition. When you factor in medical and social costs, it can easily cost thousands if not tens of thousands of dollars to transition.

Even if you’re not a member of the LGBTQ community, I encourage you to advocate on behalf of trans folks as we continue to fight to be ourselves.

In the meantime, consider donating to trans-specific charities or support trans people directly. 

Related posts:

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