Funding the transition from one gender to another requires careful planning
Even a routine medical procedure can break the bank, but the price of mending a broken bone or removing an appendix pales when compared to the process of transitioning between genders.
While the Caitlyn Jenners and Chaz Bonos of the world may be able to afford all the involved expenses, people of more modest means often struggle. With a will, of course, there is always a way, but the physical and financial side effects of some methods can be risky. In response, here are eight safe and sound options for funding gender reassignment.
What it is and how much it can be
To start, some clarification. Transgender, as defined by Merriam-Webster, is “relating to, or being a person who identifies with or expresses a gender identity that differs from the one which corresponds to the person’s sex at birth.” Which is where sex reconstruction surgery (SRS) comes in.
SRS helps a person born male or female switch their gender by changing outward appearances. Easy? Not in the slightest. But to simplify, think upper and lower body modifications — commonly referred to as top and bottom procedures.
For males transitioning to females, top modifications include breast augmentation and facial feminization. Bottom modification consists of constructing female genitalia with a vaginoplasty. According to The Philadelphia Center for Transgender Surgery, these surgeries, (along with a cosmetic procedure to complete the effect, such as rhinoplasty) cost approximately $35,000.
A female transitioning to a male may elect for top procedures such as the removal of breasts with a bilateral mastectomy, then reconstructive surgery to simulate a more masculine chest. Creating a penis, called a phalloplasty, is the lower body modification. The average cost range for the top and bottom combination is broad, at $12,000 to over $25,000, since there are multiple types of genital surgery.
Both men and women receive hormone therapy and extensive counseling before any medical procedure is performed, with $5,000 being a low annual estimate. Add extra cosmetic work to the mix — such as a tracheal shave to pare down an Adam’s apple for a more feminine look or buttock reduction to attain a mannish posterior — and the cost escalates.
In reality, the total outlay can be far higher than many anticipate or can realistically afford.
Hidden expenses arise
Aidan McCormack, 36, from Chicago, began life as a biological female. In 2005, he started the gender reassignment process. McCormack holds a graduate degree in divinity and worked in the Unitarian Universalist fellowship ministry. Securing a steady position has been tough, though, so he’s now starting his own consulting business.
“My transition-related costs are $100,000, when I include things like gallbladder surgery and concerns with my back,” says McCormack. “I include them in my transition costs because of the lack of access to care, underemployment, anxiety and weight gain, all as a result of being trans.” In a recent report issued by the Center for American Progress, transgender people experience unemployment at twice the rate of the population as a whole.
McCormack is still waiting on “top” surgery, after having completed hormone therapy, and has researched physicians based on price and procedures offered. “I finally decided on a doctor who does it for $7,500, but $10,000 should cover the incidentals since techniques vary by price and surgical complications can arise, it’s wise to overestimate, too.” Up until now he has used savings for all transition-related medical costs, but is starting to raise funds with the crowdfunding website Indiegogo.
|Female-to-male estimated surgery costs (includes hospital and anesthesia)|
|‘Top surgery’ costs|
|Mastectomy||$6,000 – $8,100|
|Tummy tuck||$5,200 – $8,500|
|‘Bottom surgery’ costs|
|Phalloplasty and related procedures||$15,500-$21,250|
|Male-to-female estimated surgery costs (includes hospital and anesthesia)|
|‘Top surgery’ costs|
|‘Bottom surgery’ costs|
Financing the change
When money is scarce, the temptation to cut corners or turn to nontraditional payment methods can be intense. Most who want gender reassignment will not let anything get in their way, contends McCormack. “Often when a trans person comes to the realization, any kind of rational considerations, like finances, are not important.”
Unsurprising is the trouble that desperation can lead to: decisions with unintended, often dangerous consequences. Peruse the Internet for creative ways to fund gender reassignment and sites that advocate the any-means-necessary approach pop up. Connecting with wealthy “benefactors,” escorting and illegal sex work solutions are often among them.
“The lure of wanting do something like that is there,” says Omaha, Nebraska, resident Kitty Shanahan, who is 27, a debit card specialist at PayPal, and in the process of transitioning from male to female. “A sugar daddy who will finance it? Sounds great, but do they want to make you do something you don’t feel comfortable with? Will you owe that person? There’s always the desire for the easy way, but there’s also always a catch.”
Another popular method to save money is by having sex reconstruction procedures done abroad. There are online guides galore, as procedures can be significantly less expensive in the Philippines, Mexico and Thailand. The potential for profound hazards is inherent, though.
In short, it all can go horribly wrong. “If you’re paying $4,000 to $5,000 for a surgery that costs $30,000 in the States, what’s the quality going to be? What if there’s no feeling? [Nerve damage] happened to a friend of mine. For something that important, you need to have the exact right doctor to make sure you have the best outcome.” says Shanahan.
Research, therefore, is critical. Reputable online guides for doctors who perform sex reconstruction in the States are published on Planet Transgender.
Be wary of bargain basement deals, warns McCormack: “Going for the cheapest is common. I had a friend who had top surgery done and the results are not perfect, but it was OK — the lesser evil of not having it done.”
Sensible payment options
Holly Hanson, author of “The LGBT and Modern Family Money Manual” and founder of Los Angeles-based Harmony Financial Strategies, says the following are prudent ways to finance gender reassignment.
- Health insurance. Some insurance plans do cover transgender-related health care (the Human Rights Campaign maintains a comprehensive list of employers offering transgender benefits). Check the terms carefully. Warns Hanson: “Some say they do cover the procedures and then don’t. It’s tricky. Hormones are often covered. Therapy can be if you’re in depression, but not if you’re ‘just’ transitioning. Wording is important.” As far as most cosmetic work, however, those costs are usually the responsibility of the individual. Local governments can go above and beyond, though. For example, the City and County of San Francisco covers employees’ gender transition procedures, with the average total costs per claimant being approximately $25,542.
- Work, save, invest. “The earlier a person starts planning for upcoming costs, the better,” says Hanson, who explains that budgeting can go a long way. “Transitioning is the most important thing. If we can show that by eliminating this or that expense, they can save for it, it’s effective,” Also, the more years someone has to invest the cash, the more they can count on their investments growing over time. Invest $200 every month and in 10 years, you’ll likely have about $30,000 for your goal, assuming a 7 percent return. It’s harder to project investment earnings for shorter time frames, but even if you were to set aside that same amount for just three years with no investment earnings, you’d have more than $7,000.
- Family funds. “If a family member is supportive and has the means, they can gift up to $14,000 a year per person year, which is tax-free income for the recipient,” says Hanson. Interpersonal loans are a possibility, too, but take care to formalize the deal. “Anytime money is exchanged, write up a contract,” she urges, and include terms, dates and conditions.
- Use assets. Look at what you’ve amassed, says Hanson: “Do you have a 401(k) and can take out a loan? Or a pension plan where you can take a lump sum?” Check with a financial adviser to learn the tax and fee implications, but it is yours to use. She also suggests making a list of tangible assets and selling what won’t be missed.
- Crowdsource. GoFundMe, Indiegogo and similar crowdfunding platforms are fantastic, says Hanson. “I’ve seen so many different projects on this and the money raised can be impressive.” Her tip: “Get a great message. Complete strangers will need to know why to give to you as opposed to someone else.”
- Philanthropists, foundations and other charitable organizations. Free money for financially strapped people does exist. Search transgender organizations, such as the Jim Collins Foundation, which provides financial assistance in the form of medical grants to those needing gender-confirming surgeries.
- Medical installment plans. Some health care professionals allow patients to make partial payments. Others partner with financial institutions that provide loans. It pays to ask. But repay on time, Hanson stresses, as “you’ll be working with these people for the long haul, and jeopardizing a vital health care relationship is a bad idea.”
- Credit cards and personal loans. There’s nothing wrong with borrowing for necessary procedures, but take pains to control the debt, says Hanson. “If you’re going to do this, always pay more than the minimum.” Don’t, and the balance can get out of hand, fast.
In fact, Shanahan has paid for her portion of the procedures with a credit card. “I used my credit card for almost everything, exclusively for the points,” she says. “My mom is a banker, so I learned from a young age. I pay it all off and get the rewards. Because she rarely carries over a balance, she almost never pays extra for accumulated interest.”
Shanahan is also fortunate in that her insurance covered almost 90 percent of her surgical costs. The final cost for her procedures will be around $65,000, but the out-of-pocket costs will be only about $6,000. “Bottom surgery is mainly covered,” says Shanahan, as is travel to California, where the surgery will take place. Still, other expenditures are her responsibility. “I have to pay a lot upfront for electrolysis and that’s $75 per hour.” As generous as her insurance plan is, reimbursements are slow. “My bank account is low right now!” she says.
In the end, says McCormack, “Do whatever you can to make yourself more comfortable with your body. But the truth is your gender is not dependent on any procedure. Yes, it will help, but you are whole already; a full person and worthy of care and love.”
See related: 10 financing options for cosmetic surgery