The Cost of Gender Transition: Hormone Therapy, Transgender Surgery, and More

Nicolas Cesare  | 

Gender transition is a process whereby transgender people undergo certain medical, social, and legal steps in order to transition into a gender other than the one that they were assigned at birth. Like many forms of medical treatment, however, gender transition for transgender people often costs money. This article will inform you about how much gender transition costs, how much certain transgender surgeries cost, and more.

The Process of Gender Transition

There is no single right way to transition. However, many gender transitions do end up sharing certain similar steps and milestones that will be covered here.

Why Transgender People Transition

Many transgender people are diagnosed with a condition called gender dysphoria, where they feel a level of discomfort — ranging from mild to extreme — with the physical characteristics or social roles of the gender that they were assigned at birth. A literature review by Cornell University looked at publications in medical journals from 1991 to 2017, and found overwhelming evidence that gender transition was an effective treatment for gender dysphoria.

Starting Gender Transition

There is no single right way to begin gender transition, and the best way to access services related to medical transition may vary depending on where you live. However, in general, you should expect to begin medical transition by visiting a trained and licensed therapist. After several sessions, a therapist may officially diagnose you with gender dysphoria and write a referral letter, directing a medical doctor to begin hormone therapy.

Once you have picked out a qualified medical doctor, they will supervise hormone therapy as part of your medical transition. They may also be able to answer any questions you have about other medical aspects of transition, including transgender surgeries.

Milestones for medical transition often include seeing a therapist and getting a hormone prescription from a doctor, but it’s also important to remember to create a budget in order to account for the regular cost of medications and visits to the doctor.

Hormone Therapy

Best practices surrounding access to transgender hormone therapy are still being worked out by doctors and mental health professionals. However, the World Professional Association for Transgender Health recommends in their Standards of Care that individuals seeking hormone therapy:

  • Have persistent, well-documented gender dysphoria.
  • Have the capacity to make fully informed decisions about medical treatment.
  • Are of the age of majority in their country, or otherwise have parental consent to begin hormone therapy.

After starting hormone therapy under the supervision of a qualified medical doctor, a person can expect to take on some secondary sexual characteristics of their target sex over the course of several months, or even years.

According to the Trans Care Project, people who are undergoing hormone therapy as part of a transition from female to male (FtM) should expect to take the hormone testosterone, typically either in the form of a patch or cream that is applied to the skin or an injection of testosterone directly into the muscle. In the United States, testosterone is a schedule III controlled substance, so you will need a doctor’s permission to use it.

Also according to the Trans Care Project, people who are undergoing hormone therapy as part of a transition from male to female (MtF) should expect to take the hormone estrogen, typically in a pill, a patch or cream applied to the skin, or an injection of estrogen directly into the muscle. In addition to estrogen, people transitioning from male to female should also expect to take an anti-androgen, a type of drug that blocks the body’s natural production of testosterone. This will prevent testosterone from overriding the estrogen that a person is taking and allow feminizing effects to take place. There is some anecdotal evidence (but no definitive medical evidence) that the hormone progesterone has feminizing effects as a part of medical transition, so some people will take progesterone in addition to estrogen and an anti-androgen.

Transition Surgery

Although the media often focuses on genital surgery as the definitive surgical procedure for gender transition, the reality is not so simple. While genital surgery is an important part of gender transition for many transgender people, it is not always the first surgery that a person might seek out. In fact, some transgender people transition completely without getting genital surgery at all. Which transgender surgeries (if any) are right for you is a discussion for your doctor, but here are some surgical options that some people choose as part of a gender transition.

Genital Surgery

As stated above, surgery in order to reconfigure a person’s genitals into those of their target sex is an important part of medical transition for many people.

Top Surgery

As part of female puberty, many people undergoing an FtM transition have developed unwanted breast tissue. Top surgery is a general term for a variety of surgical procedures that can be used to remove this breast tissue, leading to a quality of life improvement for the patient. Some people who undergo an MtF transition may choose to have breast augmentation surgery if they are unsatisfied by the development of breast tissue as a result of their hormone therapy.

Facial Feminization Surgery and Facial Masculinization Surgery

Facial bone structure often changes as a result of male puberty, and these changes play an important role in the way that we see gender in the world. For example, they are one reason why we can often tell a person’s sex only by looking at their face.

In cases where hormone therapy is not sufficient to alter a person’s face to either appear more feminine (for MtF transitions) or more masculine (for FtM transitions), cosmetic surgery on the face can be used to either reduce bone in certain areas or use surgical implants to add the appearance of new or shaped bone.

How Much Does Transgender Hormone Therapy Cost?

When figuring out the cost of your hormone therapy, you should remember to account for several things:

  • Whether or not your insurance will help to cover the cost of hormones, including copay amounts. Many medications used as part of hormone therapy have generic versions, which will often be covered at the lowest copay by your insurance, but some do not. If your insurance covers these medications, then you should ignore the prices given below, which are determined without considering insurance coverage.
  • The cost of visits to the doctor and blood tests that are a necessary part of hormone therapy for many people. If possible, ask your doctor to bill hormone blood tests as preventative. This way they are more likely to be covered by insurance and at a better rate.
  • Prices below are derived from GoodRX reportings as of September 2018. Keep in mind that the cost of medication may fluctuate depending on availability, the pharmacy that you buy from, and the region where you are located.

FtM Hormone Therapy

  • Testosterone Cypionate: This popular injectable form of testosterone costs between $40 and $90 per 10 ml bottle of 200 mg/ml solution without insurance. Keep in mind that a single 10 ml bottle can last you for several months, depending on the dosage prescribed by your doctor. Needles and syringes are very inexpensive and can be bought at the pharmacy or online.
  • Androgel: The generic equivalent of this topical form of testosterone can cost between $30 and $80 without insurance for a packet of six patches, which may last about a month depending on your dosage. Brand-name patches will cost upwards of $130 for comparable amounts.

MtF Hormone Therapy

Estrogens

  • Estradiol Pill: Generic estradiol is an incredibly cheap pill form of estradiol that many transgender women take. A bottle of 30, 2-mg tablets costs just $4 at the Walmart pharmacy. Other vendors may charge up to $40, but generic estrace is often covered by insurance at reasonable rates.
  • Estradiol Patch: Patches deliver hormones through your skin and a single patch may be worn for up to a week. While patches may be more convenient than pills, since you only have to worry about application once a week, they also cost more. A packet of four generic estradiol patches that deliver 0.1 mg of estradiol per day will cost you between $30 and $60.
  • Injectable Estradiol: Hormone injections are, for some people, the most convenient way to administer the medication. Unlike patches, they leave no visible indications on your body of the hormones that you are taking and, as long as you don’t mind injecting yourself or having a nurse or trusted friend do it for you, administration is an easy process that takes 10 to 15 minutes every one or two weeks, depending on the dosage determined by your doctor. However, injectable estradiol is also more expensive than other forms. Generic injectable estradiol (estradiol valerate) has experienced supply shortages in the past, but a 5 ml vial may cost you between $40 or $100. Depending on your dosage, a single vial may last a little over a month. Non-generic injectable estradiol (estradiol cypionate) has a longer half-life inside the body than valerate, meaning that you can go longer between injections, but it also costs more. Estradiol cypionate (or depo-estradiol) may cost around $120.

Anti-Androgens

  • Spironolactone: Spironolactone is the most commonly prescribed anti-androgen in the United States, in part because it is cheap and easy to acquire. Without insurance, spironolactone may cost between $4 and $12 per month.
  • Cyproterone: Cyproterone is another popular anti-androgen. However, it is more expensive than its counterpart, Spironolactone, at anywhere between $12 to $35 for a monthly supply.

How Much Does Transgender Surgery Cost?

For many transgender people, surgeries are an important part of gender transition that are used in addition to or in lieu of hormone therapy. Although certain surgical procedures are often highlighted in media coverage of transgender people, the reality is that there are many transgender surgeries available, and deciding which ones are right for you and your transition is a personal matter. Below, we will cover some of the more popular transgender surgeries, and how much they cost without help from your insurance provider. With any surgical procedure, make sure that you research your surgeon to find out their qualifications and the prices they charge.

Facial Surgery

In order to correct certain gendered features in the face, some transgender people will undergo facial cosmetic surgery, called facial feminization surgery (FFS) or facial masculinization surgery (FMS). Neither FFS nor FMS is a single procedure by itself. Instead, they represent a wide variety of procedures that contribute to sexual characteristics in the face. As a result, the price that you can expect to pay for FFS or FMS will vary wildly depending on the surgeon you choose and the procedures they perform. According to individuals that we spoke to who had sought out these procedures, surgery could cost you between $5,000 or $50,000, although most surgeries are likely to fall somewhere in the middle, as few people only get a single small procedure or an extremely large number of procedures.

Top Surgery

Surgical procedures centered around the chest or “top surgery” are designed to either augment or remove breast tissue, depending on the person’s transition goals. For many FtM individuals, top surgery is a very important part of transition and seen as a major milestone. It may be more optional for those making an MtF transition, as hormone therapy will develop breast tissue in many people. According to individuals that we spoke to who had sought out these procedures, top surgery can cost between $3,000 or $10,000, depending on the surgeon that you choose, and how difficult or time-consuming the procedure will be to perform for them.

Transgender Bottom Surgery

The term “bottom surgery” is used to refer to genital surgery, or gender confirming surgery, for transgender people. Although it is popularized in the media as the most important surgery that a transgender person can get, there are many people who consider their transitions complete without bottom surgery.  According to individuals that we spoke to who had sought out these procedures, MtF bottom surgery can cost between $10,000 or $30,000. Once again, this depends heavily on the surgeon that you choose and the exact procedures that they perform. Bottom surgery for FtM people is often more expensive, as the surgical procedure is more involved. It may cost between $20,000 and $50,000 depending on the surgeon you see and the techniques used.

Fortunately, although many medically necessary surgical procedures as a part of transition are not covered by insurance, bottom surgery is receiving more and more coverage as insurance companies partner with specific surgeons.

How Much Does it Cost to Legally Change Your Gender?

Unfortunately, healthcare costs aren’t the only costs related to gender transition. In order to change you legal sex (for example, the sex marker on your driver’s license), you will have to pay a fee in many states in order to have your legal name and gender changed. For example, in Massachusetts a legal name change costs $185. You should speak with your state government in order to find out how much they will charge. There are also some additional costs that you may or may not have to pay as part of changing your legal name and gender:

  • A lawyer’s fee is you’re having difficulty changing your name because of a criminal record.
  • The cost of publishing your name change in a local newspaper, which many states require, but which can be waived by a judge.
  • The cost of new legal identification documents, such as a new driver’s license or passport.

Paying for Gender Transition

With all of these costs, paying for gender transition isn’t easy. Especially since transgender people are four times more likely to have a make less than $10,000 a year than the average person in the United States. If you’re struggling to figure out how you can pay for your transition, here are some things to consider:

Health Insurance Coverage

Health insurance companies are slow to add on new coverage, especially for minorities who are already the subject of heated political debates. However, insurance coverage for gender transition is slowly beginning to catch up to modern medical science. Many insurance companies will cover hormone therapy at the same rate as any other prescription from your doctor. Surgical procedures, such as bottom surgery and FtM top surgery, are also being covered more widely, and some insurance companies will even cover cosmetic surgery as part of gender transition.

Find a Good Job

Getting on the right insurance plan can be a matter of working for a company with good employee benefits. Finding a job that fits your personality can help you excel. It goes without saying that making more money will help you to pay for transition, although in order to do this, you may have to make a choice between money and job satisfaction.

Paying Medical Bills With Your Roth IRA

Typically, if you have a Roth IRA retirement plan, you will receive a tax penalty if you withdraw money from it before you reach age 59 and a half. However, you can avoid this tax penalty if you’re withdrawing from your Roth IRA in order to pay for a medical procedure that costs more than 7.5 percent of your annual income.

Medical Loan Providers

Some surgeons and doctors will partner with medical loan providers such as CareCredit. They offer loans specifically for the cost of a your surgery or other medical procedures. If you do decide to take out loans to pay for transition, make sure that you have a good credit score so you can receive competitive interest rates. It’s also very important that you pay debt back, so that you can avoid default, wage garnishment, or tanking your credit history.

Using a Credit Card to Pay for Transition

It is possible to use a credit card to pay for gender transition. However, you will need an acceptable credit history to get approved for a credit card in the first place. It’s also unwise to use a credit card to make payments if you won’t be able to afford your credit card bill at the end of the month. Credit cards tend to have very high interest rates compared to other forms of debt and companies tend to slap on credit card fees wherever they can. If you do decide to use a credit card to pay for your gender transition, use is sparingly and pay off your entire balance as quickly as possible.


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Nick Cesare is a writer from Boise, ID. In his free time he enjoys rock climbing and making avocado toast.

This post was updated September 19, 2018. It was originally published September 19, 2018.