With Possible Roadblocks Ahead, Here’s What You Need to Know About Financing Gender Confirmation Surgery

According to a recent report from UCLA School of Law’s Williams Institute, the number of transgender and gender non-conforming youth (ages 13 to 17) has more than doubled since 2017, from nearly 150,000 to just over 300,000. For many transgender and gender non-conforming individuals (including the more than 1.3 million adults ages 18 and older who identify that way), treatments that enable a medical transition — mainly hormonal treatment and/or gender confirmation surgery — are necessary to resolve the gender incompatibility into which they were born.

Those numbers are growing too: More than 16,300 gender confirmation surgeries were conducted in 2020, up from just over 14,600 in 2019, according to the American Society of Plastic Surgeons. But gender confirmation surgery is not cheap, and depending on where you live and the procedures you want, it’s not always covered by insurance. Here’s what you need to know to finance either your or a loved one’s transition.

The cost of gender confirmation surgery is high, and insurance may only cover part of the bill.

The two main medical gender transition options are hormonal therapy and gender confirmation surgery. While people who choose the former don’t necessarily choose the latter, those who do choose surgery typically must undergo hormone therapy for at least 12 months in order qualify for the procedure.

The cost of gender confirmation surgery (also sometimes called gender affirmation surgery) can vary significantly depending on location, number and types of surgery chosen. Hospitals and clinics don’t commonly divulge their pricing schedules, but one clinic, the Philadelphia Center for Transgender Surgery, does; while it may not reflect what a medical center near you might charge, it can help give a rough idea of costs to help you plan ahead.

For male-to-female patients: Vaginoplasty may cost $25,600; breast augmentation, around $9,000; and facial feminization, upwards of $70,000, which includes a thyroid cartilage reduction that can cost up to $5,400.

For female-to-male patients: A bilateral mastectomy can cost between $7,800 and $10,900; genital procedures including phalloplasty (the creation of a penis), scrotoplasty and testicular implants, can reach around $24,900; and facial masculinization procedures can add up to more than $78,000.

Many health insurance plans, including state Medicaid plans, now cover what they determine are "medically necessary" procedures. These typically include:

The catch is that there are usually many hoops a person needs to jump through before insurance will agree that a procedure is medically necessary, including getting two letters of approval from a medical and psychological professional, being officially diagnosed with gender dysphoria, and having gone through 12 continuous months of hormone therapy while living as the gender that is congruent with the individual’s identity. (There are clinics that offer hormone therapy and even procedures via informed consent — meaning they trust the individual to make their own decisions without going through the above checklist — but insurance may not cover it.)

Nevertheless, many individuals with insurance can still face obstacles or exclusions that effectively deny coverage, leaving them with no choice other than try to appeal or pay for the surgery out of pocket. And even if your insurance will cover most of the procedures, copays and co-insurances can still add up.

If you’re stuck footing the bill, here’s how to pay for out-of-pocket expenses

More than 230 anti-LGBTQ+ bills (most of which take aim against the trans community) have been filed in state legislatures across the country since the start of 2022, including ones preventing minors from gaining access to the recommended medical care for gender dysphoria. Some of these bills have already been passed into law.

But there are still several ways to help finance your health care when insurance either isn’t an option or doesn’t cover enough:

Credit cards: When paying surgery bills with a credit card, you can either open a medical credit card, like CareCredit and the AccessOne MedCard, that offer special 0% interest financing that lasts a set amount of time (usually 12 or 24 months, depending on the amount). A credit card with an introductory 0% APR period is another option, but only if you have good to excellent credit. The no-interest period typically lasts up to 18 months, which could give you a good cushion for paying back medical debt.

Loans: There are different types of loan options to cover medical expenses. If you have a good credit score and history, bank or credit union loans would be the best bet. If your credit history is less than stellar, then an online personal loan is a good option, though their interest rates tend to be higher. If a family member (or members) can extend you a personal loan, that could prove to be the most ideal option, though make sure to create an agreed-upon loan agreement so that you both have a repayment schedule in writing.

Grants: There are dozens of foundations that offer financial assistance to help offset costs for medical transition. The Campaign for Southern Equality has compiled a list of national resources, but check your local LGBTQ+ or trans-supportive organizations to see what additional grants might be available in your area.

Crowdfunding: Consider using one of several crowdfunding sites, including GoFundMe or Fundly. Remember, though, most of these websites take a commission from the money raised. You could also organize your own fundraiser using a service like PayPal, Venmo or Zelle.