The Cost of Being Trans in 2019: Gender-Affirming Healthcare Comes With a Hefty Price Tag

Ezra Mal Fry (he/him)

I have been fairly fortunate in my life as a trans* man. I (eventually) gained the support of my parents, who have been very helpful in my pursuit of a medical transition. However, there is still a very real cost to all of this. And I don’t mean in any mental or emotional form. I mean money, and lots of it.

When I got top surgery the summer before I came to UofM, I was still insured. However, as many trans* people can attest, that is basically meaningless when it comes to getting transition related care. My surgeon had an out-of-pocket quote of about $8,000. After insurance that number went down, but not by much. My initial copay was to be $4,000 dollars with potentially another $2,500 stacked on top afterwards, based on what the insurance company deemed a “reasonable cost”.

When I first saw those numbers come back, my heart sank. There was simply no way that I was going to be able to come up with that much money by the summer. My surgeon decided to cut me the best deal he could; he would only require $2,000 for my down payment. Thank god for my parents, who shifted money into Care Credit, a credit card designed to pay off healthcare costs. It felt like a dream when I finally got to the hospital on June 10th of 2019.

I woke up into a nightmare. My insurance company was doing anything to deny my claim. My legal name change had put all of my paperwork in limbo. Different documents had different names, based on the criteria they used to decide which name to write down. After quite a few phone calls, that finally got ironed out. However, even with insurance, as the bills started to roll in, it was becoming clear that I would pay more than the remaining balance of $4,500.

My initial plan had always been to use extra money from my student loans to pay the surgery off. And that would have worked if I hadn’t accepted a work study, which ate my disbursement. So I did what I could to pay off the bills, making small payments every month. It wasn’t enough and I got turned over to collections by the anesthesiologist. I now spend most of my days dodging calls from the bill collectors and the hospital. My credit has tanked and I can’t keep up.

Now, faithful reader, you may be looking at this and thinking that I was irresponsible and should have waited. And I understand, and wonder the same thing as well. Should I have waited? I think, though, that what you have to understand is that not having this surgery was its own kind of risk. Binding every day was doing considerable damage to my breast tissue as well as my ribs and back. On top of that, there are social risk factors that come into play with being a trans* person in early transition. I did what I had to do.

The point of this article is not to make you feel bad for me. I don’t regret a thing. The point is to highlight something else: my story is not even one of the worst. Trans* people everywhere can’t get the medical care they need due to the high costs and many surgeons’s requirement that you pay the full balance up front. I was lucky to have an amazing surgeon that did great work and helped me be able to get surgery so that I could start my independent life in a body I was comfortable with. I was lucky to have amazing parents who have helped me figure out how to pay everything off and have put up a lot of the money themselves.

The cost of being trans* in 2019 is astronomical. Many trans* people simply cannot afford the costs of their healthcare. It isn’t just surgeries either. For someone who is uninsured and out in the world, the costs of lab work, hormones, and mental healthcare can be a significant barrier in obtaining the care they need. In the period of time between when I lost my insurance and when I came to university, my costs for continuing hormone replacement therapy would have been over $350 if I had not scheduled an emergency appointment for labs and a prescription renewal the day before my coverage ended.

​This is a very real problem, and it is one that can be solved. It is time that we stand up and ask our healthcare system to do better. Because, while healthcare is not just a trans* issue, it does disproportionately affect the trans* community. Trans* people are more likely to be uninsured, and those that are insured are facing difficulties getting the coverage they not only need, but have paid for. We can, and must, do better for our transgender community.