how much does gender reassignment cost

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Gender Confirmation Surgery (GCS)

What is Gender Confirmation Surgery?

• Transfeminine Tr

Transmasculine Transition

• Traveling Abroad

Choosing a Surgeon

Gender confirmation surgery (GCS), known clinically as genitoplasty, are procedures that surgically confirm a person's gender by altering the genitalia and other physical features to align with their desired physical characteristics. Gender confirmation surgeries are also called gender affirmation procedures. These are both respectful terms.

Gender dysphoria , an experience of misalignment between gender and sex, is becoming more widely diagnosed.  People diagnosed with gender dysphoria are often referred to as "transgender," though one does not necessarily need to experience gender dysphoria to be a member of the transgender community. It is important to note there is controversy around the gender dysphoria diagnosis. Many disapprove of it, noting that the diagnosis suggests that being transgender is an illness.

Ellen Lindner / Verywell

Transfeminine Transition

Transfeminine is a term inclusive of trans women and non-binary trans people assigned male at birth.

Gender confirmation procedures that a transfeminine person may undergo include:

• Penectomy is the surgical removal of external male genitalia.
• Orchiectomy is the surgical removal of the testes.
• Vaginoplasty is the surgical creation of a vagina.
• Feminizing genitoplasty creates internal female genitalia.
• Breast implants create breasts.
• Gluteoplasty increases buttock volume.
• Chondrolaryngoplasty is a procedure on the throat that can minimize the appearance of Adam's apple .

Feminizing hormones are commonly used for at least 12 months prior to breast augmentation to maximize breast growth and achieve a better surgical outcome. They are also often used for approximately 12 months prior to feminizing genital surgeries.

Facial feminization surgery (FFS) is often done to soften the lines of the face. FFS can include softening the brow line, rhinoplasty (nose job), smoothing the jaw and forehead, and altering the cheekbones. Each person is unique and the procedures that are done are based on the individual's need and budget,

Transmasculine is a term inclusive of trans men and non-binary trans people assigned female at birth.

Gender confirmation procedures that a transmasculine person may undergo include:

• Masculinizing genitoplasty is the surgical creation of external genitalia. This procedure uses the tissue of the labia to create a penis.
• Phalloplasty is the surgical construction of a penis using a skin graft from the forearm, thigh, or upper back.
• Metoidioplasty is the creation of a penis from the hormonally enlarged clitoris.
• Scrotoplasty is the creation of a scrotum.

Procedures that change the genitalia are performed with other procedures, which may be extensive.

The change to a masculine appearance may also include hormone therapy with testosterone, a mastectomy (surgical removal of the breasts), hysterectomy (surgical removal of the uterus), and perhaps additional cosmetic procedures intended to masculinize the appearance.

Paying For Gender Confirmation Surgery

Medicare and some health insurance providers in the United States may cover a portion of the cost of gender confirmation surgery.

It is unlawful to discriminate or withhold healthcare based on sex or gender. However, many plans do have exclusions.

For most transgender individuals, the burden of financing the procedure(s) is the main difficulty in obtaining treatment. The cost of transitioning can often exceed $100,000 in the United States, depending upon the procedures needed.

A typical genitoplasty alone averages about $18,000. Rhinoplasty, or a nose job, averaged $5,409 in 2019.  

Traveling Abroad for GCS

Some patients seek gender confirmation surgery overseas, as the procedures can be less expensive in some other countries. It is important to remember that traveling to a foreign country for surgery, also known as surgery tourism, can be very risky.

Regardless of where the surgery will be performed, it is essential that your surgeon is skilled in the procedure being performed and that your surgery will be performed in a reputable facility that offers high-quality care.

When choosing a surgeon , it is important to do your research, whether the surgery is performed in the U.S. or elsewhere. Talk to people who have already had the procedure and ask about their experience and their surgeon.

Before and after photos don't tell the whole story, and can easily be altered, so consider asking for a patient reference with whom you can speak.

It is important to remember that surgeons have specialties and to stick with your surgeon's specialty. For example, you may choose to have one surgeon perform a genitoplasty, but another to perform facial surgeries. This may result in more expenses, but it can result in a better outcome.

A Word From Verywell

Gender confirmation surgery is very complex, and the procedures that one person needs to achieve their desired result can be very different from what another person wants.

Each individual's goals for their appearance will be different. For example, one individual may feel strongly that breast implants are essential to having a desirable and feminine appearance, while a different person may not feel that breast size is a concern. A personalized approach is essential to satisfaction because personal appearance is so highly individualized.

Davy Z, Toze M. What is gender dysphoria? A critical systematic narrative review . Transgend Health . 2018;3(1):159-169. doi:10.1089/trgh.2018.0014

Morrison SD, Vyas KS, Motakef S, et al. Facial Feminization: Systematic Review of the Literature . Plast Reconstr Surg. 2016;137(6):1759-70. doi:10.1097/PRS.0000000000002171

Hadj-moussa M, Agarwal S, Ohl DA, Kuzon WM. Masculinizing Genital Gender Confirmation Surgery . Sex Med Rev . 2019;7(1):141-155. doi:10.1016/j.sxmr.2018.06.004

Dowshen NL, Christensen J, Gruschow SM. Health Insurance Coverage of Recommended Gender-Affirming Health Care Services for Transgender Youth: Shopping Online for Coverage Information . Transgend Health . 2019;4(1):131-135. doi:10.1089/trgh.2018.0055

American Society of Plastic Surgeons. Rhinoplasty nose surgery .

Rights Group: More U.S. Companies Covering Cost of Gender Reassignment Surgery. CNS News. http://cnsnews.com/news/article/rights-group-more-us-companies-covering-cost-gender-reassignment-surgery

The Sex Change Capital of the US. CBS News. http://www.cbsnews.com/2100-3445_162-4423154.html

By Jennifer Whitlock, RN, MSN, FN Jennifer Whitlock, RN, MSN, FNP-C, is a board-certified family nurse practitioner. She has experience in primary care and hospital medicine.

You Won't Believe How Much It Costs to Be Transgender in America

I decided to come out to my family and friends as transgender at 15. At the time I didn't really know what impact that decision would have on my life, but I knew I'd been in the wrong body for as long as I could remember. I didn't quite have the words to articulate my feelings until I found a YouTube of someone transitioning. I realized there was a medical term for the feelings, and that I too could transition to the gender I identified with — I was born a boy, but now I could become a girl.

Luckily, everyone I told was extremely understanding and supportive. My parents took the time to educate themselves on the issue and did everything in their power to make my transition as easy as possible. I was incredibly fortunate to have this foundation of support, as one of the greatest setbacks that transgender teens face is being shunned by families. Many in fact, end up homeless or attempting suicide .

Another frequent setback is the cost of transition. It's a very expensive process, and unfortunately, unlike in other Western countries, healthcare doesn't automatically cover most (or any) of these costs . (Some insurances and employers do, however, and the Human Rights Campaign website has an excellent resource that can walk you through the process.) This makes the prospect of transitioning seem unachievable to a lot of people struggling with gender identity. So how much does it all cost exactly? It depends of course on the desired transition, but here are some of the most popular treatments and procedures, and what they've cost me so far. It should also be noted, however, that no one has to undergo any of the below in order to identify as transgender. This is simply my journey.

Hormone Therapy: $1,500/Year

Deciding to transition into the opposite gender is not a decision that should be taken lightly. I underwent two years of therapy despite knowing in my heart that I was making the right choice. This process was one of the most rewarding stages of my transition. It felt liberating to have a healthcare professional validate my decision and help me understand my feelings on a deeper level. Unfortunately, professional therapy costs thousands of dollars a year, and most trans youth simply can’t afford it. Once my therapist and I decided that transitioning was the right decision for me, I began hormone replacement therapy, also known by its nickname: HRT. It's one of the most powerful tools a person transitioning can have at their disposal. I was initially put on anti-androgens to halt my body’s production of testosterone. This stopped my male puberty right in its tracks, and prevented the development of things like facial hair, excessive muscle, and a deeper voice. Three months later I was placed on estrogen, which was super exciting for me. Soon thereafter my body began to change—my skin became softer, my fat began redistributing itself to my breasts and hips, and my voice started changing. You can’t even begin to imagine how rewarding this process can be for a transgender teenager. Sadly, this incredibly crucial transformation also comes at a price. I had to visit my MD once a month to have my hormone levels checked, and to renew the prescription for my medication. It also costs a whopping $1,500 every year (at least). Once some people complete their gender reassignment surgery, they stop taking this medication, but I'm still on it. I started when I was 16 and am now 25, so that's about $13,500 so far, and I plan to be on HRT for the rest of my life.

Gender Reassignment Surgery: $30,000-Plus

Nearly two years after beginning my therapy and hormone replacement therapy, I was ready for my gender reassignment surgery at 18. In order to have this surgery, most doctors will require proof of at least two years of therapy, as this is not a reversible procedure. They also need to be certain that you're fully aware of the decision that you're making and all of its consequences. For me, it was one of the happiest moments in my life. There are really no words to describe the excitement and anticipation I felt leading up to surgery. I will say, however, that I cannot stress enough enough how important it is to do your research before choosing a GRS surgeon. Only a handful of doctors in the world are truly experts in this field, and choosing the wrong one can lead to catastrophic results. This step in the transition is very expensive, and the average cost is upwards of $30,000. In addition to the actual procedure, you also have to pay for travel costs and hotel accommodations if a good physician does not live in your neighborhood. But in my opinion, this is a small price to pay for a lifetime of completion. I feel incredibly blessed that I had the opportunity at such a young age, and the opportunity to live my life in a way that feels true to me, in part, because of this surgery.

Facial Feminization Surgery: $25,000-$60,000

A year after having gender reassignment surgery, I went back under the knife for facial feminization surgery — a set of reconstructive procedures that alter typically male facial features to bring them closer in shape and size to typical female facial features. In my personal experience, this is the most life changing surgery of them all. As a young transgender woman, nothing was more important to me than being able to "blend" into society seamlessly. It's not only crucial for vanity reasons (what girl wants to look like a boy?), but also for safety reasons. Being trans often subjects you to discrimination, bullying, and physical aggression .

It's so important to members of the trans community that our outward appearance and inner self are in complete harmony. Speaking from personal experience, although not often, I did occasionally come across some level of bullying prior to having FFS. It's simply a lot easier to be singled out and targeted when the aggressor can identify you as being trans. But again, there's a price to pay for the procedure. Board certified surgeons that are qualified to do these procedures will charge anywhere from $25,000 to $60,000 depending on the amount of work you get. Mine cost about $30,000 , as I only opted for the procedures that I thought would benefit me the most at the time, which were forehead and jawline contouring.

Breast Augmentation: $5,000-$10,000

Having a breast augmentation as a transgender woman is an entirely personal choice. I know many who have chosen not to, and instead let their hormones do all the work when it comes to breast development. I chose to have surgery because I wanted a fuller bosom, and my hormones didn't help completely on that front. This surgery will cost between $5,000 and $10,000, and it all depends on the surgeon you choose, where that person is located, and what type of implant you want. Breast augmentation was by far the most painful of all the surgeries. In fact, after all the other procedures, I usually only felt some level of discomfort. When I woke up from this one, it was like an elephant was sitting on my chest.

Looking back at those two years of my life, from about 16 to 19, in which most of my transition took place, I often tell friends that I didn’t feel any less "female" prior to having the surgeries. And I think this is very important. Transitioning simply brought all the puzzle pieces together. I never had a waking moment where I thought in order to feel or be female, I needed to undergo multiple surgeries. My brain, heart, and soul felt 100% female prior to transition. Oftentimes, after surgery, my relatives would ask if I felt any different. My answer was always the same: no. I've always been the same old Elle.

I chose to undergo these surgeries to better my life experience, not to "become" female because I already was. Nowadays, I really only think about the process of transition when I am filming a Youtube video related to it. My journey into the person I am today would not have been possible if that 15-year-old me hadn't stumbled upon someone else going through the same thing. I hope I can help others in the same way.

For more information on transgender individuals and some of the issues and hardships they frequently face, check out the LGBT organization, the Human Rights Campaign .

Related: Trans Teen Wins Right to Use Bathroom of His Choice

Check out Teen Vogue ’s December/January issue cover star, Fernanda Ly.

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Does Insurance Cover Gender-Affirming Care?

Determining what your plan covers.

• Gender-Affirming Surgery Costs
• Gender-Affirming Medication Costs

Other Ways to Pay for Gender-Affirming Care and Surgery

Tips for financing gender-affirming care and surgery, the bottom line.

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In many cases, health insurance in the U.S. covers gender-affirming care. However, whether or not your insurance plan will cover a specific gender-affirming treatment can depend on your state, your employer, and your plan's benefits.

Key Takeaways

• Health insurance generally covers gender-affirming care.
• Not all plans cover all procedures, however, and the process can be murky and require preauthorization.
• Gender-affirming care can cost tens of thousands of dollars without insurance coverage.

Major insurance companies today generally recognize transgender-related care as being medically necessary . However, at least 24 states have passed new laws or enacted new policies limiting coverage of gender-affirming care for people up to age 18. And some transgender people may still be denied coverage for certain procedures by their insurers.

1.6 million

The estimated number of Americans age 13 or older who identify as transgender, according to a 2022 study.

Health insurers generally cover an array of medically necessary services that affirm gender or treat gender dysphoria, according to the American Medical Association, which reaffirmed its advocacy for such care in 2023. Gender dysphoria is a condition that occurs when someone feels a conflict between the sex they were assigned at birth and the one they now identify with.

Gender-affirming care is the phrase used by most medical groups for dysphoria treatment. This care can include hormones, surgery, or counseling. The care aligns a person's gender identity with gender expression in appearance, anatomy, and voice.

In 2010, the federal Affordable Care Act (ACA) banned health insurance discrimination based on sexual orientation and gender identity. Before the law's passage, medically necessary gender-affirming surgeries and hormones often weren't covered by insurers.

A 2024 rule from the Department of Health and Human Services stated that covered entities (a term that includes both insurance plans and providers such as doctors) could not "deny or limit coverage, deny or limit coverage of a claim, or impose additional cost sharing or other limitations or restrictions on coverage, for specific health services related to gender transition or other gender-affirming care if such denial, limitation, or restriction results in discrimination on the basis of sex."

However, insurance is also regulated at the state level and rules can vary based on whether it is an ACA, public, or employer plan, so they don't apply evenly to all insurers.

Investopedia / Candra Huff

Policyholders and plan members can generally find out what's available to them in their member booklet. This should have been given to you when you got the policy or, if it's an employee plan, when you joined the company. It may be called a certificate of coverage, a benefit plan, a summary plan description, a certificate of insurance, or something similar.

This document should describe the insurer's clinical evidence criteria to qualify for claim coverage. For example, to begin hormone therapy, the requirements might include a diagnosis of gender dysphoria from a licensed mental health professional.

Some plans may list exclusions for certain procedures. Even if an exclusion exists in the documentation, it can still be worthwhile to apply for pre-authorization or pre-approval for the procedure to obtain an official decision. For one thing, as the Transgender Legal Defense & Education Fund, notes, "the plan booklet may simply be out of date."

Even if you're turned down, that is not necessarily the final word. If a preauthorization request or a claim is denied, an attorney, healthcare advocate, or your human resources department may be able to help with filing an appeal. Appeals should include individualized, extensive documentation of a service's medical necessity and appropriateness.

Here, we list four types of health insurance and how they might cover gender-affirming care.

Employer-Provided Insurance

Altogether, 24 states and the District of Columbia prohibit transgender exclusions in private health insurance coverage, according to the nonprofit LGBTQ+ advocacy organization Movement Advance Project, leaving half the states without such protections.

However, health coverage benefits that a private employer provides can vary based on whether the employer buys its coverage from an insurance company or is funding the plan itself. If the employer's plan is self-funded, it is governed by the federal law ERISA, the Employee Retirement Income Security Act , which overrides any state nondiscrimination law. The employer can decide what health care is or is not covered.

In the Human Rights Campaign's 2023-2024 Corporate Equality Index, a record 94% of the companies it evaluated offered at least one transgender-inclusive plan option.

Employer-based plans are governed in the state where the plan was issued, not where you live.

Affordable Care Act Plan Coverage

Individuals can buy their own health insurance policies, often with the help of federal subsidies, through the Healthcare.gov Marketplace. Most insurers have eliminated transgender-specific exclusions, which ACA regulations explicitly ban.

Still, policies vary by state and in what they cover. As the Healthcare.gov website notes, "Many health plans are still using exclusions such as 'services related to sex change' or 'sex reassignment surgery' to deny coverage to transgender people for certain health care services."

It suggests that before enrolling in a plan, consumers should carefully review its terms: "Plans might use different language to describe these kinds of exclusions. Look for language like 'All procedures related to being transgender are not covered.' Other terms to look for include 'gender change,' 'transsexualism,' 'gender identity disorder,' and 'gender identity dysphoria.'"

Fortunately, according to Out2Enroll, an organization connecting the LGBT+ community with healthcare coverage, when it recently reviewed silver Marketplace options in 32 states it found that "the vast majority of insurers did not use transgender-specific exclusions" and that "40% of plans had language indicating that all or some medically necessary gender-affirming care would be covered by the plan." (ACA coverage is broken down into bronze, silver, gold, and platinum plans, with silver being a moderately priced level.)

Out2Enroll also has state-specific Transgender Health Insurance Guides on its website for help in choosing a plan.

Medicare and Medicaid Coverage

About 6% of transgender adults receive their health coverage from Medicare, the federal insurance program primarily for Americans over age 65. Under these plans, medically necessary care—including some gender-affirming procedures—is covered. Private Medicare Advantage plans should abide by the same rules as traditional Medicare, but patients on such plans should try to get preauthorization before accessing transition-related services, the National Center for Transgender Equality advises.

Some 21% of transgender adults receive Medicaid, the joint federal and state health insurance plan for low-income Americans. On a state-by-state basis, Medicaid coverage is uneven. Medicaid programs explicitly cover transgender-related care in 26 states and the District of Columbia. Meanwhile, programs in 10 states bar coverage of transgender-related care for people of all ages, and programs in three states prohibit coverage of transgender-related care for minors.

Military and Veteran Coverage  

Active military members can access some types of gender-affirming care. TRICARE, the health benefits provider for military members, says it "covers hormone therapy and psychological counseling for gender dysphoria. TRICARE generally doesn't cover surgery for the treatment of gender dysphoria. However, active duty service members may request a waiver for medically necessary, gender affirming surgery."

The Veterans Health Administration offers gender-affirming healthcare, including hormones and prosthetics, mental health care, and other healthcare. Coverage for gender-affirming surgery has traditionally been denied but is currently undergoing a review.

How Much Does Gender-Affirming Surgery Cost?

The cost of gender-affirming care might range from $25,000 to $75,000, according to an estimate from the Human Rights Campaign.

Gender-affirming surgeries may include top surgery (breast removal or augmentation), bottom surgery, vocal surgery, and face and body surgeries such as browlifts, jawline contouring, Adam's apple removal, and forehead reduction.

Bottom surgery may include:

• Phalloplasty : Creation of penis 
• Metoidioplasty : Phallus created from existing genital region tissue. 
• Hysterectomy : Uterus and cervix removal  
• Nullification surgery : Creating a gender-neutral look in the groin
• Oophorectomy : Removal of one or both ovaries
• Vaginoplasty and vulvoplasty : Creation of vagina and vulva 
• Orchiectomy : Testicle removal 

Research published in 2022 by JAMA Surgery found that while gender-affirming surgery can be costly, insurance (for patients who have it) will often cover most of the cost. Looking at phalloplasty and vaginoplasty procedures specifically, it reported:

However, not all transgender people desire surgery. According to 2019 research statistics, only 28% of transgender women get any type of surgery, and only 4% to 13% receive genital surgery. Surgery is more common among transgender men, with 42% to 54% getting some type of surgery; up to 50% get genital surgery.

How Much Does Gender-Affirming Medication Cost?

Gender-affirming medication is far more common than surgery. As many as 65% of transgender people received gender-affirming hormone therapy in 2019, up from 17% in 2011, according to the Journal of Law, Medicine & Ethics .

The costs of gender-affirming medications can vary widely. While they are often at least partially covered by insurance, they also come with out-of-pocket costs, which may continue through the patient's lifetime.

For example, a study in the Journal of General Internal Medicine reported that, "in 2019, median prices for feminizing and masculinizing hormone therapy ranged from $6.76 to $91.15 and $31.82 to $398.99, respectively." At the same time, patients' "median out-of-pocket costs ranged from $5.00 to $10.71 and $10.00 to $12.86 for feminizing and masculinizing hormone therapy, respectively." Those prices refer to a 30-day supply.

Other costs can be involved as well. For example, patients who are taking hormones may need periodic blood tests to monitor their health.

A 2020 study in Annals of Family Medicine found that among insured respondents taking gender-affirming hormones, almost 21% reported that their claims were denied. This group (and those who are uninsured) were more likely to take nonprescription hormones from unlicensed sources, which may not be monitored for quality and potentially carry serious health risks.

Aside from health insurance, how can you pay for gender-affirming care or surgery? Here are some options.

Payment Plans 

Some healthcare providers offer payment plans directly or through lenders that let you pay off medical bills over time.

You might take out a personal loan or even a type of personal loan called a medical loan to cover expenses related to gender-affirming care or surgery. A medical loan is just a personal loan used to pay for medical expenses.

Credit Cards 

Credit cards cab be another avenue for covering the costs of gender-affirming care or surgery, although they tend to have very high interest rates if you run a balance.

Even with health insurance, hormone therapy may be less expensive if you comparison shop and use pharmacy programs, such as GoodRx.

Surgery Grants

Several organizations, such as the Jim Collins Foundation, offer grants for people seeking gender-affirming care or surgery.

Health Accounts 

If you have a flexible spending account (FSA) or health savings account (HSA) , consider allocating some account money for gendering-affirming care or surgery if you are anticipating it.

Health Reimbursement Agreement 

A health reimbursement agreement (HRA) is an employer-funded group health plan that reimburses employees for qualified medical expenses, which might include gender-affirming care or surgery.

Home Equity Loan or Line of Credit (HELOC) 

You could take out a home equity loan or line of credit to cover the costs of gender-affirming care or surgery. With these types of loans, you can typically borrow up to a certain percentage of your home's equity. Interest rates are generally lower than those on a personal loan, because your home serves as collateral. Just realize that if you can't repay the loan, your could lose your home. 

Friends and Family Loans 

If you've got supportive friends or relatives, they might be willing to chip in money to pay for your gender-affirming care or surgery. To avoid misunderstandings, it's usually best to have a written agreement and repayment plan.

Crowdfunding

You might consider setting up a crowdfunding campaign on a platform like GoFundMe to raise money from friends, relatives, colleagues, or even strangers.

When you're financing gender-affirming care or surgery, you may be able to save some money if you follow these tips.

Shop Around 

A number of online tools such as Hospital Cost Compare and Healthcare Bluebook allow you to compare costs for the same procedures and treatments offered by different healthcare providers. Doing this homework could save you a lot of money.

Check the Interest Rate Before You Borrow 

Be sure to investigate how much you'll pay to borrow money if you decide to go the credit card or loan route. 

Try Negotiating or Set up a Payment Plan

You can sometimes negotiate with a healthcare provider to lower the costs of gender-affirming care or surgery. For instance, a healthcare provider might discount your services if you agree to pay off your medical bills quickly. If a healthcare provider isn't willing to provide a discount, they might let you make interest-free payments as part of a payment plan.

Ask About Financial Assistance

Some nonprofit healthcare providers offer financial assistance programs that will cover all or some of your medical expenses.

What Are the Different Types of Gender-Affirming Care?

Various types of gender-affirming care include puberty-blocking medication, hormone therapy, top surgery, bottom surgery, nullification surgery, laser hair removal, facial feminization surgery, speech therapy, and mental health services.

How Much Does Gender-Affirming Care Cost in the U.S.?

The cost of gendering-affirming care varies widely, depending on the type of procedure or treatment involved. A common range is anywhere from $25,000 to $75,000, according to the Human Rights Campaign. Health insurance may cover these costs to varying degrees.

Does Insurance Cover Puberty Blockers?

According to one 2019 study, about 31% of the plans it looked at online claimed to cover puberty blockers. That makes it all the more important for patients and their families to shop around for insurance.

The campaign for transgender rights in the U.S. has experienced victories and setbacks in recent years—in some cases affecting coverage of gender-affirming care. Even amid progress, some people still encounter problems obtaining health insurance to cover such care or paying the out-of-pocket costs involved. People who expect to need gender-affirming care will want to read their insurance plan's coverage details carefully and ask questions if they're unsure about what's covered.

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KFF. " Policy Tracker: Youth Access to Gender Affirming Care and State Policy Restrictions ."

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UCSF Transgender Care. " Initiating Hormone Therapy ."

American Medical Association. " Transgender Coverage Issue Brief ."

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Transgender Legal Defense & Education Fund. " Health Insurance – Understanding Your Plan ."

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Out2Enroll. " Plan Information for 2024 ."

Healthcare.gov. " How to Pick a Health Insurance Plan ."

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Movement Advancement Project. " Medicaid Coverage of Transgender-Related Health Care ."

TRICARE. " Gender Dysphoria Services ."

U.S. Department of Veterans Affairs. "VHA LGBTQ+ Health Program. "

Annals of Family Medicine, November 2020. " Insurance Coverage and Use of Hormones Among Transgender Respondents to a National Survey ," See Abstract: Results.

Translational Andrology and Urology. " Demographic and Temporal Trends in Transgender Identities and Gender Confirming Surgery ."

JAMA Surgery. " Spending and Out-of-Pocket Costs for Genital Gender-Affirming Surgery in the U.S. "

The Journal of Law, Medicine, and Ethics. " Utilization and Costs of Gender-Affirming Care in a Commercially Insured Transgender Population ."

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Americans considering gender-affirming surgery can find themselves at the start of an exciting new chapter but the costs to be steep. For many, managing the expenses related to transitioning requires planning and may call for more than one financing solution.

Wolsey Bradley and his wife, Lucky, had to be creative in financing their procedures. The couple used credit cards, medical credit cards, cash and insurance to pay for nearly $50,000 in medical expenses related to their transitions.

"We’ve probably paid for our surgeries in every way you can think of," Wolsey says.

Borrowing money or financing a procedure can also be an option when savings or insurance doesn’t cover all the costs.

How much does gender-affirming surgery cost?

The price tag for individual gender-affirming surgical procedures can range from $8,000 to $64,000, according to 2022 research in the Journal for Law, Medicine and Ethics. The cost generally covers the surgeon’s fee, facility costs, anesthesia fees, medical tests, medication and post-surgery needs, depending on the type of procedure.

For people who need a series of procedures, the combined expenses can reach six figures.

Ways to finance gender-affirming surgery costs

The best-case scenario is for health insurance to cover the costs of gender-affirming surgery, also known as gender-confirmation surgery. If that’s not an option, other ways include personal loans and credit cards. Consider these options to pay for gender-affirming surgery and care:

Online personal loan.

Credit union personal loan.

Credit card.

CareCredit.

Home equity line of credit.

Family loan.

Online personal loan

Online lenders offer unsecured personal loans that can be used for almost any purpose, including medical costs. Loan amounts range from $1,000 to $100,000, and interest rates and monthly payments are fixed over the life of the loan.

Online lenders typically let you pre-qualify and apply for a personal loan online, and some loans have next-day funding. However, online loans can be one of the most expensive ways to cover gender-affirming surgery costs. Compare the annual percentage rates (APRs) of multiple lenders to receive the best rates and monthly payments that fit your budget.

Use our personal loan calculator to see estimated rates and monthly payments.

Whom it’s best for: Borrowers who qualify for a low rate and prefer an online experience.

» MORE: Compare medical loans

Credit union personal loan

Credit unions also offer personal loans, often with lower rates and more flexible terms than those of online lenders. Like online lenders, credit unions set loan terms based on your credit score and history, but some may consider factors outside your credit score, making it easier to qualify for funding. The loan amounts offered may not cover the total cost of surgery, and you must qualify for credit union membership.

Whom it’s best for: Credit union members and those with thin or imperfect credit histories.

Credit card

Credit cards are one way to cover a small procedure or a portion of a costlier surgery, but interest rates can be high.

If you have good or excellent credit (a score of 690 or above), you could be eligible for a credit card with an introductory 0% APR . There is no interest during the card's promotional period, which can usually last 15 to 21 months. You have to pay off the balance within the promotional period to avoid paying interest.

When using a credit card, ensure that your medical costs don't reach the credit limit, which can negatively affect your credit score.

Whom it’s best for: Cardholders with a comfortable amount of credit available and who are looking to pay for minor procedures.

Wolsey says he used CareCredit to help cover $5,000 of his nearly $15,000 chest reconstruction surgery cost. CareCredit is a credit card used specifically for financing health care expenses . If your doctor accepts it, you can apply at their office or online.

CareCredit offers attractive zero-interest promotional financing for a designated term, but unlike most 0% APR credit cards, it defers interest . That means if you don’t pay your balance within the promo period, you must pay all your interest retroactively from the date of purchase. CareCredit’s standard APR is 29.99%, which may be higher than the rates of other credit card issuers.

Whom it’s best for: Individuals who need help covering a small procedure or a portion of a larger procedure and can pay off the debt within the promotional period.

Home equity line of credit

If you own a house, a home equity line of credit allows you to borrow against it, sometimes up to 85% of its appraised value minus any amount you still owe on the mortgage. You can borrow and repay the funds as often as needed during the term, and highly qualified borrowers may get lower APRs.

However, you could lose your home if you can’t repay the HELOC. Interest rates are usually variable, so monthly payments could fluctuate, and some HELOCs have closing costs, an appraisal fee or other fees.

Whom it’s best for: Homeowners with equity in their homes who are unsure of the total cost or number of procedures they’ll have and want flexible credit to draw from.

Family loan

A no-interest or low-interest loan from a relative may be an affordable and lowest-risk option. However, it’s worth weighing the potential impact of this arrangement on your relationship with the family member. Formalizing the process with a promissory note — a document that details factors like interest and repayment terms — and consulting a tax preparer can help make the feeling of borrowing from family easier.

Whom it’s best for: Those looking for a low-cost way to pay for the procedures and who feel comfortable borrowing from family members.

» MORE: Family loans: How to borrow from and lend to family

Other ways to cover gender-affirming care costs

Surgery grants.

Some foundations and organizations offer grants — funds that don’t need to be repaid — for gender-affirming surgery. The Jim Collins Foundation , Point of Pride and Genderbands are examples of organizations that offer funding. Check their websites for eligibility requirements and application deadlines.

Flexible spending accounts

Your employer-provided insurance may allow you to contribute to a flexible spending account, up to $3,050 annually. The money in an FSA isn't taxed and can be used to pay out-of-pocket health expenses like co-pays or prescriptions.

Payment plan

Some health care providers allow you to set up payment plans that break up large medical bills into more affordable monthly payments. The total monthly payment depends on the procedure’s cost and terms you negotiate with your health care provider, and there may be billing charges or fees associated with the plan.

» MORE: How to pay off medical bills: 6 options

Additional tips: Compare and plan

After managing thousands of dollars in medical expenses — and spreadsheets to track them — Wolsey and Lucky have found additional ways to save on costly surgeries.

Don’t always choose the cheapest option

It may be tempting to shop based on price alone, but it benefits you to find a reputable surgeon with experience in the procedures you need. Working with someone unsuitable could mean you’ll have to pay someone else to fix mistakes — something that Lucky has witnessed in her community.

“I had a couple of friends who went with a cheaper surgeon just because it was less money, and they ended up spending a lot more because other surgeons had to fix it," she says.

Compare options

Having multiple options allows you to make the best decision for yourself and your budget.

"You can go into any surgeon’s office and get them to give you a quote. It’s like buying a car," Wolsey says. Through this approach, Wolsey and Lucky found a surgeon who performed the procedures they needed at a more affordable price.

“The surgeon who did my first bottom surgery and Lucky’s final round of facial feminization surgery does time on the table. She does not charge for each individual procedure she does.”

Budget and plan

Before you take out a loan or apply for a credit card, add the monthly payments into your budget to determine whether you can afford them.

“I think financially you really have to check what you have. You have to be really aware of how well you are budgeting and paying off debt,” Wolsey says.

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What Is Gender Affirmation Surgery?

Surgery to change the appearance of your body is a common choice for all kinds of people. There are many reasons that people might want to alter their appearance. For transgender or gender nonconforming people, making changes to their bodies is a way of affirming their identity.

A trans person can choose from multiple procedures to make their appearance match their self-identified gender identity. Doctors refer to this as gender "affirmation" surgery.

Trans people might decide to have surgery on their chest, genitals, or face. These surgeries are personal decisions, and each person makes their own choices about what is right for them.

Learn more about gender affirmation surgery and how it helps trans people.

What Does It Mean to Be Transgender or Nonbinary?

Transgender is a word to describe people whose gender identity or gender expression doesn't match the sex they were assigned at birth. Typically, parents and doctors assume a baby's gender based on the appearance of their genitals. But some people grow up and realize that their sense of who they are isn't aligned with how their bodies look. These people are considered transgender.

Trans people may identify as a different gender than what they were assigned at birth. For example, a child assigned male at birth may identify as female. Nonbinary people don't identify as either male or female. They may refer to themselves as "nonbinary" or "genderqueer."

There are many options for trans and nonbinary people to change their appearance so that how they look reflects who they are inside. Many trans people use clothing, hairstyles, or makeup to present a particular look. Some use hormone therapy to refine their secondary sex characteristics. Some people choose surgery that can change their bodies and faces permanently.

Facial Surgery

Facial plastic surgery is popular and accessible for all kinds of people in the U.S. It is not uncommon to have a nose job or a facelift . Cosmetic surgery is great for improving self-esteem and making people feel more like themselves. Trans people can use plastic surgery to adjust the shape of their faces to better reflect their gender identity.

Facial feminization. A person with a masculine face can have surgeries to make their face and neck look more feminine. These can be done in one procedure or through multiple operations. They might ask for:

• Forehead contouring
• Jaw reduction
• Chin surgery
• Hairline advancement
• Cheek augmentation
• Rhinoplasty
• Lip augmentation
• Adam's apple reduction

Facial masculinization. Someone with a feminine face can have surgery to make their face look more masculine. The doctor may do all the procedures at one time or plan multiple surgeries. Doctors usually offer:

• Forehead lengthening
• Jaw reshaping
• Chin contouring
• Adam's apple enhancement

Top Surgery

Breast surgeries are very common in America. The shorthand for breast surgeries is "top surgery." All kinds of people have operations on their breasts , and there are a lot of doctors who can do them. The surgeries that trans people have to change their chests are very similar to typical breast enhancement or breast removal operations.

Transfeminine. When a trans person wants a more feminine bustline, that's called transfeminine top surgery. It involves placing breast implants in a person's chest. It's the same operation that a doctor might do to enlarge someone's breasts or for breast reconstruction .

Transmasculine. Transmasculine top surgery is when a person wants a more masculine chest shape. It is similar to a mastectomy . The doctor removes the breast tissue to flatten the whole chest. The doctor can also contour the skin and reposition the nipples to look more like a typical man's chest.

Bottom Surgery

For people who want to change their genitals, some operations can do that. That is sometimes called bottom surgery. Those are complicated procedures that require doctors with a lot of experience with trans surgeries.

Transmasculine bottom surgery. Some transmasculine people want to remove their uterus and ovaries. They can choose to have a hysterectomy to do that. This reduces the level of female hormones in their bodies and stops their menstrual cycles.

If a person wants to change their external genitals, they can ask for surgery to alter the vaginal opening. A surgeon can also construct a penis for them. There are several techniques for doing this.

Metoidioplasty uses the clitoris and surrounding skin to create a phallus that can become erect and pass urine. A phalloplasty requires grafting skin from another part of the body into the genital region to create a phallus. People can also have surgery to make a scrotum with implants that mimic testicles. ‌

Transfeminine bottom surgery. People who want to reduce the level of male hormones in their bodies may choose to have their testicles removed. This is called an orchiectomy and can be done as an outpatient operation.

Vaginoplasty is an operation to construct a vagina . Doctors use the tissue from the penis and invert it into a person's pelvic area. The follow-up after a vaginoplasty involves using dilators to prevent the new vaginal opening from closing back up.

How Much Does Gender Affirmation Surgery Cost?

Some medical insurance companies will cover some or most parts of your gender-affirming surgery. But many might have certain "exclusions" listed in the plan. They might use language like "services related to sex change" or "sex reassignment surgery." These limitations may vary by state. It's best to reach out to your insurance company by phone or email to confirm the coverage or exclusions.

If your company does cover some costs, they may need a few documents before they approve it.

This can include:

• A gender dysphoria diagnosis in your health records. It's a term used to describe the feeling you have when the sex you're assigned at birth does not match with your gender identity. A doctor can provide a note if it's necessary.
• A letter of support from a mental health professional such as a social worker, psychiatrist , or a therapist.

Gender affirmation surgery can be very expensive. It's best to check with your insurance company to see what type of coverage you have.

If you're planning to pay out-of-pocket, prices may vary depending on the various specialists involved in your case. This can include surgeons, primary care doctors, anesthesiologists, psychiatrists, social workers, and counselors. The procedure costs also vary, and the total bill will include a number of charges, including hospital stay, anesthesia, counseling sessions, medications, and the procedures you elect to have.

Whether you choose facial, top, or bottom or a combination of these procedures, the total bill after your hospital stay can cost anywhere from $5,400 for chin surgery to well over $100,000 for multiple procedures.

Recovery and Mental Health After Gender Affirmation Surgery

Your recovery time may vary. It will depend on the type of surgery you have. But swelling can last anywhere from 2 weeks for facial surgery to up to 4 months or more if you opted for bottom surgery.

Talk to your doctor about when you can get back to your normal day-to-day routine. But in the meantime, make sure to go to your regular follow-up appointments with your doctor. This will help them make sure you're healing well post-surgery.

Most trans and nonbinary people who get gender affirmation surgery report that it improves their overall quality of life. In fact, over 94% of people who opt for surgery say they are satisfied with the results.

Folks who have mental health support before surgery tend to do better, too. One study found that after gender affirmation surgery, a person's need for mental health treatment went down by 8%.

Not all trans and nonbinary people choose to have gender affirmation surgery, or they may only have some of the procedures available. If you are considering surgery, speak with your primary care doctor to discuss what operations might be best for you.

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How Gender Reassignment Surgery Works (Infographic)

Bradley Manning, the U.S. Army private who was sentenced Aug. 21 to 35 years in a military prison for releasing highly sensitive U.S. military secrets, is seeking gender reassignment. Here’s how gender reassignment works:

Converting male anatomy to female anatomy requires removing the penis, reshaping genital tissue to appear more female and constructing a vagina.

An incision is made into the scrotum, and the flap of skin is pulled back. The testes are removed.

A shorter urethra is cut. The penis is removed, and the excess skin is used to create the labia and vagina.

People who have male-to-female gender-reassignment surgery retain a prostate. Following surgery, estrogen (a female hormone) will stimulate breast development, widen the hips, inhibit the growth of facial hair and slightly increase voice pitch.

Female-to-male surgery has achieved lesser success due to the difficulty of creating a functioning penis from the much smaller clitoral tissue available in the female genitals.

The uterus and the ovaries are removed. Genital reconstructive procedures (GRT) use either the clitoris, which is enlarged by hormones, or rely on free tissue grafts from the arm, the thigh or belly and an erectile prosthetic (phalloplasty).

Breasts need to be surgically altered if they are to look less feminine. This process involves removing breast tissue and excess skin, and reducing and properly positioning the nipples and areolae. Androgens (male hormones) will stimulate the development of facial and chest hair, and cause the voice to deepen.

Reliable statistics are extremely difficult to obtain. Many sexual-reassignment procedures are conducted in private facilities that are not subject to reporting requirements.

The cost for female-to-male reassignment can be more than $50,000. The cost for male-to-female reassignment can be $7,000 to $24,000.

Between 100 to 500 gender-reassignment procedures are conducted in the United States each year.

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Study: Paying for Transgender Health Care Cost-Effective

Most health insurance plans do not cover care associated with transitioning to the opposite sex.

A new analysis led by the Johns Hopkins Bloomberg School of Public Health suggests that while most U.S. health insurance plans deny benefits to transgender men and women for medical care necessary to transition to the opposite sex, paying for sex reassignment surgery and hormones is actually cost-effective.

The researchers, reporting online in the Journal of General Internal Medicine , say that the cost of surgery and hormones is not significantly higher than the cost of treatment for depression, substance abuse and HIV/AIDS, all of which are highly prevalent in those who are transgender but are not in a position to medically transition to the opposite sex. In 2014, the Center for Medicare and Medicaid Services began paying for sex reassignment surgery and other transitional care, after a 33-year-ban on covering those costs was lifted.

“Providing health care benefits to transgender people makes economic sense,” says study leader William V. Padula, PhD, MS, MSc, an assistant professor of health policy and management at the Bloomberg School. “Many insurance companies have said that it’s not worth it to pay for these services for transgender people. Our study shows they don’t have an economic leg to stand on when they decide to deny coverage. This is a small population of people and we can do them a great service without a huge financial impact on society.”

Estimates vary widely but it is believed that between 3,000 and 9,000 Americans undergo sex reassignment surgery each year. Transition medical care can include hormone replacement therapy, mastectomy, plastic surgery, psychotherapy and more.

For their study, Padula and colleagues analyzed data from the 2011 National Transgender Discrimination Survey, which includes information on access to medical care and health outcomes, as well as the Healthcare Bluebook, which outlines the cost of medical services. They also looked at previously published research on the topic.

When determining cost-effectiveness of medical services in the U.S., policymakers consider something cost-effective if the price is below $100,000 per year of quality of life. In the first five years, the researchers found, providing health care for transgender people cost between $34,000 and $43,000 per year of quality of life; after 10 years, the cost dropped to between $7,000 and $10,000 per year of quality of life.

Padula likens the case of paying for transgender care to caring for people with rare diseases. For example, cystic fibrosis affects just 30,000 people in the United States but can be treated as a chronic condition with the availability of new medications at a cost of $300,000 per year. While this is neither cost-effective nor individually affordable, Padula says, society has decided to pay for the treatment out of compassion. The same can be done for transgender people, he says.

Health insurance policies also pay for treatments that can be considered elective, such as breast reduction and spinal fusion as well as medication for erectile dysfunction. Some employers and health insurance companies do offer at least one plan that covers transition care, but that is not the norm, Padula says.

“Most U.S. health insurance policies still contain transgender exclusions, even though treatment of gender identity disorder is neither cosmetic nor experimental,” he says.

The new analysis calculated that the cost to cover transgender people would be fewer than two pennies per month for every person with health insurance coverage in the United States.

“We would be paying a very small incremental amount to improve the quality of life for a population that is extremely disenfranchised from health care and other services we consider a right,” Padula says. “For this small investment for a small number of people, we could improve their lives significantly and make them more productive members of society.”

He says that providing sex-reassignment surgery and other services to transgender people could help mitigate the expenses of treating depression, which often occurs in people who cannot transition, often because they do not have the financial means, as well as drug abuse and HIV/AIDS.

“ Societal Implications of Health Insurance Coverage for Medically Necessary Services in the U.S. Transgender Population: A Cost-Effectiveness Analysis ” was written by William V. Padula, Shiona Heru and Jonathan D. Campbell. Heru worked with the Commonwealth of Massachusetts Group Insurance Commission and Campbell is with the University of Colorado.

Funding for this study includes an F32 National Research Service Award from the Agency for Healthcare Research and Quality, a University of Chicago Medicine Small Grant in Diversity Research and a merit fellowship from Western New England University School of Law in affiliation with the Gender and Sexuality Center.

Media contacts for the Johns Hopkins Bloomberg School of Public Health: Stephanie Desmon at 410-955-7619 or  [email protected]   and Susan Murrow at 410-955-7624 and  [email protected] .

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Financing & Support for Gender Confirmation Surgery

Laura Dorwart

Laura Dorwart is a writer living in Oberlin, Ohio, with her family. She has bylines at VICE, The New York Times, The Guardian and many others. She has a Ph.D. from UCSD, an MFA in nonfiction writing from Antioch University Los Angeles and experience in UX writing and copywriting for brands such as KeyBank. Follow her work at www.lauradorwart.com.

Patrick McHugh

Chief Creative Officer and Cofounder at Euphoria.LGBT

Patrick McHugh is the Chief Creative Officer and Cofounder of Euphoria.LGBT, a health-tech company building technology for the transgender community to alleviate the great pains associated with gender transition. A communications, research and design specialist, McHugh leads the research and content-writing efforts for Solace and Bliss.

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Updated: December 5, 2023

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Advertising & Editorial Disclosure

Between 1.4 million and 1.65 million adults in the U.S. identify as transgender, according to the Williams Institute at UCLA's School of Law. For many transgender and gender non-conforming individuals, medical transition is a significant and empowering part of their journey. Transition may include hormonal treatment and/or surgery known as gender confirmation surgery or gender affirmation surgery.

Many transgender individuals go through the process of transition — which includes legal, psychological, social and medical experiences — to resolve gender incongruence between their internal sense of self and external anatomy. Gender identity refers to an individual's experienced gender and sense of self.

Not all transgender people want to undergo gender confirmation surgery. But for those who do, the process can help to alleviate gender dysphoria . Gender confirmation surgery also doesn’t change or “reassign” one’s gender or sex. Instead, it allows transgender and gender non-conforming people to change their bodies to reflect their gender identity more accurately.

While hormonal treatment and/or surgery is a deeply important step for many trans and gender non-conforming people, it can also be expensive. Learn more about the average costs of medical transition care options and find resources and ways to help fund procedures.

Medical Transition Care Options and Average Costs

Medical transition care options are diverse in terms of procedures, costs and outcomes. Each transgender person, along with their medical provider, should choose the options that make the most sense in terms of budget and desired results.

The main two medical transition care options are hormonal transition and gender confirmation surgery. Here’s a breakdown of the average costs of each kind of gender-confirming healthcare treatment.

Hormonal Transition

Average Cost: $20–350/month

The majority of transgender individuals who seek out medical transition choose to undergo hormonal transition, also known as hormone therapy. Because of its relative affordability and accessibility, hormone therapy can be a particularly effective option for those experiencing gender dysphoria or looking for an alternative to surgery. Hormone therapy can help trans men and women, as well as nonbinary and gender non-conforming individuals, achieve significant physical changes.

Patients who undergo masculinizing hormone therapy often take testosterone. Testosterone therapy can affect a patient’s fat distribution, facial characteristics, vocal cords, hair growth patterns, libido, menstrual cycles and more. Testosterone typically comes in the form of injections (approximately $80 per month), patches ($300 per month), and gels ($300–350 per month) .

Patients who go through feminizing hormone therapy often take estrogen or testosterone blockers such as spironolactone and/or progesterone. Like testosterone therapy, this can affect a patient’s voice, facial appearance, libido, fertility, emotions and fat distribution. It can also promote breast development. On average, oral estrogen costs about $20 per month, while estrogen injections can cost up to $200 per month and spironolactone up to $20 per month.

Gender Confirmation Surgeries

Average Cost: $5,000–$50,000

Gender confirmation surgery for transgender patients refers to reconstructive surgeries to bring patients' bodies into conformity with their experienced gender. Surgeries might include reconstruction of the chest and/or face. Depending on the type of surgery, patients may have a recovery period from about two weeks to several months after their initial hospitalization.

Like all surgeries, these procedures come with potential risks. But patients who seek out board-certified surgeons and follow all pre- and post-op guidelines are usually satisfied with their results.

Here are some of the most common gender confirmation surgeries that transgender and gender non-conforming patients seek out.

Types of Surgeries for Trans Men

For trans patients, gender confirmation surgery might include removing breast tissue and reconstructing the chest, facial masculinization surgery (FMS) to make their facial features appear more masculine, removing and reconstructing the external genitalia, and removing internal reproductive organs.

Here are the most common forms of gender confirmation surgery for trans men and nonbinary patients.

Average Cost: $10,000–$50,000

Here is what FMS surgery may include:

• Thyroid cartilage enhancement: An “Adam’s apple” is made using a small incision in the chin area and an implant in the throat region.
• Cheek augmentation: Small incisions inside the mouth allow the surgeon to place implants in the cheek to create a more angular appearance.
• Forehead lengthening or augmentation: Forehead lengthening and augmentation procedures involve lengthening the area between the eyes and scalp, and sometimes placing an implant, to create a more masculine, angular forehead.
• Jaw and chin augmentation: Jaw and chin reshaping and implants can help to widen the face and contour the jawline for more masculine facial proportions.
• Nose reshaping: Rhinoplasty can help to widen the nose and masculinize the facial proportions.

Surgery procedures could include:

• Facial masculinization surgery (FMS): FMS may include thyroid cartilage enhancement, cheek augmentation, forehead lengthening or augmentation, jaw and chin augmentation and nose reshaping.
• Periareolar procedure: The areolas and nipples are resized and repositioned during this surgery. Two circular incisions around the areolas allow the surgeon to remove the “ring” of chest tissue.
• Keyhole procedure: The keyhole procedure involves just one semi-circular incision below each of the nipples. Keyhole top surgery also allows most patients to keep the sensation in their nipple area.
• Double incision: In double incision top surgery, the surgeon makes two incisions at the top and bottom of the pectoral muscles. The nipples and areolas are removed and replaced with nipple grafts.
• Inverted-T top surgery: Inverted-T top surgery involves horizontal and vertical incisions and the removal of chest tissue but not nipples. Sensation is retained for most patients.
• Metoidioplasty: Metoidioplasty involves releasing the clitoris from the ligament attached to it and repositioning it to create a penis. With this procedure, patients can also choose to undergo urethral lengthening and remove vaginal tissue.
• Phalloplasty: Surgeons use skin grafts from other parts of the body (usually the thigh or forearm) to create a penis. A vaginectomy, or the closing of the opening in the front of the pelvis, as well as scrotoplasty, which creates a scrotum, can be included in some phalloplasty procedures. This is the most expensive of bottom surgery options for trans men, with price tags up to $150,000 in some cases.
• Hysterectomy: A hysterectomy includes the removal of the uterus and ovaries.

Types of Surgeries for Trans Women

Around half of trans patients choose to undergo breast augmentation, facial feminization surgery (FFS) (which involves a variety of procedures that make facial features appear more feminine) and the removal or reconstruction of genitalia.

Average Cost: $20,000–$50,000

Facial feminization surgery (FFS) may include:

• Genioplasty: Genioplasty uses surgical incisions inside the mouth to contour the chin for a softer, rounder shape.
• Cheek augmentation: Implants, fat transfers or fillers can soften the face to create a more feminine look.
• Brow lift: A brow lift raises the eyebrows for a shorter forehead, softer look, and enlarged appearance of the eyes.
• Tracheal shave: The neck bump created by thyroid cartilage is reduced in a tracheal shave.
• Lip lift or augmentation: Lip augmentation can be achieved with implants and fillers. A lip lift emphasizes the upper lip.

Here are some of the most common gender confirmation surgeries for trans women:

• Facial feminization surgery (FFS): This surgery may include genioplasty, cheek augmentation, brow lifts, tracheal shave and lip lift or augmentation.
• Breast augmentation/augmentation mammoplasty: Breast augmentation is one of the most common gender confirmation surgeries for trans women and nonbinary patients. It might involve saline or silicone implants or even fat transfers from other parts of the body.
• Vaginoplasty: In vaginoplasty, a surgeon uses skin grafts from another part of the body (usually the scrotum or abdomen) to create a vaginal canal. The surgeon also uses existing genital tissue to create a clitoris. This allows most patients to have penetrative intercourse.
• Orchiectomy: An orchiectomy is often a transfeminine patient ’s first gender affirmation surgery. It involves the removal of the testicles.
• Vulvoplasty: A vulvoplasty involves the external part of the vagina rather than the vaginal canal. Skin from the patient’s genitalia is used to create a vaginal opening, the inner and outer labia, a clitoris and an opening that allows the patient to urinate.

Additional Alternatives

Some trans women undergo voice feminizing therapy to adapt their voice to their gender identity. In voice feminizing therapy, vocal cords are surgically altered to raise the patient’s vocal pitch.

Some trans patients might also choose to undergo gender confirmation surgery in the form of body contouring procedures. These might include liposuction or abdominoplasty as well as implants in the calves, buttocks or other areas.

In the U.S., it is illegal for most public and private health insurance providers to discriminate against transgender patients or deny them transition-related care. However, trans patients may still face financial and logistical barriers. Here’s what you should know about health insurance coverage and gender confirmation surgery.

Type of Barriers

Transgender patients still sometimes face health disparities and barriers to medical care, including transition-related medical care. These are some of the obstacles that trans and gender non-conforming people might face when trying to access healthcare and insurance coverage.

• Differences in state-by-state health insurance coverage: Each U.S. state has different policies regarding health insurance and trans-related care. Some U.S. states legally require health insurance providers to cover transition-related care while others do not.
• Difficulty accessing up-to-date and accurate insurance information: The language in health insurance plan summaries can be out-of-date or vague. This can lead to discriminatory denials of care.
• Discrimination and stigma: Discrimination against the LGBTQ community remains widespread, and transgender people may face health disparities and stigma in the context of medical care as a result, as well as other financial challenges . A 2015 study by the National Center for Transgender Equality revealed that about one-third of transgender patients said they were denied medical care or harassed by a medical provider.
• Lack of training and cultural competency among health providers: Some healthcare providers haven’t had adequate training in healthcare for transgender patients, which can lead them to make questionable decisions.

Additional Insurance Considerations

Transgender patients might also have questions about Medicaid coverage and Medicare coverage for gender confirmation surgery and other transition-related care. Both Medicare and Medicaid are prohibited from denying coverage of trans-related care if it is medically necessary.

The Veterans Health Administration (VHA) provides some coverage for transition-related medical care to transgender veterans . However, there is still an exclusion when it comes to coverage of gender confirmation surgery.

If you have insurance through your employer, you might be able to save up for your out-of-pocket surgery costs with a non-taxed Flexible Spending Account (FSA).

Ways to Navigate Health Insurance for Gender-Confirming Surgeries

It can be challenging to navigate health insurance coverage for gender confirmation surgery, but it’s not impossible. It’s important to know your rights as a patient when interacting with providers and finding the best health insurance plan for your needs. Here are some tips to keep in mind.

Stay informed

Remember that your health insurance plan should cover your transition-related care. Make sure that you read your insurance provider’s member handbook. Ask for the medical policy and any specific documents about eligibility for trans-related medical care to determine if you qualify.

Find a plan with no exclusions

Look for a health insurance plan that doesn’t have exclusions for either all transition-related care or specific kinds of treatments. You can often find this information in the medical policy.

Ask your current or potential employer about coverage

If you’re in the negotiation phase of a job interview, don’t be afraid to ask your potential employer about transition-related health coverage. If your current company or school doesn’t cover transition-related care, you might want to advocate for coverage.

Understand informed consent vs. WPATH standards

Before choosing a plan and care provider, find out about your potential provider’s ethical approach. An informed consent model of care allows you to make your own transition-related decisions after being informed of the risks by a physician. The WPATH standards of care might require additional steps, such as letters of support from therapists and other providers.

Look into pre-authorization

You'll need to see your primary care physician before requesting pre-authorization for surgery. It is also known as prior authorization. You might need to gather documents such as letters from medical providers before applying. Depending on the plan you selected, your primary care physician can provide you with a referral. Keep in mind that the referral or pre-authorization may not guarantee the surgery or other procedures will be authorized. National Center for Transgender Equality addresses common health coverage questions related to pre-authorization that may be helpful. It may be a good idea to speak with your health coverage provider directly.

Appeal denials

If you are denied coverage for a transition-related procedure, do not be afraid to appeal your insurance provider’s decision. Some exclusions might be prohibited or deemed discriminatory.

Outside of partial or full health insurance coverage, there are several other options for financing gender confirmation surgery, such as loans, lines of credit, grants and scholarships and fundraising.

There are several different personal loans you can use to fund your transition-related care.

• Bank or credit union loans: To qualify for a loan from a bank or credit union, you’ll need a good credit score and history.
• Family loans: If a family member can extend you a personal loan, consider creating a promissory note so that you have a repayment schedule in writing.
• Online loans: If your credit history is less than ideal, an online personal loan could be a good option.

Grants and Scholarships

Several organizations offer grants and scholarships to cover some or all of the costs associated with gender-confirming surgeries. These can help you avoid or offset any potential medical debt .

• The Jim Collins Foundation : The Jim Collins Foundation is dedicated to funding gender-confirming surgeries for trans people who need them. Grants are awarded on an annual basis.
• Genderbands Transition Grants : Genderbands offers transition grants to offset the expense of gender confirmation surgery for trans and nonbinary recipients.
• Rizi Xavier Timane Trans Surgery Grant : Rizi Xavier Timane, DSW, established a grant program to aid in the costs of gender-confirming surgeries for trans and nonbinary individuals.
• TransMission : The Loft LGBTQ+ Community Center’s TransMission is a small scholarship fund that helps trans and nonbinary recipients with medical, surgical and legal expenses.
• Stealth Bros & Co. Surgery Support Fund : The Stealth Bros & Co. Support Fund offers financial aid to trans men and transmasculine people for surgery, hormone therapy and related expenses.
• Black Transmen, Inc. Surgery Scholarship : Black trans men in the U.S. who have already been approved for surgery by a surgeon can apply for up to $1,000 in financial assistance.
• Point of Pride : Point of Pride offers scholarship-like funding for gender-confirming surgeries on an annual basis with a competitive application process each November.

Fundraising

Many people may raise funds for their gender confirmation surgery. For example, some throw parties with suggested donation amounts so friends, family and other supporters come together. Others raise money for their procedures by selling original art and letting would-be buyers know that they’re supporting a good cause.

Line of Credit

A home equity line of credit (HELOC) is one option if you own your home. With a HELOC, you can borrow against your home’s appraised value and repay it over time.

Certain surgeons partner with medical financing companies to help gender confirmation surgery patients make payments over time. You may want to check your credit score with a free report . Other surgeons allow patients to make smaller payments in installments.

Advocacy Organizations Making a Change

Many LGBTQ advocacy organizations are making a difference in the lives of transgender and gender non-conforming people every day. Here are just a few of the LGBTQ charities , nonprofits and other organizations making positive changes.

• The Sylvia Rivera Law Project : In addition to impact litigation advocacy, the Sylvia Rivera Law Project offers legal services and resources to aid people in their journey toward gender self-determination.
• Transgender Legal Defense & Education Fund : The Transgender Legal Defense & Education Fund is a nonprofit that fights for trans rights and against discrimination. The organization’s Trans Health Project helps transgender people access trans-confirming health insurance.
• Transgender Law Center : The Transgender Law Center is a trans-led advocacy organization that offers educational materials and other resources around healthcare, immigration, incarceration and employment.
• National Center for Transgender Equality : The National Center for Transgender Equality offers educational materials, self-help guides and other resources for the trans community.
• SPARTA : SPARTA is a nonprofit organization dedicated to transgender, nonbinary and gender non-conforming people serving in the U.S. military.

Expert Insight on Financing Gender Confirming Surgery

• What steps should trans, nonbinary and gender non-conforming employees take when navigating health insurance coverage for gender confirmation surgery?
• What are some other factors that employees should consider in terms of transition-related care and employer-provided health insurance?
• What are the most important forms of support a trans or nonbinary person can get from their employer?
• What are some of the most common financial barriers faced by trans, nonbinary and gender non-conforming patients when seeking transition-related care, including gender affirmation surgery?
• What are the steps a transitioning individual might take to financially prepare for gender affirmation surgery?

Additional Resources for Trans-Related Healthcare and Support

If you are a transgender or gender non-conforming patient seeking funding or support for your gender confirmation surgery, various resources can help. Here are some of the best resources available for trans people, loved ones and allies who want to know more about gender confirmation surgery.

• National Center for Transgender Equality's Know Your Rights : The National Center for Transgender Equality regularly updates its guide to existing and expanding legal protections for trans people in the U.S.
• HealthCare.gov's Transgender Health Care : The website helps explain what to know about applying for Marketplace health insurance coverage as a trans or gender non-conforming patient.
• HRC's Corporate Equality Index : Human Rights Campaign (HRC) publishes an annual guide to workplace policies and benefits for LGBTQ employees, including a list of companies that offer trans-inclusive benefits.
• Transgender Law Center's Transgender Health Benefits Guide : The Transgender Law Center offers a guide to healthcare advocacy for trans and gender non-conforming patients, including advice on what to do if you face discriminatory denials of care.
• Out2Enroll : Out2Enroll helps members of the LGBTQ community find and enroll in health insurance plans.
• Trans-Health.com's Trans Health Clinics : The clinics in this list specialize in transition-related and trans-confirming care and mental health support.

Social Support

• Transbucket : Initially started in 2009, Transbucket is an online resource and peer-to-peer support group exclusively dedicated to trans participants, primarily discussing gender confirming surgeries and medical transition.
• Gender Spectrum : Gender Spectrum hosts online support groups for trans, nonbinary and gender non-conforming youth, as well as parents and educators.
• Sam & Devorah Foundation for Trans Youth : The Sam & Devorah Foundation for Trans Youth connects members of the trans community with mentors who can offer emotional support and advice as well as empowerment and "building the confidence and skills critical for self-agency and leadership."

Mental Health Support

• The Trevor Project : The Trevor Project provides a number of resources, including suicide prevention and crisis intervention services, to LGBTQ people under 25.
• Trans Lifeline : The Trans Lifeline is a hotline offering peer-to-peer support services for trans callers, as well as their family, friends and allies.
• The Tribe, LGBTribe : The LGBTribe offers mental health support and wellness tools to LGBTQ participants.

About Laura Dorwart

• American Psychiatric Association . " What Is Gender Dysphoria ." Accessed May 27, 2021 .
• CostHelper . " How Much Does Sex Reassignment Surgery Cost ." Accessed May 30, 2021 .
• Current Opinion in Endocrinology, Diabetes and Obesity . " Barriers to Health Care for Transgender Individuals ." Accessed May 28, 2021 .
• European Association of Urology . " First accurate data showing that male to female transgender surgery can lead to a better life ." Accessed May 19, 2023 .
• First Report Managed Care . " Transgender Patients: Calculating the Actual Cost ." Accessed May 30, 2021 .
• Gender Confirmation Center . " Techniques, Incisions, & Surgery Options Facial For Feminization Surgery ." Accessed May 30, 2021 .
• Grand View Research . " U.S. Sex Reassignment Surgery Market Size, Share & Trends Analysis Report by Gender Transition ." Accessed May 29, 2021 .
• Jones, Jeffrey M. Gallup . " LGBT Identification Rises to 5.6% in Latest U.S. Estimate ." Accessed June 1, 2021 .
• Mount Sinai Center for Transgender Medicine and Surgery . " Trans-masculine (Female to Male) Surgeries ." Accessed May 30, 2021 .
• National Center for Transgender Equality . " U.S. Trans Survey ." Accessed May 26, 2021 .
• Planned Parenthood . " Sex and Gender Identity ." Accessed May 25, 2021 .
• The International Center for Transgender Care . " Facial Masculinization Surgery ." Accessed May 30, 2021 .
• UCSF Transgender Care . " Information on Estrogen Hormone Therapy ." Accessed May 29, 2021 .
• UCSF Transgender Care . " Information on Testosterone Hormone Therapy ." Accessed May 29, 2021 .
• University of Utah Healthcare . " Transfeminine Bottom Surgery ." Accessed May 30, 2021 .
• Williams Institute at UCLA School of Law . " How Many Adults Identify as Transgender in the United States ." Accessed May 27, 2021 .
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Gender Reassignment Surgery Cost (MTF & FTM)

Explore the rising demand for gender reassignment surgery worldwide. Learn about the various procedures and their detailed costs in this comprehensive article.

• Transgender Surgery

Gender reassignment surgery cost varies depending on the type of transition. 

• For male to female (MTF) transition, the cost ranges from $2438 to $6095 and  
• For female to male (FTM) transition, the cost falls between $4876 and $9752 .

When considering the cost of gender reassignment surgery, it's important to note that these figures encompass the surgical expenses alone. Additional costs, such as:

• pre-operative consultations
• post-operative care
• hospitalization may also be involved

For a precise cost estimate that aligns with your specific needs, it is highly recommended that you consult reliable healthcare providers or clinics.

Begin with clarity. Contact us for detailed cost insights now.

There are two broad types of gender reassignment surgery : top surgery and bottom surgery. The top surgery is performed for both people assigned female at birth (AFAB) and assigned male at birth (AMAB). 

• Male to female or non-binary (MTF/N): This procedure entails using saline or silicone implants to boost chest size and form for a more feminine or female appearance. Male-to-female top surgery is done under general anesthesia.
• Female to male or non-binary (FTM/N):  During FTM top surgery, breast tissue is removed and the chest is shaped to give the patient a flat, masculine, or male appearance. Following this, a nipple graft is planted to give a complete look .

Before we discuss each service's cost, let's take a quick look at overall transgender surgery costs in different countries.

You must be curious to know the gender change surgery cost of different surgical procedures. Let's read.

What is the Cost of Male-to-Female Top Surgery?

Breast augmentation or augmentation mammoplasty is another name for MTF and MTN top surgery. 

The MTF/N top surgery or breast augmentation surgery cost in India is around USD 1290 to USD 1940 . The surgeon's expertise and experience are two of the most critical aspects that affect the cost.

For the duration of the surgery, you will be put under general anesthesia. Your surgeon may choose different breast augmentation methods depending on your desired chest size, implant kind, and incision site. The average time for MTF and MTN top surgery is 1 to 2 hours .

The insertion cost and the implant cost are the two components of the surgery cost.

Navigating your options?  Contact us today for more information on cost!

What is the cost of female-to-male top surgery?

An FTM or FTN top surgery procedure takes from   1.5 to 4 hours . Various treatments are performed to get a more flat, masculine, or male-looking chest. Double incision, periareolar, and keyhole are the most popular procedures used by surgeons. 

The FTM top surgery cost ranges around USD 3870 .

Now that we have already discussed top surgery costs, let's take a look at how much mtf bottom surgery costs.

AFAB and AMAB people can undergo bottom surgery as part of their gender confirmation process. Bottom surgery involves transforming or reconstructing the bottom or genitalia. This involves Vaginoplasty, penile transplant , phalloplasty, and metoidioplasty.

What is the cost of male-to-female bottom surgery?

Vaginoplasty surgery is the major procedure performed in bottom surgery . There are three main options under Vaginoplasty. Penile inversion, non-penile inversion Vaginoplasty, and recto-sigmoid or colon graft.

The clitoris is moulded from the head/tip of the penis in all three surgical approaches. The Vaginoplasty cost is around USD 3870 to USD 4520.

Now, let's look at female to male bottom surgery cost.

What is the Cost of Female-to-Male Bottom Surgery?

This procedure involves the removal of the female organs in the lower region and reassigning them to male sexual parts. It includes removing the uterus, vaginal remodeling, labia reconstruction, metoidioplasty, and phalloplasty.

The whole procedure may cost somewhere around USD 5160 to USD 10,335 . 

To get a clearer picture of gender reassignment surgery cost, connect with us now .

What is the Cost of Facial Feminization Surgery?

Facial feminization surgery is a technique that involves changing your facial characteristics to make them appear more feminine. FFS is concerned with bone structure and nose shape. FFS is distinct for each person and can affect any part of the face or neck.

The facial feminization surgery cost is USD 1350 . 

What is Hormonal Replacement Cost?

Hormonal replacement therapy is for both MTF/N and FTM/N transitioning.

MTF/N: The hormones for a male-to-female transition enhance the alignment of your gender identity. It helps induce physical changes in your body produced by female hormones during puberty (gender congruence). Male secondary sex traits can be avoided if feminizing hormone therapy like progesterone is initiated before male puberty. The hormonal replacement therapy cost for MTF/N is USD 12/month.

FTM/N: You'll be administered the male hormone testosterone during masculinizing hormone therapy. It suppresses your menstrual cycles and lowers oestrogen synthesis in your ovaries.  The hormonal replacement therapy cost FTM/N is USD 7/month.

To make a more informed decision, talk to us today.

Factors affecting the cost of gender reassignment surgery:

• Hospital charges:  It depends on the type of hospital you choose. Moreover, the cost also depends on whether you are admitted to a general ward or a private room.
• Psychiatrist : If you need a psychiatrist to deal with your physical changes, your cost will impact you. A psychiatrist is recommended to understand better the complex procedures and adjustments you will need before and after your surgery.
• Clinical Experts and Surgeons : You will discuss the specifics of your gender change surgery with your doctor. It includes an assessment of your medical health status, discussing your long-term gender confirmation goals, and evaluating which procedures may be most appropriate to assist you in your journey. You can ask for specific details such as risks, benefits, and what to expect from the surgery.
• Medical Insurance:  Your medical insurance will play an essential role in the procedure, saving you a lot of money.
• Accommodation Charges:  The accommodation charges are included for international patients.
• Medication charges : These charges include all the medication you will receive before and after the procedure ends.
• Pre- and Post-treatment charges:  The pre-treatment charges include doctor consultation fees, diagnosis charges, etc. The post-treatment charges may include medicine costs, doctor's revisit charges, etc.

Your health is too important to ignore –  schedule your appointment now.

Do Insurance Companies Cover Gender Reassignment Surgery?

Yes, insurance companies that cover gender reassignment surgery! There is no legal prohibition for that. Not all employers provide insurance coverage to unmarried or live-in partners of straight employees. But, several organizations nowadays provide medical insurance to their employees' same-sex partners, including coverage for gender-reassignment surgery.

Some independent companies have made it a goal to try and incorporate this coverage into their medical insurance for employees.  

Note: This article is on the cost of gender reassignment surgery, and data about it is only for your informational purposes and is subject to change.  

1. Side effects of gender reassignment surgery

• Infections.
• Side effects of anesthesia.
• Difficulty in urinating.
• Severe complications in intestines.
• Leakage of urine through openings.
• Closure of vaginal opening.

2. Who typically undergoes gender reassignment surgery?

Gender reassignment surgery is typically undergone by individuals who experience gender dysphoria, a condition where an individual's gender identity does not match their assigned sex at birth. It is usually recommended as a last resort after other treatments such as therapy, hormone therapy, and social transition have been tried.

3. What are the types of gender reassignment surgery?

The two main types of gender reassignment surgery are "top surgery," which refers to surgeries that alter the chest and breast area, and "bottom surgery," which refers to surgeries that alter the genital area. Top surgery may involve a mastectomy, breast augmentation, or breast reduction. Bottom surgery may involve genital reconstruction, orchiectomy, metoidioplasty, or phalloplasty. 4. Do the costs vary for different types of gender affirmation procedures? Yes, the cost can vary based on the specific surgeries involved, such as chest or breast augmentation, facial feminization, or genital reconstruction. References: 

https://my.clevelandclinic.org/

Dr. Josef Hadeed Plastic Surgery | Beverly Hills & Los Angeles (josefhadeedmd.com)

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Market research reports, consulting: Global Market Insights Inc. (gminsights.com)

Transgender surgery – Knowledge gap among physicians impacti... : Current Urology (lww.com)

https://jamanetwork.com/journals/jamasurgery/fullarticle/2779429  

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Question and Answers

48! yaşında bir erkeğim trans birey olarak kadın olmak istiyorum Hormon tedavisi istiyorum. Hangi ilaçlardan başlamalıyım

For someone who is 48 years old and seeking to transition from male to female, it's important to consult with an endocrinologist before starting any hormone therapy. They will guide you on the appropriate medications and dosages based on your specific needs. 

Answered on 2nd Aug '24

Dr. Vinod Vij

if I have top surgery without T can I develop pecs if I hit the gym a lot?

If you don't take testosterone or undergo top surgery, you can still build your pecs by lifting weights. Pecs, short for pectoral muscles, can grow with exercises like chest presses and push-ups, which target these muscles. Pace yourself, use the correct form, and be consistent with your workouts. Your pecs can still develop even without testosterone.

Answered on 29th July '24

I'm male and would like to know how to grow breasts without HRT?

Hormones and surgery are the only ways of growing breasts safely. The appearance of women's breasts in some regions is partly dependent on hormones during puberty and pregnancy. Trying to get a larger breast by force can cause some serious medical issues. If you are worried about your body, it's important to talk to a plastic surgeon for safe and honest guidance.

Answered on 19th July '24

I am a 32 years old male who has got into cross dressing some 8 years back, now my urge of being like this has grown, last two years I have been I’m eating dian35 prescribed by a doctor in Malaysia, but now I believe I shall be needing more strong dose since the transformation is already 2 years and can see few changes

It seems like you may be going through some changes about turning into the opposite sex. Understand that these changes are complicated and might need some medical interventions. You might require different amounts of hormones to help you through the process. Talk about what is bothering you and your symptoms with a doctor who can help you figure out the best way forward.

Answered on 18th July '24

Namaste , I am a transgender and I am feeling desperate about my facial hair and tried many ways to reduce facial hair but my hairs are growing continuously. I want to know solution

For transgender individuals, hormone therapy can often help reduce facial hair growth. It's important to consult with an endocrinologist , who specializes in hormone-related conditions, for personalized advice and treatment options. They can guide you on the best course of action tailored to your needs.

Answered on 10th July '24

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Health Reporting in the States

Bill of the month: a plan for affordable gender-confirmation surgery goes awry.

Emmarie Huetteman

Wren Vetens was promised a significant discount on the cost of her gender-confirmation surgery if she paid in cash upfront, without using her health insurance. Yet afterward, Vetens received an explanation of benefits saying the hospital had billed her insurer nearly $92,000. Lauren Justice for KHN hide caption

Wren Vetens was promised a significant discount on the cost of her gender-confirmation surgery if she paid in cash upfront, without using her health insurance. Yet afterward, Vetens received an explanation of benefits saying the hospital had billed her insurer nearly $92,000.

Wren Vetens thought she'd done everything possible to prepare for her surgery.

She chose a doctoral program in physics at the University of Wisconsin-Madison, a school that not only embraced transgender students like her, but also granted insurance coverage for her gender-confirmation surgery when she enrolled in 2016. When uncertainty over the fate of an Obama-era anti-discrimination rule allowed the state to discontinue such coverage, Vetens and her mother, Kimberly Moreland, an OB-GYN, shopped for another plan.

Deducing the procedure would run from $19,000 to $25,000, based on prices posted online, they purchased insurance from Consolidated Health Plans. It would pay a maximum of $25,000 for the operation.

With that information in hand, Vetens planned ahead: She got her insurer's preapproval and scheduled surgery during winter break of her second year, allowing time for recovery before returning to her studies.

Tell Us Your Billing Story

Do you have a medical bill or explanation of benefits that you'd like us to see? Submit it here and tell us the story behind it .

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So, she was shocked when a hospital representative called her a couple of months before the long-awaited surgery estimating the bill would be $100,000. That meant she would be on the hook for as much as $75,000 after her insurer's $25,000 payout.

With preparations for the surgery well underway, Vetens was feeling overwhelmed with stress. "There were days when I just couldn't get out of bed for a whole day," she said, describing two weeks of panic attacks.

After mother and daughter complained about the last-minute surprise, a hospital representative offered a solution: If they paid out of pocket and in full before Vetens' surgery — forgoing their use of insurance — the hospital would accept just $20,080, assuring them the hospital would charge nothing to Vetens' insurer. But if they did not decide and pay up right away, the surgery would be canceled.

"I certainly felt that I had no choice," Vetens said.

After Moreland gave the hospital her credit card number for payment, they thought the financial roller coaster was over and Vetens could focus on recovery.

Then the bill came.

Patient: Wren Vetens, then 23, a Ph.D. student at the University of Wisconsin-Madison

Total bill: $91,850.20

Insurance payment: $25,427.91

Vetens owed: $13,191.95 (after $20,080 that was counted as a deposit)

Service provider: University of Wisconsin Hospital in Madison

Medical treatment: Vetens underwent a procedure known as penile inversion vaginoplasty to address her diagnosis of gender dysphoria, a condition resulting from one's sex identified at birth being in conflict with one's gender identity.

The procedure, in which the patient's penile and scrotal tissue is used to create a vagina, generally takes about two to four hours and requires a short inpatient stay, according to Dr. Madeline Deutsch, the medical director for transgender care at the University of California, San Francisco.

Candidates for the procedure must live for at least one year in their identified gender role and undergo at least one year of hormone therapy, Deutsch said. Preparation also includes permanent hair removal.

What gives: Though gender dysphoria is relatively uncommon, many of the billing and insurance issues Vetens encountered are typical for patients planning major surgery. Much of her stress and frustration arose from the vast difference between online price estimates ($19,000-$25,000), the hospital's billed price to the insurer ($91,850) and what it was willing to accept as an upfront cash payment ($20,080).

Hospitals set list prices high because insurers with whom they have contracts typically negotiate them down. In exchange for charging an insurer's members a lower price, doctors and hospitals gain access to those customers, who have incentives to use these in-network providers. Hospitals may offer package deals for procedures to patients, if they pay cash upfront, in part because the hospital avoids the hassle of negotiation.

Officials at University of Wisconsin Hospital said they offered Vetens the option to pay $20,080 for these reasons: to secure extra experience and exposure for the hospital's programs for transgender patients, and to shield Vetens from an even bigger bill. "We were trying to protect the patient," said Dr. Katherine Gast, Vetens' surgeon.

Dr. Kimberly Moreland (left) helped her daughter shop for an insurance plan that would cover Vetens' gender-confirmation surgery. Yet mother and daughter still found themselves caught between the hospital and the insurer. Courtesy of Richard Malatesta/Kimberly Moreland hide caption

Dr. Kimberly Moreland (left) helped her daughter shop for an insurance plan that would cover Vetens' gender-confirmation surgery. Yet mother and daughter still found themselves caught between the hospital and the insurer.

As both parties hedged their bets in trying to determine what a penile inversion vaginoplasty was worth, Vetens was stuck in the middle with the prospect of hugely varying payments.

Lisa Brunette, a hospital spokeswoman, said that, despite having provided Vetens an estimate of $100,000, the hospital really did not know how much it would charge for the procedure because it did not know how much it would be reimbursed by the insurance company. Vetens was the second person to have the procedure at the hospital.

The spokeswoman for the hospital said its contract with Vetens' insurer "relies on a complex formula."

And in an apparent chicken-and-egg quandary, Drew DiGiorgio, president and chief executive of Consolidated Health Plans, said the insurer did not know how much it would reimburse because it did not know how much the hospital would charge.

When Moreland called the hospital to pay the $20,080 price — an option she acknowledged many simply could not afford — she asked for an itemized bill.

The next day, she received a brief letter outlining some of the general services included for the price, such as "physician's fee" and "post surgery labs." Then it simply said: "Penile Inversion Vaginoplasty — $20,080.00."

"How in the world did you come up with a number if you have no idea what it covers?" she asked.

Had Vetens chosen a hospital that did not contract with her insurer, the family could have been reimbursed 60 percent, or about $12,000 of the money paid, since her insurance pays a portion of out-of-network care.

But since Consolidated Health Plans has a contract with the University of Wisconsin Hospital, it said it would not reimburse anything at all. Contracts between insurers and providers discourage such sideline cash transactions, since hospitals can make more money when patients use insurance, as evidenced by Vetens' bill.

Vetens and Moreland appealed to Consolidated Health Plans, feeling that they had been "the victims of a bait-and-switch scam."

The surprises didn't end there. Though multiple hospital representatives reassured Vetens that they wouldn't charge her insurance after her cash payment, Vetens received an explanation of benefits saying the hospital had billed her insurer nearly $92,000.

A hospital bill followed, identifying their $20,080 as "pre-payment," treating it like a partial deposit. Vetens owed more than $13,000, it said.

Studies have shown that more than half of hospital bills contain errors , a problem made worse by the fact that medical bills — with codes and jargon — can be nearly impossible for even savvy patients to understand.

"That was not supposed to happen. That was an error," said Abby Abongwa, a hospital billing official. "That was absolutely an error on our part."

Resolution: After the bill for $91,850 arrived, an alarmed Vetens showed it to her surgeon. The hospital quickly apologized and repaid her insurance company.

Within a few weeks of receiving the appeal — which noted that Vetens and Moreland had contacted a national media outlet — Consolidated Health Plans reimbursed Vetens nearly $18,000, offering her no explanation for why the company had ultimately decided to reverse its earlier judgement that it would not pay anything toward her care.

With their reimbursement, Vetens and Moreland paid about $2,100 for the surgery, all told.

The Takeaway: Be mindful that online pricing estimates frequently represent cash prices, which are often far lower than the price hospitals will bill your insurance.

Ask about a cash price — you may get a better deal. But if you forgo insurance, you're on your own. Your insurer is under no obligation to pay you back for any part of the bill or help you troubleshoot billing, and any payment you make likely will not count toward your deductible.

Enlist your doctor's help. Gast, Vetens' surgeon, proved a powerful advocate for her patient when disputes arose about billing and pricing. Billing representatives might not always be responsive to patients, but it's in the hospital executives' interest to keep staff surgeons happy.

Some of these issues can be settled only through legislation. Right now, there is no legal requirement for hospitals to provide itemized bills to patients. Hospital bills are fraught with errors, and there is little accountability for providers who bill erroneously.

In the meantime, don't be afraid to ask questions and fight back.

Bram Sable-Smith, who contributed to the audio story, is part of NPR's reporting partnership with Side Effects Public Media, member station KBIA and Kaiser Health News.

Kaiser Health News is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation that is not affiliated with Kaiser Permanente.

You can follow Emmarie Huetteman on Twitter: @emmarieDC .

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Gender Transition Cost — How Much Does Hormone Therapy and Gender Reassignment Surgery Cost?

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 Changing Your Gender

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.

Gender Reassignment 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

How much does testosterone cost.

• 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

How much does estrogen cost.

• 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.

How Much Do Anti-Androgens Cost?

• 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 Feminization Surgery (FFS) Surgery Cost

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.

FtM 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.

Gender Reassignment Surgery Cost

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.

Male to Female 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.

Female to Male Surgery

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. Minorities in general may be more likely to work in jobs that only pay minimum wage . 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. If you aren’t sure of your credit history, Experian offers free credit score and credit report checks. 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.

Fact Check: Walz Did NOT Approve Legislation That Overrules Existing Protocols On Age For Gender-Affirming Surgeries

• Aug 9, 2024
• by: Uliana Malashenko

Did Minnesota Gov. Tim Walz sign a bill "allowing gender reassignment surgery for children"? No, that's not true: No state law sets a specific minimum age for gender-affirming surgical interventions, a Minnesota lawmaker told Lead Stories. Major health care providers do not operate on people under 18. One bill signed into law protects youth access to those services discussed in broad terms, but doesn't address a specific age.

The claim reproduced a frequent misconception about gender-affirming care: It ignores that such care is not limited to surgeries and includes many other treatments such as mental health services, puberty blockers and hormone therapies.

The claim appeared in a post (archived here ) on X, formerly known as Twitter, on August 6, 2024, by @BRICSinfo. It said:

Tim Walz, the VP selection for Kamala Harris, signed a bill allowing gender reassignment surgery for children and a bill requiring schools to stock tampons in boys' bathrooms. Donald Trump says he will ban gender reassignment surgery for children in all 50 states.

This is what the post looked like on X at the time of writing:

(Source: X screenshot taken on Wed Aug 7 15:37:05 2024 UTC)

What are the laws?

Rep. Leigh Finke (archived here ) who sponsored several key bills concerning gender-affirming care in Minnesota, told Lead Stories via email on August 8, 2024:

No law in Minnesota has been passed addressing the age of receiving gender affirming care, including surgery. We simply protected access to gender affirming care as it already existed for those who require it ... Standards of care in Minnesota follow the national and international guidelines for gender affirming care. Like all heathcare decisions, gender affirming care is highly personal and individualized. Families, patients, and doctors are best able to make those decisions, not the government. Minnesota's largest providers of gender affirming care do not perform any surgeries on individuals under 18.

Neither legislation about youth transgender health (archived here ), sometimes referred to as the "trans refuge" law (archived here ), nor the Governor's Executive Order on "Protecting and Supporting the Rights of Minnesota's LGBTQIA+ Community Members to Seek and Receive Gender Affirming Health Care Services" (archived here ) contains any provisions overriding existing medical protocols or sets a specific minimum-age bar for what the post called "gender reassignment surgery."

Both pieces of legislation went into effect in 2023. They discuss gender-affirming care in general terms to ensure that those who need care recognized as medically necessary (archived here ) by the Centers for Disease Control and Prevention, can safely access it.

Neither define such care exclusively as surgery. In reality, gender care can be many other things (archived here ). The transgender refuge law doesn't even explicitly mention surgical interventions -- it focuses on mental health services and other aspects of gender-affirming care.

Finke, a member of the Minnesota Democratic-Farmer-Labor Party, added:

In 2024, I carried a bill to require gender affirming care coverage among certain health care plans in the state of Minnesota. This law also did not address standards of care, including age. At no point has Minnesota legislature in the past two years passed legislation to change the standards of gender affirming care--including the age at which surgery could be conducted-- in Minnesota.

In June 2023, the Minnesota Reformer news website reported (archived here ) that "most medical centers require individuals to be at least 18 years old for bottom surgery and chest, or 'top,' surgery."

In the spring of 2024, as Minnesota's gender care legislative actions made the news, Dr. Angela Kade Goepferd, chief education officer and medical director of the Gender Health program at Children's Minnesota, told MPR (archived here ), a local public radio station, that the state does not perform gender-affirming surgeries on patients under 18 years old.

Lead Stories searched Minnesota statutes, laws and rules , but did not find anything that would explicitly set a minimum age for gender-affirming surgeries.

What are the surgeries?

" Gender (or sex) reassignment surgery " (archived here ), as the post on X calls it, is an outdated term (archived here ). It was once used primarily to refer to the medical interventions that change a person's genitalia.

The World Professional Association for Transgender Health (WPATH) manual (archived here ) -- one of the most authoritative sources of evidence-based gender care recommendations -- suggests on page 59 the term "gender-affirming surgeries," instead, . The current term incorporates several more interventions, and not all of them concern genitalia or the chest area, according to the appendix , attached to Chapter 13.

The newer term and its definition are consistent with the wording used by Minnesota's Department of Human Services (archived here ).

Who counts as a child?

In Minnesota, a child, or a minor, is any person younger than 18 (archived here ). After that, a person is generally considered an adult for many legal purposes. Though certain restrictions are still applicable (archived here ), that does not include required parental consent when it comes to health care (archived here ).

For gender-affirming care, however, "child" is not a blanket term for anyone under 18: People go through several developmental stages between birth and adulthood, and health care professionals consider that while deciding what is appropriate and medically necessary.

For example, the WPATH guidelines (archived here ) differentiates between children, pubescent youth and adults, as seen on page 67:

Unlike pubescent youth and adults, prepubescent gender diverse children are not eligible to access medical intervention (Pediatric Endocrine Society, 2020); therefore, when professional input is sought, it is most likely to be from an HCP [health care professional] specialized in psychosocial supports and gender development.

While WPATH suggests that there might be some benefits if vaginoplasty is performed before the age of 18, that appears to offer some flexibility -- not a blanket recommendation. At the same time, the organization still strongly advises against phalloplasty before that age.

The Minnesota Department Human Services (archived here ) prohibits one particular surgery -- phalloplasty -- before 18. In any case, the agency requires authorization for any other gender-affirming surgery, listing additional requirements for those younger than that age.

Trans youth and genital surgeries

Lead Stories was not able to locate any Minnesota-specific data about gender-affirming surgeries performed on people under 18, but available national statistics confirmed that genital surgeries in that age category are incredibly rare.

For example, a 2022 Reuters story (archived here ), citing an analysis of insurance claims for roughly 330 million U.S patients over five years, reported that:

The Komodo analysis of insurance claims found 56 genital surgeries among patients ages 13 to 17 with a prior gender dysphoria diagnosis from 2019 to 2021.

A 2023 study (archived here ) published by the American Medical Association's JAMA Network Open, a peer-reviewed medical journal, read:

... breast and chest procedures made up a greater percentage of the surgical interventions in younger patients, while genital surgical procedures were greater in older patients.

A 2024 article in JAMA Network Open (archived here ) found that among minors who had gender-affirming surgeries in 2019, 96.4 percent -- or 82 out of 85 cases -- were chest-related procedures, not genital surgeries.

Lead Stories contacted Minnesota Gov. Walz about the claim that is the target of this fact check. If we get a response, the article will be updated as appropriate.

About @BRICKinfo

The same account on X that posted the claim that is the focus of this fact check previously published a misleading statement about President Joe Biden before he dropped out of the presidential race. Lead Stories debunked it here .

Further reading

Lead Stories previously debunked false claims about transitions in toddlers here . Other Lead Stories fact checks concerning claims about transgender issues can be found here . Fact checks of claims about the 2024 U.S. presidential election are here .

Uliana Malashenko is a  New York-based freelance writer and fact checker. Read more about or contact Uliana Malashenko

Lead Stories is a fact checking website that is always looking for the latest false, misleading, deceptive or inaccurate stories, videos or images going viral on the internet. Spotted something? Let us know! .

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Ohio judge rules ban on health care for transgender minors can take effect, appeal expected

A Franklin County judge ruled Tuesday that Ohio's ban on gender-affirming care for transgender minors can take effect immediately.

Franklin County Court of Common Pleas Judge Michael Holbrook rescinded an earlier restraining order temporarily blocking the law , which also bans transgender girls from participating in female sports. The American Civil Liberties Union of Ohio plans to appeal the decision.

Holbrook, a Republican, ruled that Ohio's new ban doesn't violate the Ohio Constitution's health care freedom amendment or an Ohio law requiring legislation be limited to a single subject.

"The court finds the health care ban reasonably limits parents' rights to make decisions about their children's medical care consistent with the state’s deeply rooted legitimate interest in the regulation of medical profession and medical treatments," Holbrook wrote in his order.

The Ohio law prevents doctors from prescribing hormones, puberty blockers or gender reassignment surgery for patients under 18.

The American Civil Liberties Union of Ohio sued the state on behalf of two Ohio transgender girls and their families, saying the law violates their right to choose their health care under the Ohio Constitution. Holbrook  temporarily blocked the law  in April.

The ACLU of Ohio argued that puberty blockers and hormone therapy are safe and effective approaches for treating gender dysphoria. Gender dysphoria refers to the distress a person feels when their gender identity does not match their assigned sex. 

The Ohio Attorney General's Office argued that gender dysphoria should be addressed solely through mental health interventions.

Ohio Attorney General Dave Yost applauded Holbrook's decision. 

"This case has always been about the legislature’s authority to enact a law to protect our children from making irreversible medical and surgical decisions about their bodies," Yost spokeswoman Bethany McCorkle said. "The law doesn’t say 'no' forever; it simply says 'not now’ while the child is still growing."

Freda Levenson, legal director at the ACLU of Ohio, called the decision devastating and a genuine setback.

“This loss is not just devastating for our brave clients, but for the many transgender youth and their families across the state who require this critical, life-saving health care," she said in a statement. "While this decision by the court is a genuine setback, it is not the end of the road in our fight to secure the constitutional rights of transgender youth, as well as  all Ohioans’ right to bodily autonomy."

Read the decision here:

Ruling on transgender healthcare bill by Jessie Balmert on Scribd

Erin Glynn is a reporter for the USA TODAY Network Ohio Bureau, which serves the Columbus Dispatch, Cincinnati Enquirer, Akron Beacon Journal and 18 other affiliated news organizations across Ohio.