Financing & Support for Gender Confirmation Surgery

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 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.

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.

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.

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.

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.

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.

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.

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).

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.

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.

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.

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.

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.

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.

• 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."

• 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.