- Many transgender people seek medical treatments such as breast augmentation to align their bodies with their gender identities.
- Doctors say these procedures can help alleviate emotional distress linked to suicidal thoughts, but some patients can’t access them in the US because of the cost.
- About 14% of transgender people are uninsured, but even those who have insurance are often left with enormous bills because some public and private insurance providers have exemptions in their policies for certain transgender-related procedures.
- Insurance providers also categorise many surgeries like facial feminization as cosmetic and won’t pay for them.
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Following is a transcript of the video.
Claire: I probably have spent upward over $US200,000, maybe $US300,000, in just medical. It is expensive just to try to be yourself.
Narrator: Claire is among the estimated 1.4 million transgender people living in the US, where even patients with health insurance can face six-figure bills. There are surgeries like top and bottom, which can cost over $US50,000 each, hair removal, which costs hundreds of dollars a month, and a slew of other expenses that most Americans never have to think about.
Lex: Let’s really dig into it. So, like, let’s talk about surgical binders that you might need coming out of surgery. Let’s talk about…
Lex: Prosthetics, let’s talk about clothing that is comfortable, time off.
Lex: Yeah, it’s so many expenses…
Garnet: Who’s going to take care of you when you can’t work.
Narrator: The reality is that being trans comes with all kinds of costs. If you’re trans, your gender identity doesn’t match your gender recorded at birth. And this can lead to a form of emotional pain commonly called gender dysphoria.
Garnet: It feels like you’re trapped in a flesh prison. Just extreme discomfort, almost self-hatred. [Narrator] For decades, doctors tried to alleviate dysphoria through counseling. But it was…
Dr. Joshua Safer: An abysmal failure. We have suicide attempt rates of 40% among transgender people. And so we know that that’s a failed strategy.
Narrator: And that left doctors with two strategies…
Safer: Changing the brain to match the rest of the body, or changing the body to match the brain.
Narrator: And when you think about it…
Safer: It becomes pretty clear that the mucking around in your brain is gonna be the more invasive thing.
Narrator: So people like Garnet, Lex, Claire, and Emmett opt for strategy two: changing their bodies to match their brains. This process is complicated, long, and sometimes painful. But for many trans people, it works.
Claire: Being able to transition literally saved my life. My worst day, me, now, as transitioning, is better than my best day I ever had in my old life, when I presented male. I’m able to walk out this door and just be able to exist without fear, without compromise.
Narrator: But that doesn’t mean everyone can afford these procedures.
Claire: And it becomes this to the point where you can drown in debt from it.
Narrator: How much you pay for healthcare largely comes down to insurance: whether you have it, and what it covers. An estimated 14% of trans folks are uninsured. And for them, a single gender-affirming surgery like vaginoplasty can cost over $US50,000. But even if you do have insurance, you might still have to pay for care out of pocket. That’s partly because some insurance plans simply don’t cover trans-related surgeries. Even though that’s illegal in virtually all cases under anti-discrimination laws. But there’s another reason, and it’s that many insurers don’t consider certain procedures, like facial feminization or breast augmentation, “medically necessary.” They call them “cosmetic” instead, and “cosmetic” tends to be code for “out of pocket,” which is partly why people like Claire end up having to empty their savings.
Claire: They just came down with a hard no. “It is cosmetic.”
Narrator: That was in 2019, when Claire tried to get insurance to cover a scheduled breast augmentation.
Claire: Which now means that if I want to get that procedure, which I feel I need just so I can feel more comfortable with myself and just to be able to stand in the mirror and look at myself, now I’m gonna have to pay out of pocket for that procedure, and that procedure ranges anywhere between $US12,000 and $US18,000.
Narrator: And Claire, she’s just one of many. In one survey, 55% of trans people reported being denied coverage for gender-affirming surgeries. And that has consequences that extend beyond financial and emotional stress.
Safer: Let’s just say, for example, facial feminization surgery for a transgender woman, that might be a very necessary surgery. But if a significant point for that individual is to be able to walk down the street and be treated appropriately according to her gender identity, then having a feminine face is gonna be enormous both for how she’s treated and, frankly, for safety.
Narrator: And even if insurance does cover your procedures, there are plenty of other expenses that most people never have to think about. If you’re a trans man, for example, you could invest hundreds of dollars in binders.
Lex: Let’s talk about binders, right? It’s this thing that you put on so that you can bind your chest and so that your chest is not so visible. So for a lot of transmasculine-identified folk or trans men, it’s super important to, like, not have your chest visible. Also it’s, like, a matter of safety, because I could be well into my transition, and I still have my chest that can, you know, sort of, like, out me. Each binder could cost, like, $US40.
Narrator: And then there are packers, prosthetic penises, which can cost hundreds of dollars each.
Lex: You know, cis guys don’t have to pay for their penises, right? So.
Emmett: They get it for free.
Lex: Yeah, it comes with the package, you know, whether you like how it looks or not.
Narrator: Trans women, on the other hand, have a different list of expenses. Claire: So the most expensive thing for a trans woman is hair removal.
Narrator: Especially if you do electrolysis.
Claire: It’s about $US75 to $US150 per session, just for your face. And you can be doing this for anywhere between three to seven years.
Garnet: Yup. Claire: Just to get a reduction.
Narrator: And then there’s something that both trans men and women have to buy.
Emmett: Because my body changed so much when I started hormones, like, I grew out of my clothes.
Lex: Oh yeah.
Emmett: So I had to basically buy a whole new wardrobe.
Narrator: So that’s just it. Even without medical procedures, trans people might spend thousands of dollars just to be themselves. And unfortunately, many of them don’t have that kind of money to spend. The unemployment rate in the trans community is about three times higher than the national average. Plus, nearly a third of all trans people, including Lex, report being homeless at some point in their lives. And the Trump administration may be making these issues worse. In 2017, Trump announced a ban on trans troops serving in the military, which is, of course, a form of employment. And in 2019, the administration wrote new rules that will make it easier for healthcare providers to deny treatment for trans people if it violates their religious or moral beliefs. But that’s not to say the US hasn’t made any progress. In 2002, for example, 0% of Fortune 500 companies offered trans-inclusive healthcare coverage, while today nearly two-thirds of them do. And a number of states, like New Hampshire, have enacted various pro-trans laws. But no matter how the US continues to change, for better or worse, there’s at least one thing that seems to always stay the same, and that’s the unshakeable resilience of the trans community.
Emmett: Trans people are beautiful. Trans people are resilient. We’ve existed for a long time. We’re gonna keep on existing. That’s what we do.
Garnet: Oh my God, hugs!
Lex: Wait, wait, wait.
Claire: So this was awesome.
EDITOR’S NOTE: This video was originally published in July 2019.
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