Transition process full of surprising costs for transgender men and women

[Contestants apply makeup backstage before the Miss Tiffany's Universe transgender beauty contest on May 2, 2014 in Pattaya, Thailand. Beyond surgery, transmen and transwomen have many additional costs they incur, from the clothes and beauty supplies, to the expenses related to name and legal gender changes. (Photo by Taylor Weidman/Getty Images)]

Stef Sanjati is a 20-year-old Toronto-based makeup artist and YouTube star who is chronicling her male-to-female transition through candid, funny, and somewhat addictive short video updates. Within the next year, she hopes to travel to Boston for facial feminization surgery and expects expenses for the trip and procedure to reach $45,000. Because she only has $5,000 in savings, she has turned to the crowd-funding platform GoFundMe for the rest.

On her GoFundMe page, Sanjati explains how the expensive procedures will change her life more than physically: “These surgeries are about feeling like you, every day, when you wake up in the morning - before cinching, pulling, and covering every inch of your body with body shapers, tape, and cosmetics. They're about recognizing yourself in the mirror, and feeling like living, going outside, is possible, and not something to dread.”

For Canadians unfamiliar with the practical challenges of being transgender, Sanjati’s campaign might be confusing at first: sexual reassignment surgery, or gender affirmation surgery, as it’s also known, is covered by most provincial health care plans. But facial feminization and breast implants for transwomen are not. Neither is chest contouring or scar removal after a mastectomy for transmen. The surgeries that are covered have long wait lists. And the combination of high costs for certain surgeries and lengthy delays for others can be extremely burdensome. Then there are costs for medications, clothes, therapy, legal fees, and more.

Sanjati tells Yahoo Canada Finance she expects the total cost of her transition to be about $100,000.

“It’s like the cost of a house in a small town,” she says.

The fact is, transitioning in Canada is a daunting ordeal, despite recent positive developments in the Trans rights movement. For a population that’s already under or unemployed at higher rates than other groups, and that sees much higher rates of suicides among teens and adults, unmanageable expenses can be a dangerous trigger. “The people you see on the news and in the public sphere are the privileged people,” says Mickey Wilson, Executive Director of Pride Centre of Edmonton. “Their stories do not represent the lives of most people.”

Costs aren't the same for everyone

It’s impossible to put a single figure on the price of transitioning, because, as Wilson explains, the costs all depend on where someone wants to end up on the spectrum. For some, transitioning might mean simply changing one’s name and pronoun and letting family and friends know about their new identity. Others may choose top surgery to remove breasts or to acquire implants. Some transwomen may want to have a tracheal shave to reduce the size of their Adam’s apple, while others will opt for orchiectomy (castration), but not a vaginoplasty.

“It’s like a cafeteria, you pick and choose what feels right so that you can feel true to your own needs,” says Andrea James, a writer, producer and trans rights advocate in Los Angeles who started the Transsexual and Transgender Roadmap website in 1996, when information for transgender teens and adults was scant. Her site grew to contain 1,300 pages and cover all the basics, though James stopped updating the information about surgery costs about 10 years ago, as other sources of information and insurance coverage became available online.

These days, many transgender people are choosing not to have bottom surgery at all, says James, because it’s expensive and no longer necessary to legally change your gender on a passport and birth certificate. Also, the pressure to “pass” as a man or woman has become less of an issue. To successfully transition now means to reach your own goals.

Still, the enormous costs attached to transitioning can mean that some people do not reach the full results they’d hope for.

New clothes: $2,000-$3,000 or more

One of the first costs of transitioning is the price of a new wardrobe. Transwomen face the steepest out-of-pocket costs in this category. “If you looked into your closet at everything you own right now — all your skirts, all of your blouses, dresses, all your clothes — and replaced them, what would that cost?” Wilson says. At least $2,000 to $3,000 to pull it off and look good, he estimates.

Transwomen also have to consider the price of proper undergarments, like bras or the breast forms to fill them. For tall transwomen, finding clothes and shoes that fit can be tough and for James, it has meant occasionally shopping in specialty stores.

Many LGBT centres organize swaps or donate important items, like clothes for job interviews, to those in need. Otherwise, the general advice is to stick with thrift stores and cheap fast fashion from national chain stores, and to invest in only a few key pieces, like boots, a winter coat, or a classic white dress shirt. (On Transgender community websites, those starting their transition are frequently warned not to sink too much into clothes, since a person’s shape changes drastically — as can one’s style preferences — during the first year of hormone therapy and post-surgery.)

Transmen who don’t opt for surgery, or are waiting for it, often choose to buy binders for their breasts, which run $50 to $100. Then there’s makeup, which can be hundreds of dollars, especially for brands that cover facial hair.

What transmen will need to spend on clothing usually depends on their job, says Wilson. He needed dress shirts, ties, and jackets for an office position when he made his transition nearly 20 years ago, but already owned jeans and t-shirts for casual wear.

Shayne Ivany, 28, who recently moved to Oshawa from Newfoundland, says plenty of friends gave him clothes when he started transitioning socially about five years ago. But some transmen also use strap-ons or “packers” (prosthetic penises) if they’ve chosen not to undergo surgery or while waiting for a treatment date. A realistic strap-on costs about $1,000, he explains, though a good packer starts around $80 and can run as high as $200.  

Since it takes time to build up a wardrobe, replacing accessories are often the easiest way for someone to start feeling better without spending a lot of money, so eyeglasses are often the first thing people swap out.

Hair removal and wigs: $10,000

Hair — whether added or removed — can be another money pit. “Facial hair is incredibly demoralizing for a transgender woman,” says Sanjati. She was lucky to find a Groupon deal that offered four laser hair removal treatments for the price of one: $1,500. Without such discounts, “I could see people easily spending $10,000-$15,000 on laser,” she says. “And then there’s the whole issue of whether the people at the laser place are going to be okay with transgender clients.”

Laser hair removal is cheaper than electrolysis and is a viable option for candidates with dark hair and light skin, James explains. For others, electrolysis is the only option; it runs about $100 to $200 per hour and most people require several hours.

Transwomen in the market for a wig can expect to pay at least $600 for one made with real hair, though many top brands sell for $1,000 or more.

Hormone therapy: Up to $300 per month

In Canada, the medications needed for hormone replacement therapy are usually entirely or partially covered through provincial health care plans or job benefits, but if not will cost up to $300 every month depending on the cocktail of drugs prescribed. Male hormones are typically much cheaper, about $60 per month without insurance. The younger you are when you start hormone therapy, the more you’ll save on certain surgical procedures and hair removal later.

Legal fees: $100-$500

Most people who transition want to make it official in the eyes of the government, which means paying for a legal name change, a new driver’s license, birth certificate and passport. Fees to change all of these things vary from province to province. Ivany moved to Ontario midway through his transition, but first changed his name in Newfoundland, where it cost $45. In Ontario, the same service is closer to $200, he says.

Some legal documents require a notary or a lawyer — and their accompanying fees — to be processed properly. “Transgender people often need to think about paying more for a lawyer to draw up a will that will ensure their family doesn’t bury them as the gender they were assigned at birth,” says James, “if the family never accepted the transition.”

Voice training, handwriting coaching: free

Fortunately, there are a few high-impact changes that can be inexpensive to adopt. Many people choose to use DVDs or YouTube videos for voice training, for example. Transwomen can practice moving the source of their voice from their chest to their head with concise lessons from Sanjati. Transmen usually find that hormone therapy alone will deepen their voices.

Handwriting may be a dying practice, but it’s still one of the most popular topics on James’s Road Map site. Several free online tutorials can teach a person how to practice making their penmanship more feminine (rounder and consistent) or masculine.

Travel and general upheaval: Costs vary

 

Beyond the price of surgical procedures, some Canadians need to pay for the travel associated with consultations, medical treatment, and lodging while in another province. For years, there has been only one clinic in the country, in Montreal, where bottom surgery is covered by government health insurance. Policies about travel costs are different in every province.

Most employer plans will pay for psychotherapy to deal with the emotional issues surrounding a transition, but typically limit coverage to five or six sessions, which can run $150 - $180 per hour, says Wilson.

“The other piece that no one ever thinks about is the time cost associated with all of this,” he adds. “All of these offices aren't open in the evenings and weekends, so you have to take time off work to get the appointments you need. Hourly paid employees can't get those wages back.”

Worse, transitions cost people their jobs all the time, says Wilson. “It's illegal, but there are a million ways you can get rid of an employee if you are going to start writing them up for every little thing they've done wrong. People often feel so much pressure, they just leave.”

If coming out leads to the end of a significant relationship, there may be expenses and time costs attached to moving out of a home and paying for a divorce, alimony and child support.

There are credit programs available to help pay for transitions, says James, “but you need money to get money. That old story.” Thus more people will instead try crowdfunding sites or in-real-life fundraiser parties. In the U.S., a t-shirt company called Point 5 cc (a reference to a common dosage for people on HRT) runs a binder and breast form donation program and maintains a surgery fund to offer financial support to those who can’t afford gender-affirming surgeries. To qualify, applicants need to get their surgery in the U.S., but do not need to live there.

Ivany and Sanjati both know friends who have turned to sex work to fund their transition, or to pay for daily living in general. “I’m all for people who choose sex work,” says Sanjati, “but some transgender people get cornered into it.”

“A lot of trans teens that come out end up kicked out of their houses,” Ivany explains. “There are a few shelters around that will take them, but you get into shelters that are female-only or male-only, and women’s shelters often don’t like to have transwomen.”

For all of these reasons, many argue that transgender-related surgeries of all types should be covered by insurance. “I don’t think people understand how necessary this treatment is,” says Sanjati. “There’s a big difference between I don’t like my nose and dysphoria. It’s hard to find an analogy because there’s nothing quite like it.”

Sanjati never expected her GoFundMe campaign to take off, but it has already raised nearly $25,000 in three months. For that, she considers herself lucky.