How Much Does It Cost to Medically Transition?

On an unassuming Tuesday at the Out offices, I found myself paging through old issues of the magazine as I procrastinated writing about whatever gender-reveal explosion or gay-baiting straight actor was on my docket for the day. As I browsed the catalog, a 2008 cover featuring Tilda Swinton's statuesque figure caught my attention. "TRANSGRESSIVE," read the cover line, which claimed that the celebrated actress was "PUSHING BOUNDARIES" and "BLENDING GENDERS." Sure, I thought to myself, Tilda has short hair and wears a lot of suits, and she's definitely one of Hollywood's great androgynous icons.

But then I noticed that another coverline proclaimed this volume to be the "Transgender Issue." And as far as I know, Swinton is cisgender. With a creeping feeling of dread, I paged through it, beginning to feel like I was having my own transgender issue. Pages in, I found a section called "The Money Shot," which would typically break down the cost of buzzy gay products. But this issue's focus was "The Cost of Trans."

The. Cost. Of. Trans.

Left eye twitching, I perused the package, which was devoted to breaking down the cost of different gender-affirming procedures. "$1,500 -- Trachea shave (or 178 Gillette razors)," read one item, next to a photo of the razor in question. Do cis people think a tracheal shave is like shaving your face, I wondered. Do they think that getting rid of your Adam's apple gets rid of your facial hair, too? The piece went on to deconstruct the cost of "breast implant surgery" ($3,000), and vaginoplasty ($13,000), each with a fun little graphic illustrating what the cost of each product would net you in Victoria's Secret bras (86, and Victoria's Secret is a whole other mess), and rolls of duct tape (2,167).

In 2008, trans people hadn't achieved the mainstream visibility we enjoy (most of the time) today. So while it was admirable that the Out staff of 11 years ago devoted a whole issue to a then-ignored letter in the LGBTQ+ acronym, the way they'd presented it was not the way that the current Out team would share that information today -- after all, we have multiple trans folks on staff now!

Most of those trans folks on staff receive medical care at Callen-Lorde Community Health Center in New York, which centers the needs of the city's queer and trans population. Their most utilized services are HIV/AIDS and trans health care, but the way these are being accessed has changed drastically in only a few years. Callen-Lorde reports that in 2018 they saw 20,000 visits with the primary purpose being trans care and 13,000 visits with the primary purpose of HIV-related care. That's a huge increase from 2015, when they saw roughly the same number of HIV-related visits but under 10,000 trans-related visits.

"In 2016, those two lines crossed and we started seeing more trans care than HIV care," explains Gaines Blasdel, a medical case manager at Callen-Lorde's Health Outreach to Teens program. The numbers make it clear that trans folks are accessing medical care more than ever before, but the cost of these crucial tools of transition can be incredibly expensive, especially for those without access to health insurance.

While no two transitions are exactly the same, there is something of a prescribed path for trans folks hoping to align their identity and presentation through medical interventions. While low-income trans patients without health insurance would be able to access these interventions through Medicaid, we wanted the a la carte pricing, so we asked Blasdel the standard care that trans patients seek and what it costs them in cold, hard cash.

This article appears in Out's August 2019 issue celebrating the body. The cover features South African Olympian Caster Semenya. To read more, grab your own copy of the issue on Kindle, Nook, Zinio or (newly) Apple News+ today. Preview more of the issue here and click here to subscribe.