Sex Reassignment Surgery Cost

Typical costs:

• The total typical cost of a transition usually includes: expenses incurred in the year before surgery, during which hormone therapy, counseling and living full-time as the target sex are recommended; the cost of the surgery and follow-up care; and ongoing costs after the surgery, including hormone therapy for life and continued doctor visits.
• In the year before surgery, counseling can cost $50 to $200 per session, and letters from two therapists usually are needed for surgery; the total cost of the therapy and the letters can range from under $1,000 to more than $5,000 for that year. And hormone therapy could cost $300 to $2,400 for the year, depending on which hormones are prescribed. TSRoadmap.com[1] offers a detailed financial worksheets and estimates on the all the costs of transition, and estimates that it is typical to spend a total of $40,000 to $50,000 for a mid-range transition, including surgery.
• For patients not covered by health insurance, the typical cost of a sex reassignment surgery can range from about $15,000 for just reconstruction of the genitals to about $25,000 for operations on the genitals and chest to $50,000 or more for procedures that include operations to make facial features more masculine or feminine. Prices typically depend on the techniques used -- different techniques often are recommended based on body type and patient preference.
• Price examples include The Philadelphia Center for Transgender Surgery, where basic male-to-female surgery that includes testicle removal, genital surgery and breast augmentation would cost a little over $30,000 while for basic female-to-male surgery that includes mastectomy, areolar reduction and genital surgery, would cost between $12,000 and $25,000 depending on the type of genital surgery chosen. Because different doctors offer different procedures, it is important to check to see exactly what is offered for a certain price.
• Sex reassignment surgery is covered by some health insurance plans, but most have exclusions. However, employers can choose to add coverage for the surgery to their plans; Goldman Sachs offers it, as does the City of San Francisco. According to TSRoadMap.com[2] , it often is difficult to get sex reassignment surgery covered, and many companies call gender identity disorder a pre-existing condition or have exclusions.
• For patients covered by health insurance, out-of-pocket costs would include a copay or coinsurance. According to the Human Rights Campaign[3] , which tracks transgender benefits issues, City of San Francisco employees pay 15 percent of the total cost of surgery with an in-network provider and 50 percent with an out-of-network provider, with a $75,000 lifetime maximum allowance.

• For female-to-male patients, the most common surgeries are: elective bilateral mastectomy, which includes removing tissue and fat and sometimes grafting skin to make a more male-like nipple; metoidioplasty, which involves removing skin and extending the clitoris, usually already enlarged by prescribed hormones, to create a penis, and sometimes lengthening the urinary tract if the patient wants to be able to urinate while standing; or phalloplasty, an alternative to metoidioplasty that involves taking skin from the forearm to create a penis and using skin from the labia to create a scrotum; at least six months after a phallosplasty, testicular and penile implants can be inserted.
• For male-to-female patients, the most common surgeries are: breast augmentation; elective bilateral orchiectomy, the removal of both testicles through an incision in the scrotum, which reduces the male hormones in the body and allows the patient to reduce doses of prescribed hormones; a tracheal shave, which involves carving away cartilage from the Adam's apple to make it less prominent; and vaginoplasty, using skin and tissue from the penis to create a vagina, clitoris, clitoral hood and labia.
• LGBHealthChannel.com[4] offers an overview of common female-to-male and male-to-female operations.

• Hormone therapy can cost $25 to $200 per month, depending on which hormones are prescribed. The LGBHealthChannel.com has an overview of transgender hormone therapy. Usually, an experienced mental health professional must diagnose gender identity disorder in order for hormones to be prescribed.
• If psychotherapy is required, it can cost $50 to $200 per session for patients not covered by insurance.
• Male-to-female patients will need to have laser hair removal or electrolysis around their genitals before surgery to prevent hair from growing in the vagina after surgery. Some also choose to have hair removal done on the face. According to TSRoadmap.com[5] , this can cost at least $2,000 and often costs more.
• For male-to-female patients, aftercare can be very involved, and requires dilating the vaginal opening with a stent.
• Before or after undergoing surgery, many patients work with voice and movement coaches to help them adjust to living as the new sex. These coaches can cost $30 an hour or more.
• After surgery, it sometimes is necessary to consult a lawyer or pay fees in order to change the sex on official documents such as the birth certificate, driver's license and passport.

• Some surgeons offer discounts for a package of multiple surgeries.

• Surgeons who perform sex reassignment surgery usually are gynecologists or plastic surgeons. There are only a handful of surgeons specializing in sex reassignment surgery in the United States, and many patients get referrals from other patients or transgender support groups. Or, Becky Allison, M.D., a gay, lesbian and transgender advocate, offers a list of doctors[6] who perform sex reassignment surgery and a list of therapists[7] who deal with transgender issues.
• Doctors typically follow the recommendations of the Harry Benjamin International Gender Dysphoria Association[8] standards of care for gender identity disorders, which state that before undergoing sex reassignment surgery, an individual should: be 18, or the legal age of consent in their home country; have had one year of continuous hormone therapy, except for patients who cannot do so for medical reasons; one year of living successfully and continuously as a member of the new sex; psychotherapy during that year, if recommended by the patient's mental health professional; and have knowledge of the cost, risks, hospitalization requirements, necessary aftercare for the surgery; and know of competent surgeons who can perform it.
• Most sex reassignment surgeries are major operations, and risks involved may include pain, swelling, serious complications from anesthesia that could include death, and the need to return for further surgery.

1.  www.tsroadmap.com/reality/finance/fintrncost.html
2.  www.tsroadmap.com/reality/insurance.html
3.  www.hrc.org/issues/workplace/benefits/7782.htm
4.  www.healthcommunities.com/transgender-health/surgery.shtml
5.  www.tsroadmap.com/physical/hair/zapcost.html
6.  www.drbecky.com/srssurg.html
7.  www.drbecky.com/therapists02.html
8.  wpath.org/Documents2/socv6.pdf

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