What you need to know about costs and financing options for your transition.
Hormone replacement therapy (HRT) and gender confirmation surgery can be expensive, and paying for them isn’t always doable without extra financing. Unfortunately, not all healthcare companies cover these costs — and even if they do, they’ll cover only up to a specified point or have requirements that you may not be able to safely meet.
Learn more about the legal and medical costs associated with transitioning and the financing options available to you if you can’t afford them up front.
The costs of transitioning
For some people, transitioning doesn’t cost any more than the fees associated with legally changing their name and gender. These fees widely range from $100 to as much as $2,000, depending on the court and whether you need legal help.
For others, transitioning also involves HRT, which can cost $7,000 a year or more depending on your insurance, the hormones taken and how the hormones are administered. Some people maintain HRT until they receive gender confirmation surgery, while others continue it indefinitely.
Many also choose to undergo surgical procedures. Gender confirmation surgery — also called gender reassignment or realignment surgery — refers to a series of medical procedures that allow transgender people to have the physical appearance and functional abilities of the gender they know themselves to be.
Male-to-female (MTF) transitions can reach more than $140,000, while female-to-male (FTM) transitions can cost $120,000 when you include hospital stays, travel costs and other expenses. The cost of an FTM top procedure can run upward of $11,000 for the surgery alone.
Other popular surgeries include facial feminization ($25,000 to $60,000) and breast augmentation ($5,000 to $10,000). Transmasculine people may choose to undergo a double mastectomy ($3,800 to $11,000) or hysterectomy ($11,000 to $35,000).
The cost of not transitioning
Not transitioning comes with its own set of high costs, but these aren’t typically paid for in cash. According to a 2015 survey conducted by the National Center for Transgender Equality — the most recent and comprehensive data set of transgender people in the US to date — nearly 40% of transgender people surveyed experience serious psychological distress, which is often directly associated with violence, discrimination and rejection due to their gender identity. By contrast, the general population’s average is 5%.
Rates of distress are shown to diminish after transitioning: Only 24% of those who transitioned more than 10 years before the survey experienced psychological distress, compared with 49% of those who hadn’t transitioned but wanted to.
Transgender healthcare access
Excluding transgender procedures from healthcare coverage can constitute illegal sex discrimination, though some insurance companies have found loopholes that allow them to deny transgender-related healthcare costs.
According to the 2015 National Center for Transgender Equality survey, 25% of all respondents said they’d been denied coverage for hormone therapy that year. When it came to surgery, 55% of respondents were denied coverage by their insurers, and 42% received only partial coverage.
If your healthcare provider denies you coverage for a transgender-related procedure, consider appealing the decision and filing a complaint with your state’s Department of Insurance.
Denial of healthcare coverage is only part of the problem, however. Finding a doctor or surgeon that specializes and is trained in transgender medicine can be challenging, and yet it’s a crucially important step.
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Your insurance company likely won’t cover all of the costs of your medical needs, leaving you to pay out of pocket for at least some of your transition expenses.
For those of us who don’t have that kind of money at our disposal, financing options are available.
1. Personal loans
You can use personal loans to cover any legitimate personal expense, including medical costs. Loan amounts range from $5,000 and $100,000, with interest rates from 5% and 36% on repayments over one to five years.
If you have excellent credit, you’ll qualify for the best rates across the board. But if you’re looking for a better deal on rates, research nonprofit financial institutions like credit unions or getting a secured loan backed by personal assets.
- The good: Manageable monthly payments with low interest, if you qualify.
- The bad: You might not be eligible to borrow enough to cover the full cost of surgery.
- The costs: Interest and origination fees.
- Who qualifies: Basic eligibility requirements include stable employment, at least 18 years old and a credit score of 580 or higher.
2. Credit card
Credit cards can come with higher APRs but are useful for covering smaller expenses. If you have an expense that you know you can pay off over one year, consider applying for a credit card with a 0% APR introductory rate. If you qualify, you could save on unnecessary interest.
- The good: Access to financing when you need it and a potential no-interest promo for the first 12 months.
- The bad: Interest can be higher than a personal loan if you aren’t able to pay off your balance in the promo period.
- The costs: Interest and possible annual fees.
- Who qualifies: You typically need a credit score of 680 or higher to qualify for a competitive APR, as well as a steady source of income.
3. Home equity line of credit (HELOC)
Sometimes called a second mortgage, a HELOC allows you to access a line of credit that’s up to 85% of the value of your home. Because a HELOC is secured by the equity in your home, you’re typically eligible for lower rates than you’ll find with other loans.
Like with a credit card or other lines of credit, you pay interest only on the money you borrow, and you can continue borrowing up to your limit in your approved term.
- The good: Interest might be tax-deductible, and loan security means you can get rates as low as 3%.
- The bad: Interest rates are often variable, not fixed, making it difficult to predict how much your loan could cost. And you could lose your home if you’re unable to make repayments.
- The costs: Interest, application fees and appraisal fees.
- Who qualifies: To qualify for most HELOCs, you must own your home, have minimal debt and have a good credit score.
4. Surgery grants
The Jim Collins Foundation, the CK Life Scholarship Fund or Community Kinship Life, among similar organizations, offer grants that might help you pay for or cover the cost of surgery.
These grants are highly selective — foundations typically give out only a few each year — and often come with lengthy, involved application processes. But grants could be a huge help if you can’t qualify for a loan.
- The good: You might not have to pay the full costs of surgery.
- The bad: Grants are extremely competitive and don’t always cover your full surgical costs.
- The costs: None, if you qualify.
- Who qualifies: It depends on the grant, but you generally must demonstrate financial need, write essays, provide a letter of support from a medical professional and more.
5. Medical installment plans
Some healthcare providers allow patients to pay for expensive procedures in installments over a specified time, sometimes with no interest. In-house financing might be a convenient option if you have a series of procedures with one provider.
You also might be able to get a loan through your healthcare provider from a partner lender, which could minimize the timing or documentation required for your application.
- The good: You can potentially break up a big medical expense into smaller, more manageable installments at no extra cost.
- The bad: Missing a payment could halt your medical progress — which can be dangerous to your health.
- The costs: Some installment plans come with no extra costs, while others require an application fee and interest.
- Who qualifies: If your healthcare provider offers installment plans or loans, you might need to prove your income and creditworthiness.
6. Borrowing from friends or family
If you have a generous family member or friend with the means to help you, borrowing from these loved ones might be your least expensive option. If you take this option, consider drawing up a promissory note outlining the terms of your loan to avoid any confusion down the line.
- The good: You might not have to pay interest or meet any eligibility qualifications.
- The bad: You can damage relationships if you have trouble repaying your loan — or if your loved one suddenly comes into financial hardship.
- The costs: Costs depend on your friends and family, but it could be free. Generally it’ll cost you less than borrowing from a formal lender.
- Who qualifies: Anyone who knows someone who can afford to lend them enough money to cover medical costs.
Don’t have a well-off family member or friend? Consider turning to your social network for support. Crowdfunding sites allow you to set up a campaign for just about any need and share your needs with friends, family and even organizations.
Sharing on social media is vital to the success of a crowdfunding campaign, as donations typically come from people you know — not strangers.
- The good: No application process or need to repay the money you borrow.
- The bad: Some platforms won’t fund your campaign until you reach a stated fundraising goal.
- The costs: Many platforms charge fees to use them, which can involve a cut from each donation.
- Who qualifies: Anyone at least 18 years old.
8. LGBTQ community fundraising
Local community spots like bars, centers or anywhere else that holds significance for the transgender community might be willing to host fundraising parties or donate a portion of their sales to help cover the cost of your surgery.
- The good: You might not have to pay the full cost of surgery.
- The bad: You need to tell your story to local community members, and funding isn’t guaranteed.
- The costs: Potentially no costs.
- Who qualifies: It depends on your relationship with your community.
9. Getting a side gig
It’s not uncommon to fund your transition with an Etsy store or other alternative sources of income. But a side gig may not be a great solution for the short term. Making a profit upward of $100,000 can take a lot of time and work, but this option could help supplement other types of financing.
- The good: You don’t have to repay any funds.
- The bad: Saving can be slow, making it a better option in combination with other funds.
- The costs: You might need to invest in basic equipment and materials up front.
- Who qualifies: Anyone with extra time and energy.
Even something as simple as changing your name can set you back a couple hundred dollars and a good deal of time. Add to that the cost of hormone therapy and surgical procedures, and it’s enough to make your head spin.
But you do have options, from traditional sources of financing to more personal ways of drumming up funds to supplement your savings. Understanding important numbers in your personal finances — such as your credit score and your debt-to-income ratio — is a first step toward finding the right financial solution for you.