The High Cost of Gender-Confirmation Procedures

While visibility of transgender people has increased greatly in recent years, and with it acceptance -- to some degree -- this population still has many hurdles to overcome, not the least of which is financial.

Gender-confirmation surgery and other transition-related medical procedures can result in bills in the tens of thousands of dollars, notes a new Reuters article. And although the number of employers offering insurance plans that cover these procedures is on the rise, coverage is still far from universal.

Sara Davis Buechner, a concert pianist and music teacher quoted in the Reuters piece, said she spent $10,000 to have surgery in Thailand in the early 2000s, plus thousands more for electrolysis, therapy, and other services. As insurance coverage was rare at the time, Buechner paid out of pocket, even selling a piano to help pay the bills.

"I emptied all my accounts," she recalled. "And I consider myself one of the lucky ones." It was worth it, though, Buckner said, because while assigned male at birth, she had always known she was female.

Some who go through transition spend even more. Undergoing all the procedures listed by the Philadelphia Center for Transgender Surgery would total more than $100,000, Reuters notes.

And transgender people often have few financial resources. They are four times more likely than other Americans to live in extreme poverty, according to a report that came out this year from the Movement Advancement Project and the Center for American Progress.

Meanwhile, only 5 percent of U.S. companies offer workers insurance to help with these costs, reports the Society for Human Resource Management, and although that's up from 2 percent in 2011, it's still a tiny percentage. Among large employers, it's somewhat better, with one-third of Fortune 500 companies providing such coverage, according to the Human Rights Campaign's Corporate Equality Index. And growth in transgender-inclusive antidiscrimination laws and corporate policies will likely lead more employers to offer the coverage.

For those with some resources, the best strategy is to "plan ahead, know what your costs are going to be, and what your insurance will cover, and what it won't," Wells Fargo financial adviser Paula Heichel told Reuters.

Buechner added, "Just imagine, you have to take every stitch of clothing you own and put it in the garbage. The best analogy I tell people is, 'What if you moved to Bolivia tomorrow, how much would it cost to start a totally new life?' The costs are enormous. Start counting."