Can You Pay For That? How Class Privilege Defines the Trans* Experience
Emily Vrotsos | On 19, Jun 2013
Anyone’s trans*ition is dominated by how much it will cost. From someone working in the Women and Gender Studies field, and from someone who has a trans* sibling, I wish I could say that my sister’s happiness and fulfillment is the only thing that matters, or is the only thing that has any influence over her trans*ition. But that wouldn’t be true.
Don’t get me wrong, when she first came out to her family, friends, and relevant community members, she was adamant about changing her body. But in the initial stages of the process, our first instincts were to evaluate what would make her happiest. What could we do to satisfy her need for change? It was all very academic, very abstract. The thought process surrounding her situation was literally all talk. But the reality sunk in that if she was ready to move forward, tangible steps would need to be taken in order to reach her desired tangible end.
This meant doing research, a lot of which my sister guided and scoped for herself, with very specific ideas of what she wanted as the end result of this experience. Not every trans* individual wants to make such radical changes to their bodies, and sometimes it has nothing to do with physical characteristics at all and is more about transcending the gender and sex binaries in which many of us live. To say that being trans* relies wholly on the make-up of one’s body would reduce an individual’s value to their genitals, and no one wants that.
However, my sister’s trans*ition has been overtly physical. Ultimately, she decides who she is and how she wants to express who she is. It’s the identity of each individual that matters, and how we define ourselves is most important. The fact that my sister’s trans* identity is at least partially wrapped up in her body helps us understand why she wants to change it.
When I first started learning about my sister’s desire for sex reassignment, I must admit that I underestimated all the physical changes that could be made to reach my sister’s goal (keep in mind that the following discussion is focused strictly on male-to-female sex reassignment as it is relevant to my sister’s lived and living experience). I anticipated genital reconstruction and breast augmentation, but I have definitely taken for granted all of the ways my own body is female and feminine aside from my breasts and genitals. To name a few, my hips are wide, my body is curvy, my voice is high, my face is soft and rounded, my trachea bears no resemblance to an Adam’s apple, and my body produces hormones naturally to develop and maintain these features of my body. My physical features are just as expressive of my gender and sex identity as my mind, and outwardly so.
Recognizing these advantages as a cis individual has helped me, personally, to appreciate my sister’s deep desire to assuage the dysphoria she feels regarding the (dis)connection between her mind and her body. Obviously, for someone I love, I want to do my best to improve her quality of life in ways that will satisfy her. But to what cost?
To what cost, indeed. A lot of cost, actually. In gearing up to make these physical changes, there is the understanding that they will take place over an extended period of time and will be combatting the body’s natural cycle at every turn. These changes cost money.
Unfortunately, any physical aspects of an individual’s trans*ition that require medical attention of any kind are not covered under health insurance. Because an individual’s life is not in danger due to terminal illness or some other immediate threat, sex reassignment procedures of any kind are all listed as “cosmetic” procedures. Let me spell it out for you: “cosmetic” procedures are not covered by health insurance. All “cosmetic” procedures must be covered by the individual seeking them, including someone pursuing sex reassignment on any level. Nevermind that someone’s identity is compromised, just begging to break free.
What does this mean for the trans* population? It means that whatever physical changes they make to align their bodies with their minds will be coming directly from their own funds. For anyone who has spent a few hours in the emergency room and been put through a few medically necessitated tests without health insurance (or even with a co-pay option), you know you can be rung up for upwards of $3,000 in that short amount of time.
Prices will obviously vary from provider to provider, but the following is a list of approximated prices for various sex reassignment procedures: breast augmentation may start just under $4,000; genital surgery can cost anywhere from $4,000 to $9,000 minimum; lifelong hormonal supplements may cost anywhere from $15 to $55 per prescription refill; tracheal shaving may end up somewhere between $800 and $3,500.
Now, imagine compounding all of these sex reassignment medical procedures with multiple $3,000 hospital visits (bed, food, staff wages, etc.) over the course of several years (plus, the lifelong hormone supplements). Depending on what procedures an individual opts for throughout their trans*ition, it can cost upwards of $25,000. To put this in perspective, that could be four years of college tuition, a downpayment on a home, or buying a new car outright. That is a huge sum. But loans are an option for most individuals seeking an education, house, or car. Bank loans are not available for those seeking sex reassignment, or any of the related procedures. But that huge sum is still required, often as prepayment.
This huge sum is not had by all — in fact, it is had by few. Without a high-paying job, donations, etc. it can be damn near impossible to afford all desired procedures. Due to high costs, trans* individuals often need to pare their list of wanted therapies down to one or two more bank-account-approved options. In other cases, a complete trans*ition (as in, every medical procedure an individual wants, not as in having gone through every procedure listed above) may take a decade or two of scraping and saving for an individual to accomplish. In fact, there are multiple online communities where individuals can offer products and services to raise funds for their trans*itions. Ranging from recordings of an individual’s starring role in queer porn to pay for breast augmentation to outright pleas for donations for every procedure, these sites illustrate just how back-breaking the cost can be.
Money is such an integral part of all of our lives. Our wealth (or lack thereof) determines our worth. In a society where our contributions are measured in capital, either from our occupational earnings, inheritance, or providing a service and/or product worth the spending of someone elses funds, there is a reliance on the monetary system because it determines our actions and inactions.
Take this a step further. Not only are we measured by the money we have, the money we spend, and the money we (have the potential to) earn, having an access point for any money flow is crucial to our overall participation in the system. This can be taken back all the way to each individual’s birth, the socioeconomic classes we are born into. Individuals born into a higher socioeconomic class are more likely to get an education, have time for extracurriculars, go on to work in a well-paid career field … and more likely to garner funds for sex reassignment procedures.
In a perfect world, an individual’s trans*ition would be marked by celebration, dedicated to their instinctive disconnection from their bodies and/or the societal binaries that surround us, and without cost (or, at least, fully-funded). But this isn’t a perfect world.
Ours is a species dominated by cost. And so far, I don’t see any feasible way around it. So, what does that mean? It means either biting the bullet and paying through the nose for procedures that would (hopefully) mean harmony of mind and body, or going without.
We are coming up on the U.S.’s Independence Day in less than a month. A time when we chant in the streets about living the American Dream with streamers and fireworks. When we put our hands over our hearts and belt out lyrics that proclaim we are the Land of the Free.
That’s ironic, because, as far as true freedom is concerned, all I see are dollar signs.
For more information surrounding trans* issues, check out the following resources:
Written by Emily Vrotsos
Follow her musings on having a trans sibling, books she’s reading, and how she does feminism at Bend it. Break it. All of it. and her gardening and sustainability endeavors at The Outdoor Amateur. She also has fun on Twitter and is a little bit obsessed with Pinterest.
1.5 years transitioning w testosterone on June 7th, 2012.
been good and challenging times. im happy with myself emotionally/ physically. went thru depression with reducing dosage(painful 4.5 months)
the adventures of naijaboi continues. picture from the Philly Trans Health Conference June 2012. had an incredible time showing my film and meeting good brown folks.
These underwear. I desire them. For reasons. *paws at screen* I can feel pretty AND right at the same time.
i found a site for folks to purchase:
If you are an American trans guy who can’t get T because of lack money or your insurance doesn’t cover it, you may be able to get it for free directly from the pharmaceutical company that makes it.
One example is ‘Abbot’ who produce Androgel. They have a website (linked below) that is…
where’s the love 4 people transitioning after 1yr?
i wish i saw more in the community for folks who have been transitioning past 1yr. seems most articles/ videos/ etc are about the journey to come and all the great things that transitioning will bring. reminds me how this culture loves things that are pretty and young because you can commodify it for money and fun. what happens after the excitement fazes and its past a year, do people forget about you and your troubles/newsness?
there are many things that happen the 9 month-15month mark i would love to hear about especially when it comes to how your emotional and spiritual health are doing. how are you relating to your constantly changing body and face? how are you relating to how society treats you? how are you relating to the person that is on the inside of your body transformation? is your spirit still transcending gender or have your brought into the gender binary?
i would love to hear these stories and im sure people would love to hear mine. i will see if i can write and/or do a video im march. im starting to de-transition and have many things to say about it and the journey i’ve been on.
ok folks give some love to the folks on the journey past a year. they need as much love, attention, support as the folks either taking their first shot or speaking their identity out into the world for the first time. to the folks with some bruised knees on this journey of gender exploration i give you shout outs and much love because i know how much you, i and we need it.
take care all the bois/gender non conforming/ gender queer/ trans.
Thoughts of Detransitioning - Postgender
Introspection into their life. Their transition, gender, society and privilege. Choices they have made, the effects those decisions have made and issues subscribing and relating to the male identity.
Very interesting imo.
Laidbaqq’s 2 years on T slideshow. Neat to see the changes that occur after the first year!
Japanese professional speedboat racer Hiromasa Ando, dominated the sport as a woman for 18 years and built a reputation as a strong competitor, before transitioning to a man in 2002 at the age of 39. Ando has found acceptance by both the general public and the Japan Motorboat Racing Federation. The JMRF adapted its rules for him until he could complete his sex change surgery at Okayama University Hospital. “I think they’ve made an amazing decision,” Ando told Shukan Shincho magazine. “I was reborn. I am the happiest person on Earth today.” Hiromasa Ando came fifth in a field of six in the Sports Nippon Cup Osaka Award race held in Suminoe Ward after his transition. ”I feel great. I could participate as my real self,” Ando said, who was racing for the first time since December that year.