Understanding the Cost and Criteria for Gender Reassignment Coverage

By Holly Hanson, CFP, CIMA, ADPA

There are certain steps that a transgender individual must go through before transition, one of which is receiving a diagnosis of gender identity disorder (GID). GID is characterized by a person's strong and persistent desire to be, or belief that he or she is, the other sex, including:

  • A preoccupation with getting rid of primary or secondary sex characteristics.
  • An absence of any physical intersex condition.
  • Clinically significant distress or impairment in social, occupational or other areas of functioning due to perceived incongruence between anatomical sex and perceived gender identity

GID Clearance

Clearance from a mental health professional/therapist is required for any type of body modification procedure except cosmetic surgery. The therapist should have familiarity with gender non-conformity and exhibit sensitivity in providing care.

The therapist will perform a psychological screening/assessment covering areas of emotional functioning, including peer and other social relationships. He or she will discuss possibilities and limitations of different treatments for GID.

Individuals with GID typically undergo treatment as prescribed by the World Professional Association for Transgender Health. This treatment follows a three-step approach to gender reassignment. It begins with the administration of cross-gender hormones to affect changes in physical appearance. The person being treated must then go through the "real-life" experience, which is a trial period of living as his or her true gender. The 12-month duration of the trial allows for the range of different life experiences and events that may occur throughout the year, including family events, holidays, vacations and season-specific work and/or school events.

Once this is complete, sex reassignment surgery — consisting of genital sex reassignment and/or nongenital sex reassignment — may be considered.

Preparing for GID Surgery

Here's a snapshot of what is required before each surgery as well as the estimated costs.

Criteria for breast/chest surgery for transgender men

  • Referral from ONE mental health professional
  • Evidence of persistent, well-documented gender dysphoria
  • Capacity to make a fully informed decision and consent to treatment
  • Legal age (18+)*
  • Reasonable control of any preexisting medical concerns. (Hormone therapy is not a prerequisite.)

Some younger individuals may be eligible.

(Read more about FTM top surgery.)

Criteria for breast/chest surgery for transgender females

  • Persistent, well-documented gender dysphoria
  • Capacity to make fully informed decision and consent to treatment
  • Legal age (18+)*
  • Reasonable control of any preexisting medical concerns

Although not a criterion, it is recommended that male to female (MTF) patients receive hormonal therapy for a minimum of 12 months prior to breast implant surgery to maximize breast growth.

Some younger individuals may be eligible.

(Read more about breast augmentation for transgender women.)

Criteria for genital surgery

Hysterectomy (removal of uterus and ovaries) for transgender males and orchiectomy (removal of testicles) in transgender females.

  • Referral from TWO mental health professionals
  • Legal age (18+)
  • Capacity to make fully informed decision and consent to treatment
  • Reasonable control of any preexisting medical concerns
  • One year of hormone therapy to meet gender goals (unless hormones are contraindicated for any medical reason).

Criteria for genital reconstructive surgery

Metoidioplasty/Phalloplasty in transgender males and vaginoplasty in transgender females.

  • Persistent, well-documented gender dysphoria
  • Capacity to make fully informed decision and consent for treatment
  • Legal age (18+)
  • Reasonable control of any preexisting medical concerns
  • One year of hormone therapy to meet gender goals
  • One year spent living in a gender role that is congruent with their gender identity

Although not a criteria, it is recommended that these patients also have regular visits with a mental health or other medical professional.

Average Cost for Gender Reassignment

Counseling $50 - $200 per session
Hormone Therapy $300 - $2,500 yearly
Therapy + Letter of Referral $1,000 - $5,000

Electrolysis for unwanted hair removal can cost $100 to $200 per session. This is optional, but can be among the most costly of procedures for transgender females. Electrolysis is not covered by insurance in these cases.

The average total cost for transgender males is $50,000.

The average total cost for transgender females is $7,000 - $25,000.

The overall cost varies greatly. For starters, different doctors charge different amounts based on where their practice is based. In addition, some transgender individuals leave the country for the procedure(s). Some may not choose cosmetic surgery, and others may only undergo one or two procedures rather than committing to them all.

Insurance companies generally cover medically necessary procedures such as genital surgery and any surgery that alleviates severe gender dysphoria. Some insurance companies even partially cover hormone therapy since it could be considered hormone imbalance. Cosmetic surgery is not considered medically necessary and is not covered by most insurers.

Holly Hanson is the author of The LGBT and Modern Family Money Manual: Financial Strategies For You & Your Loved Ones. http://www.harmony-financial.com/