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Originally Posted by Rlyss
My only question is about money. Surgery, therapy, hormones, medication, all of this stuff costs a hell of a lot of money. How does one pay for that sort of stuff? Medical bills often put people in a lifetime of debt, can this type of surgery come under a health or insurance plan? Has your sister saved p her whole life for this, or am I exaggerating the cost?
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I was Sissy's legal guardian from the time she was 15 to the time she turned 18, and listed her on my family plan insurance through work. Unfortunately, transsexual services are almost always excluded, either specifically, or in the case of my insurance, as "cosmetic procdures". So we, Grace and I, essentially paid cash for everything. Older MTF's can usually get doctor's visits and hormones paid for, but seldom surgery, and I've never heard of hair removal being covered.
The single biggest expense for most MTF transsexuals is one you didn't mention, and one most people don't think of, and that is hair removal. The male beard, once it begins growth, doesn't respond to hormone therapy. It must be removed permanently, either through electrolysis, laser, or a combination of the two. An older MTF typically needs some 200-300 hours of electrolysis to completely remove the beard, at a rate of some $60-$100 per hour. In some cases, it can take as much as 500 hours to completely finish.
Body hair does respond, and over a couple of years, male body hair will thin out. The younger the MTF when she starts, the more thinning she gets. Older MTF's still need some more removal, and if they respond well to the hormones, waxing and other typical methods of female hair removal will suffice, but most still need some kind of permanent romoval for chest, back, and arm hair.
Hair removal can eventually cost as much as $20,000-$30,000. Sissy fortunately started hormones early, and had late onset of puberty, so she essentially had female puberty in place of male. There was still some beard hair, but very little, and almost no body hair to remove.
Hormones vary in cost, but the most common regimens, estogen, androgen blockers, and sometimes progestins, can cost more than $100 a month initially, though that cost goes down after a couple of years, especially following orchiectomy or SRS. In additon doctors visits including bloodwork, done at 3-6 month intervals, cost a few hundred dollars a pop, though these are typically covered by insurance.
Therapy costs typically $100-$150 an hour, and must be done for a minimum of 12 sessions to get a hormone letter, then again for 8 sessions to get an SRS letter. Therapy may be covered by insurance if it covers mental health services.
SRS costs vary greatly, depending highly upon where it's done. The cheapest place, and the place where the most surgeries are performed, is Thailand, where the complete package costs around $7,000 currently. My friend Jen is planning to have hers there in a couple of years. If you get one of the better surgeons, the results can be quite good and are generally satisfactory. In the US, costs vary from a little over $15,000 to close to $25,000 for the first stage procedure, and another $3000-$3500 for the second stage if needed and/or desired. In Canada, the most prominent surgeons currently charge about $12,000, and in Europe it's a bit less than the US, though more expensive than Thailand.
Breast implants cost about the same as for a natal woman. Facial surgery is relatively new and is very expensive, costing as much as $30,000 for the chin, jaw, forehead, nose, and trachea, or less depending on which prodedures the patient gets. These are never covered by insurance.
Another one you missed is voice therapy, which costs typically $100-$150 per hour long session.
Overall costs can run from some $30,000-$70,000 dollars for full transition including SRS, in additon to which many risk the loss of their jobs and or careers.
Younger transsexuals will typically get by with hormones, acquired through unofficial channels such as overseas pharmacies that don't require a prescription. Those who transition in their teens almost universally seek SRS, and have to save for it, which is a big part of the reason why Thai surgeons are so popular. Drag clubs often feature MTF transsexuals who perform there because it's the only employment other than as a prostitute available to them that provides the income they need to live on and save for the surgery, and some end up as prostitutes because rejection by their families and not having any job skills or means of making a living leaves them with little choice in the matter.