Ohio’s House of Representatives passed a bill this summer criminalizing gender-affirming care for transgender youth, adding another bill to the growing pile of anti-trans healthcare legislation in states across the U.S.
Today, 16 states, plus Washington, D.C., require insurance to cover gender-affirming care: California, Colorado, Connecticut, Delaware, Illinois, Massachusetts, Michigan, Minnesota, Montana, Nevada, New York, Oregon, Pennsylvania, Rhode Island, and Vermont.
But in states like Ohio, where insurance is not required to cover gender-affirming care, trans people and their families are stuck paying the costs. Even with insurance through The Ohio State University, Wes Wislar, a disability and trans rights activist based in Columbus, Ohio, had to pay close to $3,000 out of pocket for his top surgery.
“I feel really lucky that I had my top surgery when I did, and that I started hormones when I did, because I can’t imagine that it’s going to get better,” Wislar told Ms.
Yet trans Ohioans continue to persist. How much does it actually cost to transition without insurance coverage? And how are trans people in unprotected states persevering?
Top Surgery: $8,000
Top surgery masculinizes or feminizes the chest by either removing or adding breast tissue. Gender-affirming surgeon Dr. Medalie of Cleveland Plastic Surgery estimates that top surgery costs between $7,500 and $8,500.
Wislar organized a GoFundMe for his top surgery, selling T-shirts he designed. GoFundMe platforms hundreds of surgery campaigns for gender-affirming care.
“Even within a context where I have the best possible insurance that I could, it was still not accessible to me as a grad student,” Wislar said. “I still had to find some alternate way to make it work.”
Bottom Surgery: Up to $25,000
Commonly referred to as either FTM (“female to male”) or MTF (“male to female”), bottom surgery refers to a range of procedures that can either feminize or masculinize genitalia, including hysterectomy and vaginoplasty. Healthcare company Ro estimates the cost of bottom surgery varies from “$6,400 to $24,900 for FTM bottom surgery” and “$25,000 for MTF bottom surgery.”
And with anti-trans healthcare legislation continuing to roll out—with 28 bills introduced in 2023 so far—the stakes can feel higher than ever to pursue gender-affirming operations.
“I am planning on starting the hysterectomy process really soon,” Wislar said. “And that’s honestly something that I wasn’t always sure I wanted or needed… but I would rather do it while I can.”
Hormone Replacement Therapy (HRT): Up to $800 Associated Testing Costs (Including a full Hormone Panel or Blood Labs), Plus $40–400 a Month
Hormone replacement therapy introduces estrogen or testosterone into the patient’s system, modifying certain physical traits over time including the voice. Wislar also takes testosterone as part of hormone replacement therapy. To help protect trans patients, gender-affirming doctors in states like Ohio are finding innovative ways to ensure patients continue to get care.
“I feel really lucky to have a doctor who is a really huge advocate,” Wislar said. “We basically changed my diagnosis in my chart from gender dysphoria to low testosterone. So even if gender-affirming care gets completely criminalized in Ohio, I can still get testosterone.”
Other Forms of Gender-Affirming Care
Gender-affirming care refers to a wide spectrum, and the decision to pursue procedures, if at all, is a personal choice made by each trans person.
One procedure existing outside of the umbrella of top and bottom surgery is facial feminization surgery, which seeks to reshape certain bones in the face for a more feminized appearance. Trans activist Dylan Mulvaney has been open in sharing her journey with facial feminization surgery on TikTok, as well as acknowledging her financial privilege and reaffirming her support for trans people who do not pursue gender-affirming care.
“A friendly reminder as we start the New Year: Not all trans people desire affirming surgeries or hormones,” she posted to TikTok along with a picture of her in recovery on Jan. 2. “They are still trans. … Please show up for all trans people the way you’ve shown up for me.”
How Are Trans People in Unprotected States Supplementing These Costs?
Internet-based gender-affirming care providers like Plume offer financial assistance for gender-affirming care.
Wislar’s GoFundMe campaign was so successful that he made more money than needed for his care and was able to redistribute donations to other trans peoples’ surgery funds.
“It was really, really fun. And I kept joking that I felt like trans Santa!” Wislar said.
Mutual aid is a powerful example of how “the community really shows up for each other in a way that is really unique and born out of this urgency,” said Wislar. And through mutual aid, trans people—from Iowa to Tulsa—continue to persist.
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