Once a person has made the decision to have a sex change, what is involved? How much does it cost? How much “maintenance” is involved and how much does that cost? How much, if any, is covered by medical insurance?
Am I safe in assuming that a female-to-male change costs more? Way back in the late 70’s, CBS ran a series called “The Body Human” and one episode covered this topic. One doctor said, in a rather frank way, “It’s easier to cut one off than it is to put one on.”
Before you ask, I’m not planning on an operation. I’m just curious.
Well, people don’t normally just get sex-changes and that’s it. The process of being coming the opposite sex involves a lot more than one operation. Tons of hormones, maybe other types of surgeries are also involved not to mention the cost of the psychiatrists that are required before any ethical doctors will operate.
Here is the online listings provided by one doctor.
That’s why I asked about what’s involved. How long does it take to get to a point (on average) where a psychiatrist gives someone the okay to have the surgeries?
Normally people can’t afford it, so it depends on how much money they have around. Most of the transgendered people I know were taking hormones illegally and getting electrolysis long before they saw a psychiatrist. Cost also depends on how much work you need. People that start the transition at a younger age have to get less surgery than those who start later. Also, some people just naturally have faces that are more masculine or feminine and may need an extra bit of surgery.
This page talks about after care. After aout 10 to 12 weeks, the person can have normal sexual intercourse.
As for how long it takes to get an ‘okay’ from the psychiatrist, that depends on the psychiatrist, but I think it is a minimum of 2 years.
Most of my info is from googling and what my transgendered friends and exes have told me, so hopefully someone who’s actually had the surgery can give us better details.
How much you spend on hormones depends on where you get them. You can buy them really cheap online from overseas companies, but this is very dangeous and unsafe. The amounts you need depend on your size and how much your body naturally produces.
Hair removal is pretty expensive and can take a long while. Electrolysis’ costs are between $2,000 and $20,000. Again, it depends on how much hair you have, how the hair reacts to the treatment and the local costs of the beautician. I’ve heard it is less expensive to get work done on the west coast than on the east.
It is a very, very rare insurance policy indeed that covers any transsexual-related treatments, medicine, or procedures. I have heard of one but never seen an actual policy to know if it was typical Internet BS and lies.
The cost can vary wildly, from under $20k to above $70k. A principal reason is “additional” procedures. Some women are naturally, before any treatments, very female in form and take to hormones very well - they could pass with just clothing and makeup before they took their first pill. Others (especially the ones of large build) need quite a bit more hormone treatment, and often many, many other surgical treatments.
You know, things like laser treatment - I know a woman who only needed about $500 of lasering to become less hairy than just about any natal woman. And I also know other women who after $15,000+ of lasering and electrolysis still need work to get to where they feel they should be. Some women respond very well to hormones, and develop full breasts. Others feel they need augmentation, or implants. Some go to terrible extremes - tracheal shaving/shaping, implants in the bottom and thighs, I’ve even read of (unconfirmed) cases of ribs being removed - it sounds urban legendish to me, but there you have it.
Sometimes the surgery itself is the problem - some surgeries go very well, and after the follow-up labiaplasty the results are perfect. Some women are very dissatisfied with the initial results, and return for further and further re-shaping. Sometimes there are problems with the vagina that is created, and it needs to be…re-opened (shudder). Whether or not vaginaplasty is done also greatly varies the amount of cost - and the maintenance required.
Anyhow. The point is, because there is a wide variation in starting points, and a wide variation in ending points, and a wide variation in-between, the costs vary.
On another message boards (oh, about 10 years ago) there was a m-f transgendered person who underwent the surgery and kept the board updated with her progress. Quite fascinating, and she provided link to photos of the surgery (not her surgery, but her surgeon had a very detailed site that also contained very graphic photos – not for the squeamish). I’ll see if I can find the site (if it exists) and I’ll be sure to follow the two-click rule with lots of disclaimers.
The end “product” (to use a rather gauche expression) was stunning. Part of the glans was used to create the clitoris so that the patient coudl still experience decent sexual sensation and pleasure, and I would never have guessed that the patient had not been born a woman.
She had breast implants first, then the genital reconstruction a few years later. And her post about the first time she showered and was really able to feel on all female body was such a marvelously well-written post it brought tears to my eyes.
Anyway, I recall that an important part of the post-op maintenance was very regular “dialtions” of the newly formed vaginal canal. Basically they were a set of, well, dildos, each with a different girth. She had to insert them several times during the day for specific durations (I can’t remember the details). This was to help prevent some kind of collapse. She said it was only uncomfortable at first when there was post operative swelling and bruising.
Alas, I don’t remember how long that was required.
Lemme see if I can find her doctor’s site (if it’s still around – it was 10 years ago, remember). It was incredibly informative and had detailed instructions about post-operative maintenance.
Hm. I think I found her surgeon’s website but it has changed to some Flash thing that is less informative. However, there’s a good journal that covers the six months of post-op care.
(No images at all, just text. But big TMI warning for those who are squeamish about their parts or about surgery stuff.)
IIRC, the surgical procedures still don’t yield the greatest results.
A metoidioplasty will create a normal looking but very small penis. Results vary depnding on the individual’s response to hormone therapy – the clitoris will enlarge under hormone therapy (lotsa testosterone) and surrounding skin is released from the pubis to give a greater appearance of length. A scrotoplasty can be done to form a scrotum and (after balloons are used over a period of six months or so, to stretch a scrotal sack), permanent testicular prosthetics can be added. The ureathra can be lengthened and the vagina removed (IIRC you can get a hysterectomy and your ovaries removed but I don’t think it’s required – NOTE: I may be mistaken about that.)
Again, the final results do NOT produce an adult sized penis. You can pee standing up, but not engage in satisfying vaginal intercourse if you have a female partner. You get a small uncircumsized-looking penis.
Again, that’s ten-year-old info so things may have changed.
FTM also usually includes a mastectomy. Many surgeons will do “Top” only.
I don’t know what the maintenance times are requirements are. If you google “metoidioplasty journal” you might get lucky.
And I have no idea of the cost of these things. I never asked and I’m not in contact with the MTF woman I used to know on that other board. I expect it varies greatly depending on which parts you wish to get rid of and which parts you get. As well as all the postoperative care, hormone therapies etc.
The cost of top surgery for FTMs varies greatly, it depends if you go to one of the “Big Names” surgeons or not, the range is 5000-10 000 USD.
An Hysto and oopho alone is about 10 000 I think.
That’s also about the price of a meta (short for metoidoiplasty) with testicle implants (some surgeons use indeed expanders to stretch skin, others not) and urethral hook-up, (in this case you had to have an hysto yeah), you can also just free up the former clitoris to gain more visible length, it’s about half the price.
Size of meta ranges from 4 to 10cm.
For a phallo the latest prices are about 40 000-50 000 USD for a sensate phallo made with forearm skin. Usually you can also at the same time get top surgery and a hysto is done if this hadn’t been taken of before, it’s included in the price for some surgeons.
The amount of sexual sensations, orgasms post-op depends a lot on who did your surgery and what exaxtly was done to the former clitoris when building the phallo. (let on top or between the shaft and scrotum, buried in the scrotum, integrated to the shaft and the nerves connected along the shaft, etc)
Top is name for phallo is often said to be Monstrey, in Belgium, he seems to yeild the best results sexually wise and it’s pretty realistic looking, compared to other surgeons.
(I’m keeping a ressource site for FTMs in my country so I try to stay updated with prices and techniques and all)
This simply isn’t true anymore. More and more insurance companies are covering services relating to transsexualism, up to and including SRS (but almost always excluding hair removal). Exclusions for sexual reassignment surgery are illegal in California and in Minnesota; in Cook County, Illinois; in New York City; and in countless other places where employment discrimination on the basis of gender discrimination has been outlawed. Lawsuits enforcing these rules are being won more often than lost, and the list of places where such lawsuits have been won grows frequently.
In practice, your chances of getting at least some financial assistance from an employer-based insurance plan are actually pretty good these days, as long as you and your caregivers follow the Standards of Care (and your underlying mental and physical health are such that you aren’t excluded from receiving services for reasons not related to the financial).
Until a few years ago (Harris government), SRS was covered by Ontario medicare. It’s also theoretically covered by Quebec medicare but, from what I’ve been told, no actual payouts have happened for years – they just find reasons to reject everybody.
Many transsexuals, I understand, end up going to other parts of the world (e.g. Thailand) where costs are lower and the approval process is easier. At their own risk, of course.
My point is that the companies are still excluding the SRS and pre- and post-SRS treatment. Anyone can sue any insurance agency, and possibly get a court to decide something is covered. And depending on which City/State one is in, there may be local laws governing coverage as well. When I was helping a friend and ex co-worker out I could not find any companies that did not have an exemption - not a single one. Now, perhaps this could have been a result of the actual negotiated policy with the company (which can be more or less exclusive than the general policy), but still, we could not find a single one.
Which big name companies provide for coverage of SRS?
My company uses Aetna and Oxford insurance, and neither of them will cover any transgender-related procedures, which they consider to be “elective plastic surgery.”
I, of course, think that’s a crime, and that any insurance company that will pay for, say, repairing a cleft palate or club foot should pay for sex-reassigment surgery. What, they think if it’s covered, millions of people will suddenly go, “hey, that sounds like fun—I’m going out to get a sex-change at lunchtime today!”
But with the religious right taking over the country, the odds of the transgendered gaining any more rights are not bloody likely.
