Sex reassignment surgeries are still a taboo subject in today’s society. Although it can be classified as plastic surgery, the sex modification operation is, in fact, a complex intervention, with physiological, aesthetic, psychological, social, and even legal implications.
The decision to perform such an intervention completely changes the life of the person concerned, because it is irreversible, and first and foremost because it is doubled by a long-term hormonal treatment, through which to acquire the defining characteristics of the opposite sex.
How Much Does Sex Reassignment Surgery Cost?
The whole cost for a sex reassignment surgery includes more procedures such as hormone therapy at least one year prior to the surgery, living full-time as the target sex and counseling, the surgery itself and the follow-up care, plus the visits to the doctor.
For the first year before the surgery, you have to budget for the counseling sessions – anywhere between $60 to $220 for one and you must have a written document from two therapists at least. So, the costs for the counseling and consultations to get the needed written papers would be anywhere between $1,000 and more than $5,000. Also, hormone therapy is an expense you should take into account. Depending on the type of hormones prescribed it can be $350 to $2,500.
According to TSRoadmap.com, the whole cost for sex reassignment surgery is anywhere between $42,000 and $55,000.
In case you do not have insurance, the price for genitals reconstruction alone is around $16,000, while the surgeries for the chest and genital area cost around $26,000. Procedures which include the facial reconstruction would cost more than $50,000.
At The Philadelphia Center for Transgender Surgery, you would pay more than $30,000 for a male-to-female surgery. At this cost, you will get breast augmentation surgery, testicular sack removal, and genital surgery. The female-to-male surgery is less expensive, with a price anywhere between $13,000 and $26,000. At this price, you will get an areolar reduction, genital surgery, and mastectomy.
Sex Reassignment Surgery details
The process of sex reassignment is obviously radically different in the case of male-female and female-male change.
The operation of transformation from man to woman involves the removal of the penis and testicles and the construction, from the tissue derived from them, of the vagina, vulva, and lips. In some cases, in order for the appearance to be as real as possible, it is also necessary to use additional skin grafts from the person’s body.
The adjustments made do not only concern the aesthetic construction of the female sexual organ; the functional aspect is also desired. Thus, the part of the penis responsible for vascularity and erection is removed, to prevent possible swelling of the vulva and lips in the future.
The prostate atrophies due to hormonal treatment but is not removed. The urethra, which in men crosses the penis, is shortened and repositioned to perform the function of urinating in the usual female way.
The intervention by which a woman becomes a man requires several surgical steps and is considered to be more difficult and with a much lower success rate than that of change from man to woman. In fact, the number of sex-change operations from female to male is much lower.
The first procedure performed in this regard is hysterectomy, which permanently removes the uterus and fallopian tubes. In addition to the uterus and fallopian tubes, the ovaries are removed. Also, the transgender woman must go through a vaginectomy.
The most difficult step is to make a functional penis that can be used to urinate. Surgeons specializing in sex-change operations warn that the success of the operation of building a satisfactory penis can not be guaranteed.
Last but not least, the surgeons also perform a subcutaneous mastectomy, i.e. removal of the breast tissue, removal of excess skin, without removing the nipple, trying a minimally invasive intervention, in order to obtain a more natural look. In fact, the areola and the nipple are repositioned.
Important things to consider
This type of surgery is usually performed by plastic surgeons or gynecologists. There are only some surgeons specialized in this field and you have to find out about them from the transgender groups or from other patients.
The surgeries necessary for a sex change, but also the hormonal treatment (with long duration) will be applied only after the specialists will give their consent and will give the diagnosis of transsexuality.
In general, patients require this type of surgery in late adolescence and early adulthood, but it should be noted that there is no upper age limit for sex change.
The risks and complications that occur after a sex reassignment surgery are the same as for all operations that require anesthesia followed by surgery.
In particular, in the case of operations for the transformation of males into females, there is a risk of vaginal stenosis. Occasionally, for anatomical reasons (a narrow pelvis, for example), the vagina may be narrow and short. The lips may require secondary interventions for aesthetic purposes. Some patients may have urethral stenosis.
In the case of operations for the change from female to male, there could be complications in the urinary fistula or necrosis of the testicular area. At the same time, there is a risk that the patient will not be satisfied with the aesthetic aspect.
Hospitalization for recovery is quite short, and the operation is only one stage in the process of sex reassignment. Dissatisfaction can manifest later, being caused by the persistence of body hair, breast development, or voice change.
The sex reassignment of a female person is less optimal, as the ideal phalloplasty technique has not yet been discovered (research is still being done in this direction).
What are the extra costs?
Depending on the type of hormones needed, the hormone therapy would cost $30 to $220 per month.
In case there is psychotherapy required, it would be $60 to $230 per session without insurance.
For the male-to-female transformation, laser hair removal from the genitals and face is required before surgery in order to avoid hair growth after surgery. This would cost more than $2,000.
Also, after this type of surgery, a stent is required to help dilate the vaginal opening.
In order to learn how to live as the new sex, you may want to hire a coach to teach you how to adjust your voice or movements. They charge around $35 per hour.
Following the surgery, you will have to change your official documents such as the passport, birth certificate, or driver’s license. In order to do it, you may want to consult a lawyer and pay some fees.
How can I save money?
This type of surgery is covered by some health insurance companies but not all. Some employers choose to cover a part of the costs for this procedure for their employees. For example, the City of San Francisco and Goldman Sachs offer it.
In case you have health insurance, you must co-pay as not all the expenses are covered. For instance, City of San Francisco employees would pay 50% of the total cost with an out-of-network provider and 15% with an in-network provider, with the maximum lifetime allowance of $75,000.