So, what exactly is the cost of medically transitioning for trans people?

When cisgender people ask that question they’re usually asking, “What about your family, your job, your friends? Do they still love you? Do you think you’ll still be employable? Tell me, what’s the cost of being trans?” It’s very rare that someone asks me how expensive medically transitioning might be. If people do ask, they’re often shocked at my answer. Trans people get bills upwards of hundreds of dollars for trimonthly blood-work appointments, bills for meeting with their endocrinologist, bills for their hormones and syringes, bills for their surgeries that often happen in multiple stages, bills for freezing eggs and sperm, bills for electrolysis and bills for the therapist they have to see even before they’re “approved” to make an appointment with their endocrinologist. Most of these bills are rarely, if ever, covered by health insurance.

The current standard of care for transgender patients was created as a way to pathologize transness and police which trans people had access to medical care. Usually the people who are not allowed to transition under World Professional Association for Transgender Health standards of care are those of us who do not identify as men or women — those of us who identify as trans and nonbinary. For this reason, it has been apparent to the trans community that the protocols supposedly built to “help” us transition and to “help” us actualize our bodies in ways that align with our gender identities were not built for us, but were instead built to control and police our bodies.

It is no stretch to say that the medical establishment was not built to promote health and wellness for trans and nonbinary people and that it was instead built to regulate them. However, many trans and nonbinary people still find it necessary in their lifetime to go to a number of doctors for help with their medical transitions — whatever it is that transitioning for them might entail. Transitioning without health insurance (sometimes even with insurance) can involve spending between $10,000 and $50,000 dollars on average and upward of $100,000 in many cases.

“But what about the coverage at Yale? Is it easy to medically transition here?” you might ask. Well, medically transitioning under Yale Health Hospitalization/Specialty Coverage (YHHSC for short) comes with both good and bad parts. For instance, if you’re a trans person with economic privilege looking to undergo specific surgical and/or hormonal interventions, you might find it cost-effective to pay $2,264 a year for YHHSC. However, it must be acknowledged that for many poor trans people, $2,264 is an unfathomable amount of money to pay for a year of health insurance. And even if you are on full financial aid, you are still required to pay the full amount. There are trans people on campus whose families cannot support them or whose families have disowned them; they cannot afford to pay out of pocket or take out loans to cover this amount of money for their transition.

Even if you are able to afford YHHSC, it still does not cover a wide variety of things — sperm banking and egg freezing, electrolysis, even some surgeries — many people need and feel are necessary for their transitions. Furthermore, in order to even find out what is and what is not covered under YHHSC you must first be assigned a care management representative, contact them to go over which options you would like to pursue, and only then are you finally sent a list of transition-related surgeries and medical procedures that are covered. Unlike treatment options for many diagnoses and conditions — like seasonal allergies or diabetes — that are made available in the student handbook, treatment information for trans patients is not openly accessible to the public.

The lack of transparency regarding which surgeries and procedures are available to trans patients in the YHHSC handbook is reflective of how health insurance policies across the board create arbitrary divides between what medical procedures are “necessary” and which are solely “cosmetic” or “optional.” Trans people’s fight to feel safe and survive in their bodies is often seriously misunderstood by the medical community. For many of us, these surgeries are not optional. These procedures are not optional.

I have had the privilege of being able to begin my medical transition at Yale under a health coverage that allows me to receive three months’ worth of hormones at a time for $10 and to have blood testing/endocrinological visits covered under YHSSC without copay. If I am able to schedule the chest reconstruction surgery I need in order to feel comfortable in my body, I will only have to pay a $100 copay, in addition to whatever money I spend on transportation and lodging on the day of my surgery. This kind of “full coverage” for chest reconstruction surgery (or any transition-related surgery for that matter) is nearly unheard of in the trans community. However, I still had to take out student loans to cover the $2,264 cost.

I am privileged to be a white student at a prestigious university where I can easily take out student loans for my health care. I am grateful for the opportunity to begin my hormonal transition and possibly get chest reconstruction surgery at an unbelievably low cost relative to what it will cost me after my coverage under YHHSC runs out. However, I’m in my last year at Yale, and I still do not know if I will have enough time to navigate the gatekeeping barriers I need to overcome in order to petition for my surgery in time to actually receive it under the health plan.

As a nonbinary trans person, I do not know if the medical professionals who gatekeep my health care will allow me to access the surgery I need without months of petitioning. I am terrified of how long it will take me to afford chest reconstruction surgery on my own without proper coverage under health insurance. I am unsure if I will be able to find and afford doctors who are capable of prescribing me the hormones I need after I leave Yale. I am terrified of the amount of time I might be forced to live in a body that does not feel safe for me.

* * *

This is transgender awareness month. This is transgender awareness month and I want everyone reading this to know I am tired of watching trans friends from all parts of the country struggle to raise enough money to pay for a therapist, to pay to see a doctor who will prescribe them hormones or to pay for the surgeries they need in order to survive in their bodies. I am tired of fighting with my doctors and the medical establishment at large to receive the care that I need to survive as a trans nonbinary person. I am tired of my friends and I being told by health insurance companies that the surgeries or procedures we need to feel safe and survive in our bodies are purely “cosmetic” and therefore shouldn’t be covered as necessary medical care.

When I get on my Twitter at any given moment during the day, in just a few scrolls I am likely see three or four GoFundMe or YouCaring links shared by trans people who are trying to raise enough money to fund transitions. We who are trans know what it is like to scroll down our Facebook Timelines every day not only to check up on the current state of U.S. politics, but also to see several of our trans friends asking for help on their journey to feel safe in their bodies.

What many cisgender people don’t understand is that when trans people seek out surgical procedures related to their transition, those procedures aren’t “cosmetic” and for many of us they are not “optional.” It is violent to withhold them from us, and we cannot afford them without proper insurance coverage.

Cisgender people should be aware that labeling the procedures and surgeries many trans people need as “cosmetic” is one of the many ways the medical establishment continues to enact economic violence against trans patients. The number of surgeries and procedures covered by health insurance plans, including YHHSC, can and should be increased. It should not be the privilege of super wealthy trans people alone to be able to access transition related medical care. Medically transitioning can save lives. By withholding medical services to trans patients, by making us jump through needless, time-consuming hoops to access those services, the medical establishment is killing us.

And this is not hyperbole. Consider the fact that for trans people, there is a 41 percent chance that they will attempt suicide in their lifetime, a figure higher than any other group in the U.S. The stakes in denying trans people health care are much greater than in any other marginalized group. The protocols in place designed to police who among us are allowed to receive medical care are killing us. Health insurance policies denying us coverage for necessary medical care are killing us. This is economic and anti-trans violence. Many trans people are poor and struggling to find employment; so many of us cannot afford to pay out of pocket for the surgeries and procedures we need. Without a doubt, there is a trans health care crisis in the United States.

Reader: I want you to be aware of all of these things, but more importantly I want you to ask yourself, “What can I do with my privilege, voice, time and energy to help make this better?” If your health insurance provider doesn’t specify what procedures they cover for trans patients or if they flat out don’t cover surgeries and procedures for trans patients, call them and ask what steps you need to take in order to file a complaint about their lack of coverage. If you’re going to be a doctor, make sure you and your office are safe for trans patients and that you’re working with insurance companies to ensure your services are accessible to low-income trans people. Be on the lookout for trans people fundraising to afford their transitions through fundraising sites. You can go without a coffee this week, and I guarantee a $3 donation (or more if you can afford it) would help that trans person more than you ever imagine it could.

Don’t just be aware of trans-specific health care inequality after reading this. Do something to make it better in the lives of the trans people around you.

So, what does this trans person say the cost of medically transitioning is?

Too damn much.

Contact H McCormick (they/them) at h.mccormick@yale.edu .