How Much Does Bottom Surgery Cost
For many transgender people, bottom surgery is a lifelong dream — but it’s also expensive. In fact, it can cost anywhere from $50,000 to more than $100,000 depending on what type of procedure you choose and where you live. Depending on your income, that price tag could put the operation out of reach for some people. Even those who are lucky enough to be insured may have trouble affording such high prices because insurance companies often deny claims for medically necessary procedures like this one.
“There are so many things to consider when deciding if you want bottom surgery,” says Dr. Susan Ritterbach, founder of The Center for Gender Medicine in New York City. “You need to decide how much money you’re willing to spend, whether you want to wait until after puberty or not, whether you’ll use hormones before surgery.”
Ritterbach has performed hundreds of gender reassignment surgeries over the past 30 years. She estimates that around 80 percent of trans women she treats opt to take testosterone prior to having their new vagina carved out. This allows the body to grow larger breasts and hips as well as strengthen bone density. For trans men, the percentage is lower at around 50 percent.
Before they undergo bottom surgery, most trans women begin taking estrogen injections two weeks prior to the day of the operation. Estrogen therapy increases fat production in the chest area, which makes the breast tissue look fuller and firmer. It also helps increase the size of the upper arm (where the pectoral muscles will eventually be attached) and the hip, both of which become important measurements during the surgery itself. Trans men don’t typically take hormone therapy before they get bottom surgery since they already have large penises. Instead, they usually start using a penis ring, which lets them stretch their skin further and make the penis appear thicker.
The average price for a top surgery varies widely based on location and other factors. At the center where Ritterbach works, the average cost is approximately $66,000. When she first started performing these operations in 1985, she charged closer to $20,000.
In general, the cost of getting a sex change ranges between $35,000 and $60,000 total. A full surgical package including bottom surgery, labiaplasty (removal of excess tissue along the inner vaginal lips), clitoral reconstruction and phalloplasty (the construction of a neophallus) can run upwards of $85,000. If you only plan on doing partial work, the cost drops considerably; a less extensive package with clitoris removal, labial reshaping and vulvar tightening might go for just shy of $40,000.
So why do people pay such steep sums? First off, there’s no guarantee that you’ll end up happy with the results. As with any surgical procedure, there’s always a chance that something can go wrong. That’s especially true when dealing with sexual organs and anatomy that aren’t exactly in tune with each other. There’s also the possibility of postoperative complications following the actual surgery itself. Some patients experience difficulty healing due to diabetes, obesity or smoking. Others suffer from nerve damage or scarring that causes pain and discomfort. And sometimes the patient simply doesn’t like the way he or she looks afterward.
But mostly, paying so much money for such a radical transformation comes down to personal choice and preference. Take it from someone who has seen her share of cadavers — it’s hard to imagine anything feeling better than your own hands inside your own body.
Here are some tips on how to keep that big bill manageable:
Know Your Limits
Transitioning genders is an arduous process. Many trans people face medical discrimination by doctors and insurers alike. Before you even consider undergoing bottom surgery, talk to several experts about your options. You should find a doctor who understands your needs and supports you financially as well as emotionally. Make sure you understand all of the risks associated with the procedure, and what happens if you develop unexpected problems later on. Find out everything you can about the various types of bottom surgery available and ask plenty of questions.
Once you’ve decided to go ahead with the transition, set realistic goals for yourself. Determine how long you intend to remain in your current state, and then figure out what steps you need to take to achieve your final goal. Be honest about your limitations, and remember that while you may be able to afford bottom surgery now, you won’t forever.
Find Financial Help
If you’re struggling to come up with the cash, try applying for a bank loan or line of credit. Medical bills are among the largest expenses for most Americans, and having too much debt can seriously hamper your ability to pursue certain careers or otherwise lead a comfortable life. Not everyone qualifies for government assistance, however. Those who receive government benefits through Social Security or Medicaid are ineligible for loans unless they meet specific criteria.
It takes time to prepare for bottom surgery. While you can certainly alter your appearance with makeup and clothing, nothing feels quite as real as actually being born again into another identity. Don’t delay your transition indefinitely just to save money. Ideally, you should complete the initial evaluation process within six months of making the decision to undergo the procedure. Then schedule surgery four to eight weeks later.
Have a Plan B
Even the best-laid plans can fail. If you suddenly lose funding, for example, or worse yet, encounter health issues that leave you unable to continue transitioning, you still owe it to yourself to explore your options. Talk to a therapist, social worker or support group leader about alternative methods for achieving physical femininity or masculinity. You may not feel ready to give up on your dream, but the option is there for those who wish to accept it.
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