best insurance for gender reassignment surgery

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Transgender health care

A transgender person’s assigned sex at birth doesn’t match their gender identity, expression, or behavior.

Refer to glossary for more details.

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A fixed amount ($20, for example) you pay for a covered health care service after you've paid your deductible.

The percentage of costs of a covered health care service you pay (20%, for example) after you've paid your deductible.

The amount you pay for covered health care services before your insurance plan starts to pay. With a $2,000 deductible, for example, you pay the first $2,000 of covered services yourself.

Plans with transgender exclusions

An easy-to-read summary that lets you make apples-to-apples comparisons of costs and coverage between health plans. You can compare options based on price, benefits, and other features that may be important to you. You'll get the "Summary of Benefits and Coverage" (SBC) when you shop for coverage on your own or through your job, renew or change coverage, or request an SBC from the health insurance company.

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Does Medicare cover gender reassignment surgery?

Medicare provides coverage for gender reassignment surgery, although it needs to be deemed as medically necessary. A person can appeal the decision if surgery is denied.

While Medicare coverage is nationwide, there may be state variations in policies and guidelines.

In this article, we discuss gender reassignment surgeries, Medicare coverage, enrollment, and costs.

We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan: Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments. Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%. Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.

What is gender reassignment surgery?

Gender reassignment surgery is usually the last step in the process of changing from one sex to the other. The surgery can help a person with gender dysphoria transition to their desired gender.

The process usually begins with talk therapy to determine if a person is ready to go through a permanent physical change. Following that decision, the next phase involves hormone therapy . Biological men take estrogen and biological females take androgens (male hormones).

The purpose of hormone therapy is to change a person’s physical appearance. For example, females who take androgens may develop facial hair, while males who take estrogen may experience female traits such as weight redistribution and changes in the skin.

There can be complications from therapy:

Estrogen therapy may increases the risk of heart disease and diabetes , or blood clots or breast cancer .

Androgen therapy may increases blood pressure , insulin resistance, and cholesterol levels.

Doctors may ask a person to take on the role of the desired sex, socially and professionally, for up to a year before surgery.

Surgery is the final step in gender reassignment. It may take several surgeries to complete the change from a male to female or from a female to male.

Medicare resources

For more resources to help guide you through the complex world of medical insurance, visit our Medicare hub .

What is involved in the surgery?

The goal of the surgery is to give the person the appearance and function of the desired gender. To achieve that goal, a person may need to go through several surgeries. As such, the surgical team often includes a plastic surgeon, urologist, gynecologist , and an ear, nose, and throat specialist.

Surgeries may include several steps , depending on the desired gender changes.

Biological female to male

• mastectomy or breast reduction
• nipple graft
• removal of the uterus and ovaries
• closure of the vagina
• creation of a penis and scrotum
• extension of the urethra through the penis, via a tube from the bladder to the outside of the body
• penile implant
• synthetic testicles
• voice surgery
• liposuction

Biological male to female

• facial feminization
• nose surgery
• eyebrow lift
• jaw surgery
• chin reduction
• enhancement of cheekbones
• female hairline
• laser hair removal
• hair reconstruction
• voice change
• reduction of the Adam’s apple
• breast augmentation
• removal of penis and scrotum
• creation of vagina, clitoris, and labia

Are there possible complications from the surgery?

There may be complications from surgery , including bleeding, infection, and side effects from anesthesia.

Medicare coverage

Medicare does not cover what they rule as cosmetic surgery, and until 2014 , did not cover surgeries to change gender. The rule was changed to include surgeries for medical reasons, which includes gender reassignment.

However, the Centers for Medicare & Medicaid Services (CMS) has not created a national policy, which means a person’s plans will decide if the surgery is medically necessary. This online tool will help a person find more information about their local state policies.

Medicare Advantage

Medicare Advantage (Part C) plans are sold by private companies. They combine the benefits of original Medicare parts A and B. Some plans also pay for medications.

In general, Advantage plans provide the same coverage as original Medicare, parts A and B.

However, because there is no nationwide policy on access to gender reassignment surgery, a person’s Medicare Advantage plan can decide if surgery is necessary and reasonable.

To find out if coverage is available, a person can check with their plan, use the Medicare online tool .

Medicare Part D pays for hormone therapy. However, if a person does not have Medicare Part D or Medicare Advantage, they may have to pay for prescription medications themselves.

People who are aged 65 and older can enroll in Medicare . Some younger people with disabilities or end stage renal disease also can get Medicare. People can enroll online through Social Security or at their local Social Security office.

There are various times during the year when a person can enroll in Medicare:

• The Initial Enrollment Period (IEP) starts 3 months before the month of a person’s 65 birthday, includes the birth month, and ends 3 months later. There is a total of 7 months in the IEP, including the birth month.
• If a person does not enroll during the IEP, they can sign up during the General Enrollment Period, from January 1 to March 31 every year.
• During the period of October 15 to December 7, a person can drop, join, switch, or change a Medicare drug plan or Advantage plan.
• In some circumstances, called a Special Enrollment Period , a person can make changes to the Medicare drug plans or Advantage plans.

When a person does not sign up for Medicare during the IEP, they may pay a late penalty.

Most people do not pay a premium for Part A. However, if a person does not qualify for premium-free Part A, they may have to buy Part A, which can cost up to $458 per month.

The standard premium for Medicare Part B in 2020 is $144.60 each month, and there is a $198 annual deductible cost. After a person pays the deductible, Medicare pays 80% of the allowable costs. The coinsurance is 20% of the charges.

If a person goes into hospital, there is a $1,408 deductible for every benefit period. There is no coinsurance if a person is discharged within 60 days.

Premiums for Medicare Advantage plans or Part D plans vary depending on the company providing the plans. An online tool can help people find and compare plan costs.

The cost of gender reassignment while on medicare will depend on which surgeries you will need performed and what medications you will be on after surgery. You will likely pay the $1408 Medicare Part A deductible for the some of the major surgeries, but will also pay the Part B deductible and 20% coinsurance on any outpatient procedures.

Medicare pays for gender reassignment surgeries and hormone replacement therapy , as long as the surgery is deemed medically necessary. There are several surgeries a person needs to finish the process.

Medicare Advantage plans may apply different rules when considering approval for surgeries.

A person must pay the same premiums and deductibles as they would for other surgeries or medical treatments.

Last medically reviewed on August 5, 2020

• Cosmetic Medicine / Plastic Surgery
• Health Insurance / Medical Insurance
• Medicare / Medicaid / SCHIP

How we reviewed this article:

• Advanced search. (n.d.). https://www.cms.gov/medicare-coverage-database/search/advanced-search.aspx
• After surgery: Discomforts and complications. (2020). https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/after-surgery-discomforts-and-complications
• Decision memo for gender dysphoria and gender reassignment surgery (CAG-00446N). (2016). https://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=282&CoverageSelection=National&KeyWord=gender+reassignment+surgery&KeyWordLookUp=Title&KeyWordSearchType=And&bc=gAAAACAACAAAAA%3D%3D&
• Gender confirmation surgeries. (n.d.). https://www.plasticsurgery.org/reconstructive-procedures/gender-confirmation-surgeries
• Gender reassignment surgery model NCD. (n.d.). https://www.cms.gov/medicare/coverage/determinationProcess/downloads/Kalra_comment_01022016.pdf
• How do I get parts A and B? (n.d.). https://www.medicare.gov/sign-up-change-plans/how-do-i-get-parts-a-b
• How do I file an appeal? (n.d.). https://www.medicare.gov/claims-appeals/how-do-i-file-an-appeal
• Is my test, item, or service covered? (n.d.). https://www.medicare.gov/coverage
• Medicare Advantage Plans. (n.d.). https://www.medicare.gov/sign-up-change-plans/types-of-medicare-health-plans/medicare-advantage-plans
• Medicare costs at a glance. (n.d.). https://www.medicare.gov/your-medicare-costs/medicare-costs-at-a-glance
• Part A and B sign up periods. (n.d.). https://www.medicare.gov/sign-up-change-plans/how-do-i-get-parts-a-b/part-a-part-b-sign-up-periods
• Part A late enrollment penalty. (n.d.). https://www.medicare.gov/your-medicare-costs/part-a-costs/part-a-late-enrollment-penalty
• Special circumstances (Special enrollment periods). (n.d.). https://www.medicare.gov/sign-up-change-plans/when-can-i-join-a-health-or-drug-plan/special-circumstances-special-enrollment-periods
• Transwomen. (n.d.). https://thetranscenter.com/transwomen/
• Unger, C.A. (2016). Hormone therapy for transgender patients. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5182227/
• What does Medicare cover for transgender people? (n.d.). https://transequality.org/know-your-rights/medicare
• What is gender reassignment surgery? (n.d.). https://www.issm.info/sexual-health-qa/what-is-gender-reassignment-surgery/
• Your health insurance coverage. (n.d.). https://www.ssa.gov/benefits/medicare/

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Does Insurance Cover Gender-Affirming Care?

How much does gender-affirming surgery cost, how much does gender-affirming medication cost, other ways to pay for gender-affirming care and surgery, tips for financing gender-affirming care and surgery, bottom line.

• Health Insurance

In many cases, health insurance in the U.S. covers gender-affirming care. However, whether or not your insurance plan covers a specific gender-affirming treatment depends on your state, employer, and the plan’s benefits.

Key Takeaways

• Health insurance generally covers gender-affirming care.
• Not all plans cover all procedures, or the process can be murky and require preauthorization and appeals.
• Gender-affirming care can cost tens of thousands of dollars.

Major insurance companies recognize transgender-related care as being medically necessary and have put policies in place outlining coverage criteria. However, at least 20 states have passed legislation limiting coverage of gender-affirming care for people up to age 18. And some transgender people may still be denied coverage of hormone treatments or transition-related surgery by an insurer.

An estimated 1.6 million Americans at least 13 years old identify as transgender, according to a June 2022 estimate.

Health insurers generally cover an array of medically necessary services that affirm gender or treat gender dysphoria, according to the American Medical Association. Gender dysphoria is a condition that occurs when someone feels a conflict between the sex they were assigned at birth and the gender they now identify with.

Gender-affirming care is the phrase used by most medical groups for dysphoria treatment. This care includes hormones, surgery, or counseling. The care aligns a person’s gender identity with gender expression in appearance, anatomy, and voice.

In 2010, the federal Affordable Care Act banned health insurance discrimination based on sexual orientation and gender identity. Before the law’s passage, medically necessary gender-affirming surgeries and hormones often weren’t covered by insurers.

A 2022 rule from the Biden Administration noted that “categorical coverage exclusions or limitations for all health services related to gender transition are discriminatory” and that a covered entity can’t deny or limit coverage or claims, or charge more in cost-sharing related to gender transition.

However, insurance is regulated at the federal and state level based on whether it is an ACA, public, or employer plan, so the rule doesn’t apply evenly to all insurers. Coverage and requirements vary based on state, employer, plan type, and more.

Investopedia / Candra Huff

Determining What Your Plan Covers

Plan members can generally find out what’s available in their member booklet. This should have been given to you when you got the policy or, if it’s an employee plan, when you joined the company. It may be called a certificate of coverage, a benefit plan, a summary plan description, a certificate of insurance, or something similar.

This document should describe the insurer’s clinical evidence criteria to qualify for gender dysphoria treatment claim coverage. Requirements might include:  

• One or two letters from a therapist containing specific information
• Being on hormones for a year
• Being at least 18 years old to have surgery.

Some plans may still list exclusions for certain procedures. Even if an exclusion exists in the documentation, the next step is to apply for pre-authorization or pre-approval. This earns a plan’s approval in advance for claims and may even be successful if an exclusion is evident—as it allows an appeal.

"Many [patients] call their insurance carrier and are told services will not be covered, and on that basis never attempt to file a claim,” says an article on the San Francisco-based UCSF Gender Affirming Health Program’s website. “Transgender individuals and their health providers should be aware that unless a denial is in writing, it is not a denial and cannot be appealed.

Typically, documentation submitted to the health plan shows why the treatment is medically necessary or explains the legal problems with an exclusion. Not getting preauthorization can lead to a claim denial, even if a procedure is covered. For example, many plans routinely require preauthorization for all surgeries of any kind for anyone.

If denied a preauthorization request or a claim, an attorney, health care advocate, or your human resources department may be able to help with filing an appeal. Appeals should include individualized, extensive documentation of a service’s medical necessity and appropriateness, and a comprehensive overview of the transition process of gender transition.

Here, we list four types of health insurance and how they might cover gender-affirming care.

Employer-Provided Insurance

Altogether, 24 states and the District of Columbia prohibit transgender exclusions in private health insurance coverage, according to the nonprofit LGBTQ+ advocacy organization Movement Advance Project, leaving 26 states without such protections.

However, health coverage benefits that a private employer provides can vary based on whether the employer fully funds the plan. If funded by the employer, the plan is governed by the federal law ERISA, the Employee Retirement Income Security Act , which overrides any state nondiscrimination law. The employer decides what health care is or is not covered.

Employer-based plans are governed in the state where the plan was issued, not where you live.

Up to 91% of businesses on the 2022 Human Rights Campaign’s Corporate Equality Index-rated businesses offer at least one transgender-inclusive plan option, up from 0 in 2002.

Affordable Care Act Plan Coverage

Individuals can buy their own health insurance policies, often with the help of federal subsidies, through the Healthcare.gov marketplace. Most insurers are getting rid of transgender-specific exclusions, which ACA regulation explicitly banned.

Still, policies vary by state and in what they cover. Health insurance policies may feature exclusions for items such as “services related to sex change” or “sex reassignment surgery” to deny coverage.

Around 6% of Silver Marketplace plans specifically exclude coverage for exclusions for treatment of gender dysphoria, according to a survey by Out2Enroll, an organization connecting the LGBT+ community with health care coverage.

Check a policy’s terms of coverage for a full explanation of which procedures and services are covered or excluded. You can also use a state-based Trans Insurance Guide from Out2Enroll to find a plan with the coverage you want.

Medicare and Medicaid Coverage

Nearly 10,000 transgender Americans 65 and older are enrolled in Medicare or Medicare Advantage. Under these plans, medically necessary care—including some gender-affirming procedures—is covered. Coverage by Medicare Advantage plans may vary, so try to get preauthorization before accessing transition-related services, suggests the National Center for Transgender Equality.

On a state-by-state basis, Medicaid coverage is uneven for lower-income people seeking gender-affirming care. Medicaid programs cover transgender-related care in 26 states and the District of Columbia. Meanwhile, programs in nine states bar coverage of transgender-related care for people of all ages, and programs in two states prohibit coverage of transgender-related care for minors.

Military and Veteran Coverage  

Active military members can access gender-affirming hormonal treatment and therapy for gender dysphoria. Tricare, the health benefits provider for military members, does not usually cover gender-affirming surgeries. However, a waiver may be requested and granted in some cases for medically necessary gender-affirming surgery.  

The Veterans Health Administration offers gender-affirming health care, including hormones and prosthetics, mental health care, and other health care. Coverage for gender-affirming surgery has traditionally been denied but is currently undergoing a review.

For just one person, the cost of gender-affirming care might range from $25,000 to $75,000, according to estimates from the HRC Foundation.

Gender-affirming surgeries may include top surgery (breast removal or augmentation), bottom surgery, vocal surgery, and face and body surgeries such as browlifts, jawline contouring, Adam’s apple removal, and forehead reduction.

Bottom surgery may include:

• Phalloplasty : Creation of penis 
• Metoidioplasty : Phallus created from existing genital region tissue. 
• Hysterectomy : Uterus and cervix removal  
• Nullification surgery : Creating a gender-neutral look in the groin
• Oophorectomy : Removal of one or both ovaries
• Vaginoplasty and vulvoplasty : Creation of vagina and vulva 
• Orchiectomy : Testicle removal 

Research published in 2022 by The Journal of Law, Medicine & Ethics detailed the costs of gender-affirming surgery from 1993 to 2019. The chart below shows the average costs of five of the most common gender-affirming procedures within a commercially insured population over the span of those years.

However, not all transgender people desire surgery. According to 2019 statistics, only 28% of transgender women get any type of surgery, and only 5%–13% receive genital surgery. Surgery is more common among transgender men, with 42%–54% getting some type of surgery; up to 50% get genital surgery.  

Gender-affirming medication is far more common. Up to 65% of transgender people received gender-affirming hormone therapy in 2019, up from 17% in 2011, according to The Journal of Law, Medicine & Ethics. The study notes the costs of gender-affirming medication from 1993 to 2019.  

Another 2022 study from Vanderbilt University found that masculinizing hormones run $29.76 to $463.54 per fill while feminizing hormones cost $12.95 to $180.98. Much of the cost depends on the delivery method, such as injection or gel. The authors note that “the most cost-effective hormone therapies were oral estrogen and injectable testosterone esters.”

One 2020 survey found that among insured respondents taking gender-affirming hormones, almost 21% reported that their claims were denied. This group (and those uninsured) were more likely to take non-prescription hormones from unlicensed sources, which may not be monitored for quality and potentially lead to health risks.

Other costs are involved as well. For example, at Planned Parenthood of South, East, and North Florida, gender-affirming hormone treatment costs between $95 to $105. Lab monitoring may need to be run to ensure health while taking hormones, which can average $26 to $142 per visit.

Aside from health insurance, how can you pay for gender-affirming care or surgery? Here are 10 options.

Payment Plans 

Some healthcare providers offer payment plans directly or through lenders that let you pay off medical bills over time.

You might take out a personal loan or even a type of personal loan called a medical loan to cover expenses related to gender-affirming care or surgery. A medical loan is just a personal loan used to pay for medical expenses.

Credit Cards 

Credit cards may be another avenue for covering the costs of gender-affirming care or surgery, although these tend to have higher interest rates. You may see promotional materials for the CareCredit credit card in your provider’s office, but other credit cards can pay for the same healthcare costs, often with a better interest rate and without the dangerous deferred interest feature that CareCredit cards have. You’re better off with a regular credit card that has a promotional 0% purchase rate offer.

Even with health insurance, hormone therapy may be less expensive if you comparison shop and use pharmacy programs, such as GoodRx.

Surgery Grants

Several organizations offer grants for people seeking gender-affirming care or surgery, such as the Darcy Jeda Crobitt Foundation and the Jim Collins Foundation.

Health Accounts 

If you have a flexible spending account (FSA) or Health Savings Account (HSA) , consider allocating some account money for gendering-affirming care or surgery.

Health Reimbursement Agreement 

A health reimbursement agreement (HRA) is an employer-funded group health plan that reimburses employees for qualified medical expenses, which might include gender-affirming care or surgery.

Home Equity Line of Credit (HELOC) 

You could take out a home equity line of credit to cover the costs of gender-affirming care or surgery. With this type of loan, you typically can borrow up to a specific percentage of your home equity. Interest rates on HELOCs are generally lower than those on a personal loan, because your home serves as collateral. Just realize that if you can’t repay the loan, your could lose your home. 

Friends-and-Family Loans 

If you’ve got supportive friends or relatives, they might be willing to chip in money to pay for your gender-affirming care or surgery. Just make sure you have a written agreement and repayment plan.

Crowdfunding

You might consider setting up a crowdfunding campaign on a platform like GoFundMe to raise money from friends, relatives, colleagues or strangers.

When you’re financing gender-affirming care or surgery, follow these tips:

Shop Around 

A number of online tools such as Hospital Cost Compare and Healthcare Bluebook allow you to compare costs for the same procedures and treatments offered by different healthcare providers. This homework could save you a lot of money.

Explore Your Options 

Even if health insurance covers a procedure or treatment, you must cover some out-of-pocket costs. Therefore, consider looking into surgery grants, crowdfunding, friends-and-family loans or other methods to bridge the monetary gap.

Check the Interest Rate 

Be sure to investigate how much you’ll pay to borrow money if you go down that road. With the CareCredit card, for example, the APR may be higher than a regular credit card or a personal loan. 

Try Negotiating or a Payment Plan

You can negotiate with a healthcare provider to lower the costs of gender-affirming care or surgery. For instance, a healthcare provider might discount your services if you agree to pay off your medical bills quickly. If a healthcare provider isn’t willing to provide a discount, they might let you make interest-free payments as part of a payment plan.

Ask About Financial Assistance

Some nonprofit healthcare providers offer financial assistance programs that cover all or some of your medical expenses.

What Are the Different Types of Gender-Affirming Care?

Various types of gender-affirming care include puberty-blocking medication, hormone therapy, top surgery, bottom surgery, nullification surgery, laser hair removal, facial feminization surgery, speech therapy, and mental health services.

How Much Does Gender-affirming Care Cost in the U.S?

The cost of gendering-affirming care varies widely, depending on the type of procedure or treatment involved. For one person, gender-affirming care might cost anywhere from $25,000 to $75,000, according to estimates from the Human Rights Campaign Foundation. Health insurance may or may not cover these costs to varying degrees.

Does Insurance Cover Puberty Blockers?

According to one study, insurance companies cover puberty blockers 72% of the time. The estimated out-of-pocket cost for a 3-month supply ranges between $9,500 and $39,000.

The campaign for transgender rights in the U.S. has experienced victories and setbacks in recent years—in some cases affecting coverage of gender-affirming care. Even amid progress made, some people still encounter problems securing health insurance coverage for gender-affirming care or covering out-of-pocket costs. Getting coverage for care may require preauthorization, documentation of medical necessity, and an appeal. This may prompt use of alternative financing methods like crowdfunding, credit cards, loans, or grants.

U.S. Department of Health and Human Services. “ HHS Announces Prohibition on Sex Discrimination Includes Discrimination on the Basis of Sexual Orientation and Gender Identity .”

The Williams Institute at UCLA. " How Many Adults and Youth Identify as Transgender in the United States? "

American Medical Association. “ Transgender Coverage Issue Brief .”

First Report Managed Care. “ Transgender Patients: Calculating the Actual Cost .”

UCSF. " Health Insurance Coverage Issues for Transgender People in the United States .”

Transgender Health Insurance. " Health Insurance - Understanding Your Plan ."

HRC. " Corporate Equality Index 2022. "

Society for Evidence-Based Gender Medicine. “ Sweden’s Karolinska Ends All Use of Puberty Blockers and Cross-Sex Hormones for Minors Outside of Clinical Studies .”

BlueCross BlueShield of Tennessee. “ BlueCross BlueShield of Tennessee Medical Policy Manual .” 

Movement Advancement Project. " Medicaid Coverage of Transgender-Related Health Care ."

HealthCare.gov. “ Transgender Health Care .”  

U.S. Department of Veterans Affairs. "VHA LGBTQ+ Health Program. "

Williams Institute, UCLA School of Law. “ Medicaid Coverage for Gender-Affirming Care ,” Page 1.

National Center for Biotechnology Information. “ Health Insurance Coverage of Recommended Gender-Affirming Health Care Services for Transgender Youth: Shopping Online for Coverage Information .”

British Columbia Nurses’ Union. “ Position Statement: Gender-Affirming Care .”

Journal of General Internal Medicine. " Gender-Affirming Hormone Therapy Spending and Use in the USA, 2013–2019. "

Annals of Family Medicine. "Insurance Coverage and Use of Hormones Among Transgender Respondents to a National Survey ."

Aetna. “ Gender Affirming Surgery .”

Current Problems in Pediatric and Adolescent Health Care. " Gender Affirming Medical Care of Transgender Youth ."

• Guide to Finance for LGBTQ+ People 1 of 18
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• LGBTQ+ Credit Barriers: Why They Exist and How to Avoid Them 6 of 18
• Top LGBTQ+ Financial Influencers to Learn From 7 of 18
• Paying for College as an LGBTQ+ Student 8 of 18
• LGBTQ+ Representation in the Workforce 9 of 18
• LGBTQ+ Pay Gap and Unemployment 10 of 18
• Health Insurance for LGBTQ+ People 11 of 18
• How Being Nonbinary Affects Getting Life Insurance 12 of 18
• Qualifying for Life Insurance When You're Transgender 13 of 18
• Does Insurance Cover Gender-Affirming Care? 14 of 18
• How to Invest in LGBTQ+-Friendly Companies 15 of 18
• Preparing for Retirement as an LGBTQ+ Person 16 of 18
• Social Security Benefits for for Same-Sex Couples: History and How Survivors Benefits Work 17 of 18
• Finding LGBTQ+ Friendly Retirement Options 18 of 18

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Aetna Agrees to Expand Coverage for Gender-Affirming Surgeries

One of the nation’s largest health insurers is agreeing to pay for breast augmentation for some trans women.

By Reed Abelson

Allison Escolastico, a 30-year-old transgender woman, has wanted breast augmentation surgery for a decade. By 2019, she finally thought her insurance company, Aetna, would pay for it, only to find that it considered the procedure cosmetic, not medically necessary, and refused to cover it.

“I knew from my case, it wasn’t cosmetic,” said Ms. Escolastico, who contacted a lawyer after she lost her appeal last year. “I knew I had to fight for this,” she said.

Ms. Escolastico’s surgery is now scheduled for February. Working with the Transgender Legal Defense and Education Fund, a nonprofit that advocates transgender rights , and Cohen Milstein Sellers and Toll, a large law firm that represents plaintiffs, she and a small group of trans women persuaded Aetna to cover the procedure if they can show it to be medically necessary.

To qualify, the women would need to demonstrate that they had persistent gender dysphoria, undergo a year of feminizing hormone therapy and have a referral from a mental health professional.

The shift by Aetna represents an important evolution in how health insurers view the medical needs of transgender individuals . While some insurers offer a broad range of surgeries for trans women if they are deemed medically necessary, others exclude breast augmentation and other treatments as merely cosmetic.

“This has the potential to be a transformative moment,” said Kalpana Kotagal, a partner at Cohen Milstein.

Insurers have typically covered genital reassignment surgery as medically necessary. But transgender women and others say breast augmentation is also a necessary treatment for individuals who receive a diagnosis of gender dysphoria. “There is no question from a medical perspective,” said Noah E. Lewis, the director of the Trans Health Project at the fund.

In addition, he said, it is illegal for a health insurer to deny coverage of medical care because of someone’s gender identity. “It’s a really simple matter of discrimination,” he said.

Aetna, which is owned by CVS Health, had been actively reviewing the need for breast augmentation surgery for trans women, said Dr. Jordan Pritzker, senior director of clinical solutions for the insurer. He said he had talked to numerous doctors who provide the surgery.

“Our decision to update our clinical policy bulletin is consistent with many changes we have made over the years to better serve the needs of the L.G.B.T.Q. community,” Dr. Pritzker said in a statement.

Aetna said it would also reimburse some trans women who were denied coverage but had the surgery. The company said it was actively reaching out to individuals who had sought authorization for their surgeries and were denied.

Cora Brna was denied coverage for breast augmentation surgery two years ago, when she tried to schedule it at the same time that she was undergoing genital reassignment, which was covered by Aetna. “I was devastated,” she said.

“I felt like a group of people were deciding whether I was or was not a woman,” said Mrs. Brna, 32, who works as a health care worker in Pittsburgh and was one of the women who petitioned Aetna. She went ahead with the genital surgery but had the procedure to augment her breasts only after it was covered by a different health plan.

Aetna’s new policy also comes at a time when the federal government is re-examining whether denying some types of care to transgender individuals is discriminatory. Under the Affordable Care Act, insurers cannot discriminate against individuals on the basis of gender identity, and most insurance companies provide coverage for people who require gender reassignment surgery. But the law never mandated a specific benefit or detailed exactly what services the insurers would cover, said Katie Keith, who teaches law at Georgetown University and closely follows this area of the law.

“It’s almost like a parity issue,” she said.

While the Trump administration sought to undo protections for transgender individuals with a rule last June , the issue is still being sorted out in the courts, said Ms. Keith, who also pointed to the recent Supreme Court decision that said gay and transgender workers are protected from workplace discrimination under civil rights law.

The new Biden administration has already issued an executive order saying it will enforce civil rights laws that protect people from discrimination on the basis of gender identity.

Major insurance companies are uneven in their coverage. Health Care Service Corp., which offers Blue Cross plans in five states, will pay for breast augmentation and other services for trans women if they are deemed medically necessary. The insurer said it developed these policies in accordance with guidelines established by the World Professional Association for Transgender Health, a nonprofit.

But other major insurers, including Anthem and UnitedHealthcare, continue to view the surgery as cosmetic, since they do not generally cover the procedures for women without the gender dysphoria diagnosis. They say they are not discriminating against trans women.

Anthem says its “medical policy is applied equitably across all members, regardless of gender or gender identity.”

And UnitedHealthcare said in a statement that its “coverage for gender dysphoria treatment is comprehensive and, depending on members’ benefit plans, current coverage may include physician office visits, mental health services, prescription drugs and surgery to address gender dysphoria.” It added that it uses “evidence-based medicine to make coverage policy decisions,” which are regularly updated.

But lawyers for the women involved in the Aetna agreement say they are looking closely at the policies of other insurers to see if they can make the same case that their refusal to offer coverage is discriminatory. “This is something that needs to be changed across the industry,” said Ms. Kotagal of Cohen Milstein.

Reed Abelson covers the business of health care, focusing on health insurance and how financial incentives affect the delivery of medical care. She has been a reporter for The Times since 1995. More about Reed Abelson

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Health Coverage Guide

Getting your health care covered: a guide for transgender people.

Getting your insurance to cover the health care you need can be difficult. The good news is that it should be getting easier. Many insurance plans have gotten rid of exclusions that single out transgender people, and trans people are protected from public and private insurance discrimination under federal law and state laws, including in Medicaid and Medicare.

But some insurance plans still make it hard to get coverage for transition-related health care, especially surgical care. 

The most important thing to remember is that  your insurance  should  cover transition-related care.  However, you may need to show your insurance company why the treatment you need is medically necessary  for you , with letters from your health care providers.

If you are denied coverage or if your plan has an exclusion, you may also need to explain to your insurance company or employer why it is illegal discrimination to exclude medically necessary transition-related care.

Use this guide to help you navigate the coverage process.

This guide will be especially useful for people who have Medicaid or private insurance. If you are on Medicare, in the military, or a veteran who receives services through the VA, make sure to check out NCTE's specific resources for these plans: Medicare Veterans & Military

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Gender-Affirming Surgery (Top Surgery)

Gender-affirming surgery is a collection of surgical procedures for adults ages 18 and older diagnosed with gender dysphoria. The operations are often referred to as “top surgery" and "bottom surgery.” Duke Health offers several top surgery options to transgender, gender-diverse, nonbinary, and gender-nonconforming adults who want their appearance to align with their internal identity. If, after a consultation with our doctors, you decide to pursue top surgery, we work toward a positive outcome that improves your physical, emotional, and psychological well-being.

What You Should Know About Gender-Affirming Surgery

Choosing to pursue gender-affirming surgery is an individual, personal decision. You’ll want to consider how it will change your quality of life and how it will help you achieve your goals.

Gender Dysphoria One important step is understanding how much you are affected by gender dysphoria, a diagnosis that the American Psychiatric Association defines as a conflict between your physical or assigned gender and the gender with which you identify. 

Candidates for Top Surgery To be a candidate for top surgery, you must:

• Be 18 or older
• Be in good health without illness or a condition that can increase your risk of surgical complications
• Have a BMI under 35
• Provide a clearance letter from your mental health or primary care provider stating you have gender dysphoria and you have been living in your assigned gender for at least 12 months

Top Surgery Costs Some private insurance plans will cover transgender surgery when it is used to address a diagnosis of gender dysphoria. Check with your insurance plan to determine your coverage.

Understanding Which Top Surgery Is Right for You There are several approaches to transgender surgery. We will review these with you during your initial consultation and make a recommendation based on your physical exam and medical history.

You May Have Scars Your surgeon will use the natural contours of your breasts to minimize scarring as much as possible. In some cases, depending on your breast size and weight, a small bunching of tissue may result in scars known as “dog ears” following mastectomy. These can be corrected later with revision surgery.

Understand the Risks Top surgery carries the same risks as other standard surgeries. These include the risk of bleeding and infection and risks associated with general anesthesia. Your doctor will discuss these risks with you if surgery is recommended.

Initial Consultation and Tests

Consultation and Exam Your first step will be an in-person consultation. Our providers spend time meeting with you, evaluating your anatomy, answering your questions, and determining if this surgery will help you achieve your goals.

Your surgeon will review your family history, general health status, lifestyle habits such as smoking, previous operations, any medications you may be taking, and conditions that can put you at risk for surgery.

Measurements, Photographs, Tests Your breasts will be measured and assessed for size and shape, and photographs may be taken for your medical record. Before treatment is recommended, you will also undergo one or more of the following tests.

• Blood tests may be necessary to evaluate your hormone levels. Pre-surgical testing also requires several blood tests to assess your liver and kidney function and to determine if you have a previously undetected infection, blood disorder, or anemia.
• A mammogram may be performed to look for any underlying breast abnormalities. Additional imaging, including ultrasound and MRI, may also be requested.

Recommending Treatment Based on these findings, your surgeon will recommend an approach to surgery. She will discuss the expected outcome, potential risks and complications, and your post-operation recovery. Alternatively, your surgeon may recommend that you lose weight, quit smoking, or discontinue medication before surgery to ensure you experience the best possible outcome.

If You Take Hormone Therapy Some gender-affirming hormone therapy , such as testosterone, can be continued if you pursue transgender surgery. Others, such as anti-estrogen therapy, may be stopped. Your surgeon will explain what you need to do to prepare for surgery.

Top Surgeries

Chest reconstruction - mastectomy, breast reduction.

We use different approaches to remove breast tissue and contour breasts to appear more masculine. The right approach depends on your anatomy and the size of your breasts. Techniques for medium to large breasts include nipple-sparing, double incision, buttonhole, and inverted-T incision. Keyhole and peri-areolar techniques may be used for smaller breasts or for those with good skin elasticity. Your surgeon will discuss your options with you after your physical exam and consultation.

Breast Augmentation

There are also many different approaches to breast augmentation, including the use of implants and fat grafting. We can also combine breast augmentation with body contouring, liposuction, and neurotoxin injections such as Botox injections and dermal fillers.

The Procedure Length

On average, top surgery takes about two to three hours and is performed under general anesthesia in an outpatient ambulatory surgery center. In some case, an overnight stay may be required. Sometimes a second procedure is needed to further tighten skin and achieve optimal cosmetic results.

Your chest will be wrapped in bandages, and a compression chest vest or surgical bra will be worn after the procedure. Drains will be required after mastectomy but not after breast augmentation. Initial recovery takes about one week. It may take three to six months for all swelling to subside and scars to fade.

Duke University Hospital is proud of our team and the exceptional care they provide. They are why we are once again recognized as the best hospital in North Carolina, and nationally ranked in 11 adult and 9 pediatric specialties by U.S. News & World Report for 2023–2024.

Why Choose Duke

You'll Work With a Plastic Surgeon Experienced in Gender Affirmation Surgery Our plastic surgeon has worked with many individuals seeking gender confirmation surgery. She is fellowship trained in body contouring, which means she has completed additional training in procedures that improve the body shape. Our surgeon is also a member of the World Professional Association for Transgender Health (WPATH), a nonprofit organization working to standardize and improve transgender care.

Duke Health Is Committed to the LGBTQ+ Community Duke Health values diversity and has taken many steps to show its commitment to eliminating discrimination, promoting equality, and standing beside our lesbian, gay, bisexual, transgender, and queer (LGBTQ+) community. Duke University Hospital, Duke Regional Hospital, and Duke Raleigh Hospital are recognized as LGBTQ+ Healthcare Equality Leaders by the Human Rights Campaign Foundation for perfect scores across areas of patient-centered care, support services, and inclusive health insurance policies for LGBTQ+ patients.

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Does Health Insurance Cover Transgender Health Care?

For transgender Americans, access to necessary health care can be fraught with challenges. Section 1557 of the Affordable Care Act (ACA) prohibits discrimination on a wide variety of grounds for any "health program or activity" that receives any sort of federal financial assistance.  

But the specifics of how that section is interpreted and enforced are left up to the Department of Health and Human Services (HHS) and the Office for Civil Rights (OCR). Not surprisingly, the Obama and Trump administrations took very different approaches to ACA Section 1557. But the Biden administration has reverted to the Obama-era rules.

In 2020, the Trump administration finalized new rules that rolled back the Obama administration's rules. This came just days before the Supreme Court ruled that employers could not discriminate against employees based on sexual orientation or gender identity. The Trump administration's rule was subsequently challenged in various court cases.

And in May 2021, the Biden administration issued a notice clarifying that the Office of Civil Rights would once again prohibit discrimination by health care entities based on sexual orientation or gender identity.

The Biden administration subsequently issued a proposed rule in 2022 to update the implementation of Section 1557 and strengthen nondiscrimination rules for health care. The proposed rule " restores and strengthens civil rights protections for patients and consumers in certain federally funded health programs and HHS programs after the 2020 version of the rule limited its scope and power to cover fewer programs and services. "

Section 1557 of the ACA

ACA Section 1557 has been in effect since 2010, but it's only a couple of paragraphs long and very general in nature. It prohibits discrimination in health care based on existing guidelines—the Civil Rights Act, Title IX, the Age Act, and Section 504 of the Rehabilitation Act—that were already very familiar to most Americans (i.e., age, disability, race, color, national origin, and sex).

Section 1557 of the ACA applies those same non-discrimination rules to health plans and activities that receive federal funding.

Section 1557 applies to any organization that provides healthcare services or health insurance (including organizations that have self-insured health plans for their employees) if they receive any sort of federal financial assistance for the health insurance or health activities.

That includes hospitals and other medical facilities, Medicaid , Medicare (with the exception of Medicare Part B ), student health plans, Children's Health Insurance Program, and private insurers that receive federal funding.

For private insurers, federal funding includes subsidies for their individual market enrollees who purchase coverage in the exchange (marketplace). In that case, all of the insurer's plans must be compliant with Section 1557, not just their individual exchange plans.

(Note that self-insured employer-sponsored plans are not subject to Section 1557 unless they receive some type of federal funding related to health care activities. The majority of people with employer-sponsored health coverage are enrolled in self-insured plans.)

To clarify the nondiscrimination requirements, the Department of Health and Human Services (HHS) and the Office for Civil Rights (OCR) published a 362-page final rule for implementation of Section 1557 in May 2016.

At that point, HHS and OCR clarified that gender identity "may be male, female, neither, or a combination of male and female." The rule explicitly prohibited health plans and activities receiving federal funding from discrimination against individuals based on gender identity or sex stereotypes.

But the rule was subject to ongoing litigation, and the nondiscrimination protections for transgender people were vacated by a federal judge in late 2019.

And in 2020, the Trump administration finalized new rules which reversed much of the Obama administration's rule. The new rule was issued in June 2020, and took effect in August 2020. It eliminated the ban on discrimination based on gender identity, sexual orientation, and sex stereotyping, and reverted to a binary definition of sex as being either male or female.

Just a few days later, however, the Supreme Court ruled that it was illegal for a workplace to discriminate based on a person's gender identity or sexual orientation. The case hinged on the court's interpretation of what it means to discriminate on the basis of sex, which has long been prohibited under US law. The majority of the justices agreed that "it is impossible to discriminate against a person for being homosexual or transgender without discriminating against that individual based on sex."

The Biden administration announced in May 2020 that Section 1557's ban on sex discrimination by health care entities would once again include discrimination based on gender identity and sexual orientation.

And in 2022, the Biden administration published a new proposed rule for the implementation of Section 1557, rolling back the Trump-era rule changes and including a new focus on gender-affirming care (as opposed to just gender transition care).

Are Health Plans Required to Cover Gender Affirming Care?

Even before the Obama administration's rule was blocked by a judge and then rolled back by the Trump administration, it did not require health insurance policies to " cover any particular procedure or treatment for transition-related care ."

The rule also did not prevent a covered entity from " applying neutral standards that govern the circumstances in which it will offer coverage to all its enrollees in a nondiscriminatory manner ." In other words, medical and surgical procedures had to be offered in a non-discriminatory manner, but there was no specific requirement that insurers cover any specific transgender-related healthcare procedures, even when they're considered medically necessary.

Under the Obama administration's rule, OCR explained that if a covered entity performed or paid for a particular procedure for some of its members, it could not use gender identity or sex stereotyping to avoid providing that procedure to a transgender individual. So for example, if an insurer covers hysterectomies to prevent or treat cancer in cisgender women, it would have to use neutral, non-discriminatory criteria to determine whether it would cover hysterectomies to treat gender dysphoria.

And gender identity could not be used to deny medically necessary procedures, regardless of whether it affirmed the individual's gender. For example, a transgender man could not be denied treatment for ovarian cancer based on the fact that he identifies as a man.

But the issue remained complicated, and it's still complicated even with the Biden administration's proposed rule to strengthen Section 1557's nondiscrimination rules.

Under the 2016 rule, covered entities in every state were prohibited from using blanket exclusions to deny care for gender dysphoria and had to utilize non-discriminatory methods when determining whether a procedure will be covered. But that was vacated by a federal judge in 2019.

However, the new rules proposed in 2022 by the Biden administration " prohibit a covered entity from having or implementing a categorical coverage exclusion or limitation for all health services related to gender transition or other gender-affirming care. "

As of 2023, HealthCare.gov's page about transgender health care still states that " many health plans are still using exclusions such as “services related to sex change” or “sex reassignment surgery” to deny coverage to transgender people for certain health care services. Coverage varies by state. "

The page goes on to note that " transgender health insurance exclusions may be unlawful sex discrimination. The healthcare law prohibits discrimination on the basis of sex, among other bases, in certain health programs and activities ."

The page advises that " if you believe a plan unlawfully discriminates, you can file complaints of discrimination with your state’s Department of Insurance, or report the issue to the Centers for Medicare & Medicaid Services by email to  [email protected] ." (note that this language existed on that page in 2020 as well.)

State Rules for Health Coverage of Gender Affirming Care

Prior to the 2016 guidance issued in the Section 1557 final rule, there were 17 states that specifically prevented state-regulated health insurers from including blanket exclusions for transgender-specific care and 10 states that prevented such blanket exclusions in their Medicaid programs. And as of 2023, the list of states that ban specific transgender exclusions in state-regulated private health plans has grown to 24, plus the District of Columbia.

Starting in 2023, Colorado became the first state to explicitly include gender-affirming care in its benchmark plan (used to define essential health benefits ), ensuring that all individual and small-group health plans in the state must provide that coverage.

While Section 1557 was initially a big step towards equality in health care for transgender Americans, it does not explicitly require coverage for sex reassignment surgery and related medical care. And the implementation of Section 1557 has been a convoluted process with various changes along the way. Most recently, the Biden administration has restored nondiscrimination protections based on gender identity.

Do Health Insurance Plans Cover Sex Reassignment?

It depends on the health insurance plan. This description from Aetna  and this one from Blue Cross Blue Shield of Tennessee are good examples of how private health insurers might cover some—but not all—aspects of the gender transition process, and how medical necessity is considered in the context of gender-affirming care.

Since 2014,  Medicare has covered medically necessary sex reassignment surgery , with coverage decisions made on a case-by-case basis depending on medical need. And the Department of Veterans Affairs (VA) has announced in June 2021 that it has eliminated its long-standing ban on paying for sex reassignment surgery for America's veterans.

But Medicaid programs differ from one state to another, and there are pending lawsuits over some states' refusals to cover gender transition services for Medicaid enrollees.

Over the last several years, many health plans and self-insured employers have opted to expand their coverage in order to cover sex reassignment surgery and other gender-affirming care. But although health coverage for transgender-specific services has become more available, it is still far from universal.

This issue is likely to face protracted legal debate over the coming years, and coverage will likely continue to vary from one state to another and from one employer or private health plan to another.

Many health plans in the U.S. are subject to ACA Section 1557, which prohibits discrimination based on gender. But this section is implemented via HHS rules, which have changed over time: The Obama administration issued rules to protect people from gender-related discrimination in health care, the Trump administration relaxed those rules, and the Biden administration has proposed changes to strengthen them once again.

A Word from Verywell

If you're in need of gender-affirming medical care, you'll want to carefully consider the specifics of the health policy you have or any that you may be considering. If you think that you're experiencing discrimination based on your gender identity, you can file a complaint with the Office of Civil Rights . But you may find that a different health plan simply covers your needs more comprehensively.

US Department of Health and Human Services. Section 1557 of the Patient Protection and Affordable Care Act .

Keith, Katie. Health Affairs. HHS Will Enforce Section 1557 To Protect LGBTQ People From Discrimination . May 11, 2021.

U.S. Department of Health and Human Services. HHS Announces Proposed Rule to Strengthen Nondiscrimination in Health Care . July 25, 2022.

United States DoJ. Overview of Title IX of the education amendments of 1972 . Updated August, 2015.

DHS.  Nondiscrimination in health programs and activities . Effective July 18, 2016.

Keith, Katie. Health Affairs. Court Vacates Parts Of ACA Nondiscrimination Rule . October 16, 2019.

Department of Health and Human Services. Nondiscrimination in Health and Health Education Programs or Activities, Delegation of Authority . June 12, 2020.

SCOTUS Blog. R.G. & G.R. Harris Funeral Homes Inc. v. Equal Employment Opportunity Commission . Argued October 2019; Decision issued June 15, 2020.

U.S. Department of Health and Human Services. HHS Announces Prohibition on Sex Discrimination Includes Discrimination on the Basis of Sexual Orientation and Gender Identity . May 10, 2021.

National Center for Transgender Equality. Know your rights: medicare .

HealthCare.gov. Transgender Health Care .

Health Affairs. LGBT protections in affordable care act section 1557 . June 2016.

LGBT Map. Health Care Laws and Policies .

U.S. Department of Health and Human Services. Biden-Harris Administration Greenlights Coverage of LGBTQ+ Care as an Essential Health Benefit in Colorado . October 12, 2021.

Military Times. VA to Offer Gender Surgery to Transgender Vets for the First Time . June 19, 2021.

Fleig, Shelby. Des Moines Register. ACLU of Iowa Renews Effort to Overturn Law Restricting Public Funds for Trans Iowans' Transition-Related Care . April 22, 2021.

By Louise Norris Norris is a licensed health insurance agent, book author, and freelance writer. She graduated magna cum laude from Colorado State University.

The Go-To Guide to Gender Surgeons

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Preparing for Transgender Surgery

We understand that the decision to have gender-affirming surgery is life changing. Our transgender healthcare team provides support and education to help you and your loved ones know what to expect throughout the gender-affirming surgery process.

As your surgical date approaches, we schedule one-on-one preoperative education visits with our nursing team. For those seeking genital surgery, we host classes with former patients who can share their experiences and introduce you to nurses and other staff who provide care in the hospital. Preoperative and postoperative photographs of procedure outcomes are available at the time of your surgical consultation. Referrals to mental health professionals who can support your emotional and physical wellbeing are also available.

Presurgical Requirements

There are certain requirements that need to be fulfilled before surgery, including surgical referral letters from mental health professionals and clinicians who provide hormone therapy; insurance authorization, which is done by our office; and hair removal for people having vaginoplasty or phalloplasty.

Surgical Referral Letters

Our surgeons follow the standards of care guidelines provided by the World Professional Association for Transgender Health (WPATH). This requires obtaining letters from your mental health professional and the clinician who managed your hormone therapy. We provide referrals to mental health professionals who can assist with letter writing and support your emotional wellbeing during this process. Here are suggestions for what to include in your surgery recommendation letter .

Insurance Authorization

Our office makes every effort to obtain insurance authorization after surgery has been scheduled. Please confirm that your insurance plan includes gender-affirming benefits before consultation. We offer a guide to verifying your health insurance benefits .

Occasionally, our efforts to authorize procedures are not successful even for those with gender-affirming surgery benefits, and in these instances we may refer patients to options for no- or low-cost legal assistance.

Hair Removal

If your surgical plan includes vaginoplasty or phalloplasty, permanent hair removal by either electrolysis or laser treatment is required before surgery. Please message us through your NYU Langone Health MyChart account for details on hair removal requirements.

We can help you find a doctor. Call 646-929-7800 or browse our specialists .

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Insurance Coverage for Gender-Affirming Surgery

Medically reviewed by Paul Gonzales on March 13, 2024.

Navigating insurance coverage for gender affirmation surgery can be complex, but many insurance providers now recognize these forms of healthcare for transgender individuals as medically necessary and thereby deserving of coverage. This guide aims to simplify the process of finding and applying for insurance coverage for gender-affirmative surgery, also known as gender confirmation surgery.

The GCC’s list of insurance providers that cover gender-affirming surgeries

Below you can find a list of insurance providers for which our team has successfully obtained approval for top surgery procedures from here. If you don’t see your insurance listed here or are unsure, you can schedule a free, virtual consultation so our team can verify this information for you. Unfortunately, Medicare does not cover any of our procedures at this time.

*  This list does not guarantee insurance coverage for top surgery and successful approvals may vary on a number of factors, such as the type of plan for each insurance company.

How to Get Coverage: An Overview

The following information is meant to give you an overview of all the components you will need to take into consideration in finding an insurance plan that will cover your gender-affirming surgery.

• Contact your insurance provider directly to inquire about coverage for gender reassignment surgery. You can start by calling the phone number on your insurance card.
• Review your insurance policy or member handbook carefully for any exclusions or limitations related to transgender healthcare.
• Consult the Transgender Legal Defense & Education Fund (TLDEF) for a list of insurance companies known to offer coverage for gender affirmation procedures.
• Get enrollment help from Out2Enroll once you are ready to sign up for health coverage to understand your options.
• Coverage Exclusions: Federal and state laws prohibit discrimination against transgender individuals by most public and private insurance health plans. This means insurance companies must cover transition-related care that’s medically necessary and it is illegal for them to deny coverage, in most cases. Some plans may still have exclusions in their policies, but you can ask for an exception or request the removal of the exclusion.
• Medical Necessity: Virtually all major insurance companies now recognize that gender-affirming medical care for transgender patients is medically necessary. However, the specifics of what procedures or treatments are covered will depend on each insurance plan. Most of them will require letters from healthcare providers to support medical necessity. You can find a list of therapists that can provide support letters for insurance coverage through GALAP .
• Referral Letters: To secure insurance coverage, patients will need 1-2 letters from healthcare providers. Besides a therapist support letter,  if GCC surgeons are not in-network providers, you will need a referral letter from your Primary Care Physician.
• Financial Options: If your insurance provider does not cover gender-affirming surgery, other options include paying out-of-pocket, taking out a personal loan, or seeking financial help from charities and organizations.

Identifying Insurance Providers That Cover Gender Affirming Surgery

If you live in the United States, here’s a list of resources to help you identify insurance providers offering coverage for gender-affirming surgery:

• Transgender Legal Defense & Education Fund (TLDEF) provides a list of insurance companies that have coverage for gender-affirming care.
• Campus Pride provides a list of colleges and universities by state that cover gender-affirming surgery or hormone therapy under student health insurance.
• Our Insurance Advocacy Team here at the Gender Confirmation Center has successfully secured coverage for surgery from the insurance companies mentioned above.

Navigating Insurance Policies for Gender Affirming Surgery

The National Center for Transgender Equality created a guide to help navigate getting your insurance to cover gender-affirming care. This process can be summarized in 3 steps below:

• Learn what your insurance plan covers for gender-affirming care by calling your insurance company and ask what medical policies on gender dysphoria treatment are applicable to your plan. You may also find this information in the Member Handbook provided by your insurance.
• Determine the type of insurance you have (self-funded vs fully insured) to see if there are exclusions or limitations on healthcare coverage for transition-related care. Self-funded plans (e.g. insurance through work, school, or government employment) typically have exclusions or limitations to coverage that may be exempt from state protection laws. You may need to request your employer or school to remove the exclusion before insurance can cover surgery.
• Gather necessary documentation , such as letters from healthcare providers (i.e. mental health provider). Some insurance companies require at least 2 letters.
• Submit a pre-authorization request to your insurance provider by writing a letter to explain why the procedure is necessary and why refusing to provide coverage may be illegal.
• Follow up with your insurance to ensure the request is being processed or check on its status. Your insurance will send you a notification if your request has been approved or denied.

Navigating this process can be challenging but our Insurance Advocacy team works directly with your insurance for each step of this process until the insurance company reaches a decision for the preauthorization request. This service is provided free of charge for our patients to ensure the best chance of success in getting their surgery covered.

Overcoming Challenges in Insurance Coverage for Gender Affirming Surgery

• Denial of preauthorization request or claim for reimbursement: Understanding the reason for denial can help determine your options for appealing this decision. Seeking legal assistance from a lawyer may help facilitate this process.
• Dealing with out-of-network coverage: Insurance companies usually have a list of “in-network” healthcare providers that are covered by a particular plan. While some patients are restricted to these in-network providers (i.e. HMO plans), others may have the option to see out-of-network providers if the in-network options are not qualified (i.e., PPO plans). For example, your insurance may restrict you to seek care from a surgeon who can perform mastectomies but may not have training in gender-affirming techniques. In such cases, you have the right to seek out an out-of-network provider who is qualified in gender-affirming surgery, as the in-network provider cannot fulfill your specific needs. It’s essential to understand that the insurance may initially refuse coverage for out-of-network surgeons or facilities, but this decision can be challenged through the appeals process.
• Consider an independent review for denials : If the insurance company continues to deny coverage, you may have the option to request an independent review by a third-party organization. This review can provide an unbiased evaluation of your case and potentially overturn the denial.

Exploring Financial Aid Options for Gender Affirming Surgery

• Surgery Grants: Organizations and programs may offer grants or financial aid to help cover the costs of surgery. The GCC works with various organizations to help with costs of surgery. Learn more about them here.
• CareCredit: GCC has partnered with CareCredit to help patients finance the costs of surgery. Patients can apply for this credit card to see if they qualify and figure out what payment plan options are available.

Advocating for Comprehensive Insurance Coverage

The Affordable Care Act prohibits discrimination based on gender identity, which can be leveraged when seeking coverage for gender-affirming surgery. Despite this, many still face challenges with access or coverage of medically necessary transition related care. Recently, these states have limited protections for transgender youth after passing laws banning their access to gender-affirming care.

Navigating insurance coverage for gender-affirming surgery can be challenging, but our Insurance Advocacy team is dedicated to ensuring access to care for our patients. The National Center for Transgender Equality and Transgender Legal Defense and Education Fund also provides a comprehensive list of resources to help patients find and get insurance coverage for gender-affirming care.

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Policy: Gender Affirming Surgery Policy Number: CG-SURG-27 Last Update: 2021-05-20

Permanent Hair Removal:

The use of hair removal procedures to treat tissue donor sites for a planned phalloplasty or vaginoplasty procedure is considered medically necessary.

Voice Therapy and Surgery:

Gender affirming voice modification surgery is considered reconstructive when all of the following criteria have been met: The individual is at least 18 years of age; and The individual has capacity to make fully informed decisions and consent for treatment; and The individual has been diagnosed with gender dysphoria (see Discussion section for diagnostic criteria); and For gender masculinization only: for individuals without a medical contraindication or intolerance, the individual has undergone a minimum of 12 months of continuous hormonal therapy when recommended by a mental health professional and provided under the supervision of a physician; and If the individual has significant medical or mental health issues present, they must be reasonably well controlled. If the individual is diagnosed with severe psychiatric disorders and impaired reality testing (for example, psychotic episodes, bipolar disorder, dissociative identity disorder, borderline personality disorder), an effort must be made to improve these conditions with psychotropic medications and/or psychotherapy before surgery is contemplated; and Existing vocal presentation demonstrates significant variation from normal for the experienced gender; and One letter, signed by the referring qualified mental health professional* who has independently assessed the individual, is required; the letter must have been signed within 12 months of the request submission. Cosmetic and Not Medically Necessary: The following procedures, when requested alone or in combination with other procedures, are considered cosmetic and not medically necessary when applicable reconstructive criteria above have not been met, or when used to improve the gender specific appearance of an individual who has undergone or is planning to undergo gender affirming surgery, including, but not limited to, the following: Abdominoplasty Bilateral mastectomy Blepharoplasty Breast augmentation Brow lift Calf implants Face lift Facial bone reconstruction Facial implants Gluteal augmentation Hair removal (for example, electrolysis or laser) and hairplasty, when the criteria above have not been met Jaw reduction (jaw contouring) Lip reduction/enhancement Lipofilling/collagen injections Liposuction Nose implants Pectoral implants Rhinoplasty Thyroid cartilage reduction (chondroplasty) Voice modification surgery

Reconstructive Gender affirming chest surgery ( augmentation, mastectomy, or reduction ) is considered reconstructive when all of the following criteria have been met: The individual is at least 18 years of age (see Further Considerations section below for individuals under 18 years of age); and The individual has capacity to make fully informed decisions and consent for treatment; and The individual has been diagnosed with gender dysphoria (see Discussion section for diagnostic criteria); and If the individual has significant medical or mental health issues present, they must be reasonably well controlled. If the individual is diagnosed with severe psychiatric disorders and impaired reality testing (for example, psychotic episodes, bipolar disorder, dissociative identity disorder, borderline personality disorder), an effort must be made to improve these conditions with psychotropic medications and/or psychotherapy before surgery is contemplated; and For gender affirming breast augmentation procedures only : for individuals without a medical contraindication or intolerance, the individual has undergone a minimum of 12 months of continuous hormonal therapy when recommended by a mental health professional and provided under the supervision of a physician, and insufficient breast development has occurred; and Existing chest appearance demonstrates significant variation from normal appearance for the experienced gender (note: each procedure requested should be considered separately as some procedures may be cosmetic and others may be reconstructive); and One letter, signed by the referring qualified mental health professional* who has independently assessed the individual, is required; the letter must have been signed within 12 months of the request submission. Nipple reconstruction, including tattooing, following a gender affirming mastectomy that meets the reconstructive criteria above is considered reconstructive.

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Between 1.4 million and 1.65 million adults in the U.S. identify as transgender, according to the Williams Institute at UCLA's School of Law. For many transgender and gender non-conforming individuals, medical transition is a significant and empowering part of their journey. Transition may include hormonal treatment and/or surgery known as gender confirmation surgery or gender affirmation surgery.

Many transgender individuals go through the process of transition — which includes legal, psychological, social and medical experiences — to resolve gender incongruence between their internal sense of self and external anatomy. Gender identity refers to an individual's experienced gender and sense of self.

Not all transgender people want to undergo gender confirmation surgery. But for those who do, the process can help to alleviate gender dysphoria . Gender confirmation surgery also doesn’t change or “reassign” one’s gender or sex. Instead, it allows transgender and gender non-conforming people to change their bodies to reflect their gender identity more accurately.

While hormonal treatment and/or surgery is a deeply important step for many trans and gender non-conforming people, it can also be expensive. Learn more about the average costs of medical transition care options and find resources and ways to help fund procedures.

Medical Transition Care Options and Average Costs

Medical transition care options are diverse in terms of procedures, costs and outcomes. Each transgender person, along with their medical provider, should choose the options that make the most sense in terms of budget and desired results.

The main two medical transition care options are hormonal transition and gender confirmation surgery. Here’s a breakdown of the average costs of each kind of gender-confirming healthcare treatment.

Hormonal Transition

Average Cost: $20–350/month

The majority of transgender individuals who seek out medical transition choose to undergo hormonal transition, also known as hormone therapy. Because of its relative affordability and accessibility, hormone therapy can be a particularly effective option for those experiencing gender dysphoria or looking for an alternative to surgery. Hormone therapy can help trans men and women, as well as nonbinary and gender non-conforming individuals, achieve significant physical changes.

Patients who undergo masculinizing hormone therapy often take testosterone. Testosterone therapy can affect a patient’s fat distribution, facial characteristics, vocal cords, hair growth patterns, libido, menstrual cycles and more. Testosterone typically comes in the form of injections (approximately $80 per month), patches ($300 per month), and gels ($300–350 per month) .

Patients who go through feminizing hormone therapy often take estrogen or testosterone blockers such as spironolactone and/or progesterone. Like testosterone therapy, this can affect a patient’s voice, facial appearance, libido, fertility, emotions and fat distribution. It can also promote breast development. On average, oral estrogen costs about $20 per month, while estrogen injections can cost up to $200 per month and spironolactone up to $20 per month.

Gender Confirmation Surgeries

Average Cost: $5,000–$50,000

Gender confirmation surgery for transgender patients refers to reconstructive surgeries to bring patients' bodies into conformity with their experienced gender. Surgeries might include reconstruction of the chest and/or face. Depending on the type of surgery, patients may have a recovery period from about two weeks to several months after their initial hospitalization.

Like all surgeries, these procedures come with potential risks. But patients who seek out board-certified surgeons and follow all pre- and post-op guidelines are usually satisfied with their results.

Here are some of the most common gender confirmation surgeries that transgender and gender non-conforming patients seek out.

Types of Surgeries for Trans Men

For trans patients, gender confirmation surgery might include removing breast tissue and reconstructing the chest, facial masculinization surgery (FMS) to make their facial features appear more masculine, removing and reconstructing the external genitalia, and removing internal reproductive organs.

Here are the most common forms of gender confirmation surgery for trans men and nonbinary patients.

How much is facial masculinization surgery (FMS)?

Average Cost: $10,000–$50,000

Here is what FMS surgery may include:

• Thyroid cartilage enhancement: An “Adam’s apple” is made using a small incision in the chin area and an implant in the throat region.
• Cheek augmentation: Small incisions inside the mouth allow the surgeon to place implants in the cheek to create a more angular appearance.
• Forehead lengthening or augmentation: Forehead lengthening and augmentation procedures involve lengthening the area between the eyes and scalp, and sometimes placing an implant, to create a more masculine, angular forehead.
• Jaw and chin augmentation: Jaw and chin reshaping and implants can help to widen the face and contour the jawline for more masculine facial proportions.
• Nose reshaping: Rhinoplasty can help to widen the nose and masculinize the facial proportions.

How much does it cost to have surgery procedures for trans men and what are the procedures?

Surgery procedures could include:

• Facial masculinization surgery (FMS): FMS may include thyroid cartilage enhancement, cheek augmentation, forehead lengthening or augmentation, jaw and chin augmentation and nose reshaping.
• Periareolar procedure: The areolas and nipples are resized and repositioned during this surgery. Two circular incisions around the areolas allow the surgeon to remove the “ring” of chest tissue.
• Keyhole procedure: The keyhole procedure involves just one semi-circular incision below each of the nipples. Keyhole top surgery also allows most patients to keep the sensation in their nipple area.
• Double incision: In double incision top surgery, the surgeon makes two incisions at the top and bottom of the pectoral muscles. The nipples and areolas are removed and replaced with nipple grafts.
• Inverted-T top surgery: Inverted-T top surgery involves horizontal and vertical incisions and the removal of chest tissue but not nipples. Sensation is retained for most patients.
• Metoidioplasty: Metoidioplasty involves releasing the clitoris from the ligament attached to it and repositioning it to create a penis. With this procedure, patients can also choose to undergo urethral lengthening and remove vaginal tissue.
• Phalloplasty: Surgeons use skin grafts from other parts of the body (usually the thigh or forearm) to create a penis. A vaginectomy, or the closing of the opening in the front of the pelvis, as well as scrotoplasty, which creates a scrotum, can be included in some phalloplasty procedures. This is the most expensive of bottom surgery options for trans men, with price tags up to $150,000 in some cases.
• Hysterectomy: A hysterectomy includes the removal of the uterus and ovaries.

Types of Surgeries for Trans Women

Around half of trans patients choose to undergo breast augmentation, facial feminization surgery (FFS) (which involves a variety of procedures that make facial features appear more feminine) and the removal or reconstruction of genitalia.

How much is facial feminization surgery (FFS)?

Average Cost: $20,000–$50,000

Facial feminization surgery (FFS) may include:

• Genioplasty: Genioplasty uses surgical incisions inside the mouth to contour the chin for a softer, rounder shape.
• Cheek augmentation: Implants, fat transfers or fillers can soften the face to create a more feminine look.
• Brow lift: A brow lift raises the eyebrows for a shorter forehead, softer look, and enlarged appearance of the eyes.
• Tracheal shave: The neck bump created by thyroid cartilage is reduced in a tracheal shave.
• Lip lift or augmentation: Lip augmentation can be achieved with implants and fillers. A lip lift emphasizes the upper lip.

What are the surgery procedures for trans women and how much do they cost?

Here are some of the most common gender confirmation surgeries for trans women:

• Facial feminization surgery (FFS): This surgery may include genioplasty, cheek augmentation, brow lifts, tracheal shave and lip lift or augmentation.
• Breast augmentation/augmentation mammoplasty: Breast augmentation is one of the most common gender confirmation surgeries for trans women and nonbinary patients. It might involve saline or silicone implants or even fat transfers from other parts of the body.
• Vaginoplasty: In vaginoplasty, a surgeon uses skin grafts from another part of the body (usually the scrotum or abdomen) to create a vaginal canal. The surgeon also uses existing genital tissue to create a clitoris. This allows most patients to have penetrative intercourse.
• Orchiectomy: An orchiectomy is often a transfeminine patient ’s first gender affirmation surgery. It involves the removal of the testicles.
• Vulvoplasty: A vulvoplasty involves the external part of the vagina rather than the vaginal canal. Skin from the patient’s genitalia is used to create a vaginal opening, the inner and outer labia, a clitoris and an opening that allows the patient to urinate.

Additional Alternatives

Some trans women undergo voice feminizing therapy to adapt their voice to their gender identity. In voice feminizing therapy, vocal cords are surgically altered to raise the patient’s vocal pitch.

Some trans patients might also choose to undergo gender confirmation surgery in the form of body contouring procedures. These might include liposuction or abdominoplasty as well as implants in the calves, buttocks or other areas.

In the U.S., it is illegal for most public and private health insurance providers to discriminate against transgender patients or deny them transition-related care. However, trans patients may still face financial and logistical barriers. Here’s what you should know about health insurance coverage and gender confirmation surgery.

Type of Barriers

Transgender patients still sometimes face health disparities and barriers to medical care, including transition-related medical care. These are some of the obstacles that trans and gender non-conforming people might face when trying to access healthcare and insurance coverage.

• Differences in state-by-state health insurance coverage: Each U.S. state has different policies regarding health insurance and trans-related care. Some U.S. states legally require health insurance providers to cover transition-related care while others do not.
• Difficulty accessing up-to-date and accurate insurance information: The language in health insurance plan summaries can be out-of-date or vague. This can lead to discriminatory denials of care.
• Discrimination and stigma: Discrimination against the LGBTQ community remains widespread, and transgender people may face health disparities and stigma in the context of medical care as a result, as well as other financial challenges . A 2015 study by the National Center for Transgender Equality revealed that about one-third of transgender patients said they were denied medical care or harassed by a medical provider.
• Lack of training and cultural competency among health providers: Some healthcare providers haven’t had adequate training in healthcare for transgender patients, which can lead them to make questionable decisions.

Additional Insurance Considerations

Transgender patients might also have questions about Medicaid coverage and Medicare coverage for gender confirmation surgery and other transition-related care. Both Medicare and Medicaid are prohibited from denying coverage of trans-related care if it is medically necessary.

The Veterans Health Administration (VHA) provides some coverage for transition-related medical care to transgender veterans . However, there is still an exclusion when it comes to coverage of gender confirmation surgery.

If you have insurance through your employer, you might be able to save up for your out-of-pocket surgery costs with a non-taxed Flexible Spending Account (FSA).

Ways to Navigate Health Insurance for Gender-Confirming Surgeries

It can be challenging to navigate health insurance coverage for gender confirmation surgery, but it’s not impossible. It’s important to know your rights as a patient when interacting with providers and finding the best health insurance plan for your needs. Here are some tips to keep in mind.

Stay informed

Remember that your health insurance plan should cover your transition-related care. Make sure that you read your insurance provider’s member handbook. Ask for the medical policy and any specific documents about eligibility for trans-related medical care to determine if you qualify.

Find a plan with no exclusions

Look for a health insurance plan that doesn’t have exclusions for either all transition-related care or specific kinds of treatments. You can often find this information in the medical policy.

Ask your current or potential employer about coverage

If you’re in the negotiation phase of a job interview, don’t be afraid to ask your potential employer about transition-related health coverage. If your current company or school doesn’t cover transition-related care, you might want to advocate for coverage.

Understand informed consent vs. WPATH standards

Before choosing a plan and care provider, find out about your potential provider’s ethical approach. An informed consent model of care allows you to make your own transition-related decisions after being informed of the risks by a physician. The WPATH standards of care might require additional steps, such as letters of support from therapists and other providers.

Look into pre-authorization

You'll need to see your primary care physician before requesting pre-authorization for surgery. It is also known as prior authorization. You might need to gather documents such as letters from medical providers before applying. Depending on the plan you selected, your primary care physician can provide you with a referral. Keep in mind that the referral or pre-authorization may not guarantee the surgery or other procedures will be authorized. National Center for Transgender Equality addresses common health coverage questions related to pre-authorization that may be helpful. It may be a good idea to speak with your health coverage provider directly.

Appeal denials

If you are denied coverage for a transition-related procedure, do not be afraid to appeal your insurance provider’s decision. Some exclusions might be prohibited or deemed discriminatory.

Outside of partial or full health insurance coverage, there are several other options for financing gender confirmation surgery, such as loans, lines of credit, grants and scholarships and fundraising.

There are several different personal loans you can use to fund your transition-related care.

• Bank or credit union loans: To qualify for a loan from a bank or credit union, you’ll need a good credit score and history.
• Family loans: If a family member can extend you a personal loan, consider creating a promissory note so that you have a repayment schedule in writing.
• Online loans: If your credit history is less than ideal, an online personal loan could be a good option.

Grants and Scholarships

Several organizations offer grants and scholarships to cover some or all of the costs associated with gender-confirming surgeries. These can help you avoid or offset any potential medical debt .

• The Jim Collins Foundation : The Jim Collins Foundation is dedicated to funding gender-confirming surgeries for trans people who need them. Grants are awarded on an annual basis.
• Genderbands Transition Grants : Genderbands offers transition grants to offset the expense of gender confirmation surgery for trans and nonbinary recipients.
• Rizi Xavier Timane Trans Surgery Grant : Rizi Xavier Timane, DSW, established a grant program to aid in the costs of gender-confirming surgeries for trans and nonbinary individuals.
• TransMission : The Loft LGBTQ+ Community Center’s TransMission is a small scholarship fund that helps trans and nonbinary recipients with medical, surgical and legal expenses.
• Stealth Bros & Co. Surgery Support Fund : The Stealth Bros & Co. Support Fund offers financial aid to trans men and transmasculine people for surgery, hormone therapy and related expenses.
• Black Transmen, Inc. Surgery Scholarship : Black trans men in the U.S. who have already been approved for surgery by a surgeon can apply for up to $1,000 in financial assistance.
• Point of Pride : Point of Pride offers scholarship-like funding for gender-confirming surgeries on an annual basis with a competitive application process each November.

Fundraising

Many people may raise funds for their gender confirmation surgery. For example, some throw parties with suggested donation amounts so friends, family and other supporters come together. Others raise money for their procedures by selling original art and letting would-be buyers know that they’re supporting a good cause.

Line of Credit

A home equity line of credit (HELOC) is one option if you own your home. With a HELOC, you can borrow against your home’s appraised value and repay it over time.

Certain surgeons partner with medical financing companies to help gender confirmation surgery patients make payments over time. You may want to check your credit score with a free report . Other surgeons allow patients to make smaller payments in installments.

Advocacy Organizations Making a Change

Many LGBTQ advocacy organizations are making a difference in the lives of transgender and gender non-conforming people every day. Here are just a few of the LGBTQ charities , nonprofits and other organizations making positive changes.

• The Sylvia Rivera Law Project : In addition to impact litigation advocacy, the Sylvia Rivera Law Project offers legal services and resources to aid people in their journey toward gender self-determination.
• Transgender Legal Defense & Education Fund : The Transgender Legal Defense & Education Fund is a nonprofit that fights for trans rights and against discrimination. The organization’s Trans Health Project helps transgender people access trans-confirming health insurance.
• Transgender Law Center : The Transgender Law Center is a trans-led advocacy organization that offers educational materials and other resources around healthcare, immigration, incarceration and employment.
• National Center for Transgender Equality : The National Center for Transgender Equality offers educational materials, self-help guides and other resources for the trans community.
• SPARTA : SPARTA is a nonprofit organization dedicated to transgender, nonbinary and gender non-conforming people serving in the U.S. military.

Additional Resources for Trans-Related Healthcare and Support

If you are a transgender or gender non-conforming patient seeking funding or support for your gender confirmation surgery, various resources can help. Here are some of the best resources available for trans people, loved ones and allies who want to know more about gender confirmation surgery.

• National Center for Transgender Equality's Know Your Rights : The National Center for Transgender Equality regularly updates its guide to existing and expanding legal protections for trans people in the U.S.
• HealthCare.gov's Transgender Health Care : The website helps explain what to know about applying for Marketplace health insurance coverage as a trans or gender non-conforming patient.
• HRC's Corporate Equality Index : Human Rights Campaign (HRC) publishes an annual guide to workplace policies and benefits for LGBTQ employees, including a list of companies that offer trans-inclusive benefits.
• Transgender Law Center's Transgender Health Benefits Guide : The Transgender Law Center offers a guide to healthcare advocacy for trans and gender non-conforming patients, including advice on what to do if you face discriminatory denials of care.
• Out2Enroll : Out2Enroll helps members of the LGBTQ community find and enroll in health insurance plans.
• Trans-Health.com's Trans Health Clinics : The clinics in this list specialize in transition-related and trans-confirming care and mental health support.

Social Support

• Transbucket : Initially started in 2009, Transbucket is an online resource and peer-to-peer support group exclusively dedicated to trans participants, primarily discussing gender confirming surgeries and medical transition.
• Gender Spectrum : Gender Spectrum hosts online support groups for trans, nonbinary and gender non-conforming youth, as well as parents and educators.
• Sam & Devorah Foundation for Trans Youth : The Sam & Devorah Foundation for Trans Youth connects members of the trans community with mentors who can offer emotional support and advice as well as empowerment and "building the confidence and skills critical for self-agency and leadership."

Mental Health Support

• The Trevor Project : The Trevor Project provides a number of resources, including suicide prevention and crisis intervention services, to LGBTQ people under 25.
• Trans Lifeline : The Trans Lifeline is a hotline offering peer-to-peer support services for trans callers, as well as their family, friends and allies.
• The Tribe, LGBTribe : The LGBTribe offers mental health support and wellness tools to LGBTQ participants.

About Laura Dorwart

Laura Dorwart is a writer living in Oberlin, Ohio, with her family. She has bylines at VICE, The New York Times, The Guardian and many others. She has a Ph.D. from UCSD, an MFA in nonfiction writing from Antioch University Los Angeles and experience in UX writing and copywriting for brands such as KeyBank. Follow her work at www.lauradorwart.com.

• American Psychiatric Association . " What Is Gender Dysphoria ." Accessed May 27, 2021 .
• CostHelper . " How Much Does Sex Reassignment Surgery Cost ." Accessed May 30, 2021 .
• Current Opinion in Endocrinology, Diabetes and Obesity . " Barriers to Health Care for Transgender Individuals ." Accessed May 28, 2021 .
• European Association of Urology . " First accurate data showing that male to female transgender surgery can lead to a better life ." Accessed May 19, 2023 .
• First Report Managed Care . " Transgender Patients: Calculating the Actual Cost ." Accessed May 30, 2021 .
• Gender Confirmation Center . " Techniques, Incisions, & Surgery Options Facial For Feminization Surgery ." Accessed May 30, 2021 .
• Grand View Research . " U.S. Sex Reassignment Surgery Market Size, Share & Trends Analysis Report by Gender Transition ." Accessed May 29, 2021 .
• Jones, Jeffrey M. Gallup . " LGBT Identification Rises to 5.6% in Latest U.S. Estimate ." Accessed June 1, 2021 .
• Mount Sinai Center for Transgender Medicine and Surgery . " Trans-masculine (Female to Male) Surgeries ." Accessed May 30, 2021 .
• National Center for Transgender Equality . " U.S. Trans Survey ." Accessed May 26, 2021 .
• Planned Parenthood . " Sex and Gender Identity ." Accessed May 25, 2021 .
• The International Center for Transgender Care . " Facial Masculinization Surgery ." Accessed May 30, 2021 .
• UCSF Transgender Care . " Information on Estrogen Hormone Therapy ." Accessed May 29, 2021 .
• UCSF Transgender Care . " Information on Testosterone Hormone Therapy ." Accessed May 29, 2021 .
• University of Utah Healthcare . " Transfeminine Bottom Surgery ." Accessed May 30, 2021 .
• Williams Institute at UCLA School of Law . " How Many Adults Identify as Transgender in the United States ." Accessed May 27, 2021 .

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Advocates: Ban on reassignment surgery for minors would have broad impact on NH health care

Apr. 26—CONCORD — Alice Wade, a transgender woman from Dover in her 20s, said she had to go to Washington to have gender reassignment surgery last summer, and the follow-up services she received at a local hospital here were "laughable."

Wade and many transgender activists said that passing legislation to ban these procedures for anyone under 18 would harm the entire LGBTQ+ community.

"New Hampshire needs to improve when it comes to trans health care, and bills like this will make it harder," Wade testified during a hearing last week on the House-passed ban HB 619.

State Rep. Erica Layon, R-Derry, said the prohibition is appropriate because of the risks and experimental nature of the surgeries, especially on young people.

Layon noted state law does not allow a minor to use a tanning bed until they turn 18.

"I want people to be their authentic selves, but minors having this surgery is a disservice to parents and to minors," Layon said.

If the bill becomes law, New Hampshire would join 23 states that outlaw gender reassignment surgery for minors.

Transgender people like Wade have left the state to get the surgery where it was legal and available.

A coalition of health care organizations also spoke out against the legislation, which would contain the first provision in New Hampshire law to block physicians from making a medical referral, presumably in this case to an out-of-state provider who could perform the surgery.

Those organizations included the New Hampshire Hospital Association, National Alliance for Mental Illness, NAMI New Hampshire, the New Hampshire Medical Society and New Futures, a public health advocacy group.

Dr. Keith Loud, director of the Children's Hospital at Dartmouth-Hitchcock, said it's already hard to attract medical professionals to perform specialized procedures even without such proposed laws.

"Bills like this have a chilling effect on the ability to recruit and retain highly skilled individuals," Loud told the Senate Judiciary Committee.

Sen. Becky Whitley, D-Hopkinton, a candidate for Congress, said she found the ban on referrals the most troubling.

"Why in this one case are we legislating the practice of medicine?" Whitley asked Layon at one point.

Layon said the state has created guardrails for some medical practices, including a ban on conversion therapy for gay people.

Chris Erchull, a lawyer with GLBTQ Legal Advocates & Defenders (GLAD) said a report from the Journal of the American Medical Association found from 2016-2021 there were 101 gender reassignment surgeries for minors under 18 in the U.S., about 20 a year.

Often this was a vaginoplasty for a 17-year-old trans person so the surgery and recovery was complete before the minor headed off to college, Erchull said.

"This targets a class of people and denies them access to treatment," he said. "It is unconstitutional to single out a group of people for treatment under the law."

Under the bill, minors could still have surgeries if needed to correct a "malformation, malignancy, injury or physical disease." Surgery would also be permitted for sex development disorders or circumcision of males.

The House passed the bill last January, 199-175. The vote was not along party lines.

House Republicans backed it, 186-2.

Rep. Dan Hynes, a Bedford Republican who changed to independent before later resigning from the House, also voted against the bill.

House Democrats opposed it, 172-11.

[email protected]

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Down 3-0 in the first round, Phoenix is all but guaranteed an early exit in the big three's first season together. Where do the Suns go from here?

A wrestling match over who should control robotaxis is playing out in California

Cities around the country have long been crying out for more control over how autonomous vehicles are deployed on their streets. In California, they might finally get their wish. The bill, which passed the Senate Transportation Committee this week, is one of several laws that have been introduced in California this year dedicated to putting guardrails on the pioneer technology.

Resumes have changed. Here's what job seekers need to know.

Over the last five years, the workplace has changed, and along with it, the way job seekers should write resumes.

'I no longer have to hide my neck': Women 50+ rave about this firming cream, on sale for $25

The combo of retinol, collagen, and hyaluronic acid help restore a youthful look to skin above the collarbone, fans say.

Reese Witherspoon always travels with this face wash — and a big bottle's down to $13

Also on sale for only $9: The superstar's go-to eyelash curler.

'Vampire facials' likely infected 3 women with HIV. Here's what health experts want you to know about these beauty treatments — and how to stay safe.

Vampire facials themselves may not be dangerous, but unsafe practices at unlicensed spas can lead to infections, experts say.

NFL Draft: Patriots pair 2nd round WR Ja'Lynn Polk with their new QB Drake Maye

The Patriots have a new receiver to go with their new quarterback.

Trump trial updates: Focus shifts to $130,000 payment made to Stormy Daniels

Former National Enquirer publisher David Pecker concluded his testimony about a deal to kill negative stories about former President Trump during the 2016 campaign, and two more witnesses were called.

Michael Penix Jr. said Kirk Cousins called him after Falcons' surprising draft selection

Atlanta Falcons first-round draft pick Michael Penix Jr. said quarterback Kirk Cousins called him after he was picked No. 8 overall in one of the 2024 NFL Draft's more puzzling selections.

8 ways to keep your brain healthy, from doing crossword puzzles to limiting alcohol

Brain health is something people of all ages should be thinking about, say experts. Here are some smart steps you can take to do just that.

Photo-sharing community EyeEm will license users' photos to train AI if they don't delete them

EyeEm, the Berlin-based photo-sharing community that exited last year to Spanish company Freepik after going bankrupt, is now licensing its users' photos to train AI models. Earlier this month, the company informed users via email that it was adding a new clause to its Terms & Conditions that would grant it the rights to upload users' content to "train, develop, and improve software, algorithms, and machine-learning models." Users were given 30 days to opt out by removing all their content from EyeEm's platform.

Report: Amazon and NBA reach agreement on broadcast deal

Amazon Prime Video and the NBA are reportedly nearing an agreement that would make the streaming and retail giant a major platform for game telecasts.

NFL to allow players to wear protective Guardian Caps in games beginning with 2024 season

The NFL will allow players to wear protective Guardian Caps during games beginning with the 2024 season. The caps were previously mandated for practices.

Chevrolet Equinox Plus is a PHEV for China, maybe America

The 2025 Chevrolet Equinox Plus, a plug-in hybrid SUV, recently debuted at the Beijing Auto Show, promising a long driving range and familiar styling.

Elon Musk plans to ban engagement farming on X. What does this mean for the platform?

Elon Musk announced that X would start cracking down on engagement farming. Here's what it means for the app.

King Charles announces return to public royal duties following his cancer treatment. Here's what to know about his health journey.

What to know about King Charles's recent health issues, from an enlarged prostate to a cancer diagnosis.