In the first part of this, I gave the science behind all of this. There are many ongoing studies that show the differences, some subtle, some not too subtle, in physiology. In this second part, I want to bring up another reason that the idea that this is a life choice is utter nonsense. I can sum it up in one word.

Cost!!!!!!

No one in their right mind would ever choose a path that could potentially alienate them from family and friends, and mostly financially ruin them. The costs to transition add up very quickly. For most, it begins with the cost for counseling, whether it is with a counselor, a psychiatrist or a psychologist, those costs start to add up. In most cases, these are considered specialists so for most, they have to pay the higher copay. That is if they even have coverage! For myself, a regular GP copay is $40. A specialist is $50. When you first start, you might have to go every week. The counselor is working on many fronts as many transgender folk are also dealing with depression and thoughts of suicide. They are also trying to discern whether this is stress-induced, or true gender dysphoria.

Let’s take a small step back for a second. I have had some training to be a counselor. My high school counselor wanted me to go into psychology. I do have an aptitude for it and the empathy and compassion needed. So I am not just speaking blindly, but from many years of learning and observation. As I have learned on my journey, there isn’t really a black and white. We want to pigeon-hole everyone into cute little cubby boxes, male/female, gay/straight, masculine/feminine. However, research shows, that there really isn’t a strict black and white. There are varying shades of grey.

We see this with the idea of sexuality, whether straight or gay. Yet, there are also those who claim to be bisexual. Even from that middle point, there are shades of grey as there are hetero-curious, bi-curious, gay-curious. There are those who claim to be straight, but might acknowledge a certain guy or girl that could make them rethink that. There are also those who are pansexual, who really don’t care whether you are male or female, gay or straight, they fall in love with the person.

The same applies to gender. There are those who claim to be cis-gendered. Not sure when this term came out. It refers to people whose body and mind are in alignment. It is the obverse of transgender, where the body and mind are at odds. Yet, even with this there are many shades of grey and new terms have arisen as people want to differentiate themselves from specific boxes. New terms such as gender queer and gender fluid have arisen to differentiate themselves from the binary of cis or trans.

That all being said, a counselor, psychologist or psychiatrist has their work cut out in helping their client find where they lie on a spectrum. Going forward, we will refer to the three simply as counselor. So a client comes in and has all of this, as well as all the social interactions coming into play. They have to help them sort through their thoughts and feelings to the point of being able to define a direction. When I first attempted to come out in the 90’s, it was under the Benjamin protocols and you were challenged at every step to ensure you were truly transgendered. I was in counseling for five years. In the end, I went against my psychologists wishes and reverted to regain my ability to work and support my kids. Eventually most family came back, but most of the friends I had, except those who had stayed with me on my journey, never came back.

I had also started seeing an endocrinologist and electrologist. While I had to just do copay with the endo, I had to pay the full amount for electrolysis. In the end, all that money was basically thrown out the window when I reverted, as well as the cost for clothes.

This time around, I was on the accelerated program since I had already gone through this in the 90’s and I had the support of my wife. That has made a lot of difference. I started weekly sessions last year. Soon I was able to move to every other week. I started back with a new endo. Each visit cost me about $50 for copay and then the blood work at around $80 or so. If I remember, the visits were at one month, the third month and then the sixth. I am on every six months now.

I heard about laser being able to do a better job of clearing in only eight sessions. I found a Groupon for a place in Fall River, only $400, and set up eight sessions. Well, when you are older,  you have a lot of grey and white. Laser doesn’t work too well on that, so I am back with an electrolysis. Prices are based on time, but my weekly sessions run between $40 and $65 per visit. As one person noted, they are at over seventy visits. So this is not cheap. It is also very painful. This can add up quickly. As Cindy jokes with me, “See, I told you it costs a lot to be beautiful!”.

I am fortunate in that I have soft features already, but for many they have to have female feminization surgery which can run around $10,000. I am not sure if insurance picks this up, as that is another issue as some policies specifically exclude transgender coverage. For yet others, they might need a procedure called a tracheal shave to minimize the Adam’s Apple. So for many, the costs can add up quickly.

Of course, we haven’t gotten to the cost of Gender Reassignment Surgery or GRS. I haven’t gotten any recent quotes but I have heard reports of costs near $40,000 for the surgery. Add to that, you need to stay nearby for about a week before they allow you to go home. Since most surgeries are done in a very few clinics, this also means air fare and hotel costs. I have heard that more hospitals are starting to do the surgery again. One of the Boston hospitals has reportedly decided to start doing them again, so hopefully I will be local. That is if I can come up with that kind of money.

Mind you, due to insurance companies refusal to cover transgender care, or companies excluding it from their insurance, many transgender people have to pick up the total costs. For many, they end up in the sex trades or other questionable professions in order to raise the funds. I have also seen tweets from people that have started go-fund-me sites to help with the costs.

I have only tried to present the costs for counseling and medical here. There is also the costs for transitioning such as buying a whole new wardrobe, shoes, etc. There are the charges for changing over your name from court costs, I think it was $185 for mine. There are the costs to change things over with the DMV. There are fees with town clerks for changing over other documents.

In the end, it is not cheap to finally become the person you have always felt you were. It can be financially ruining as many lose their jobs because the protections are not there. Many find it hard to get a job even though they may be highly qualified. So there are hidden costs there also. The costs for counseling and medical can be mountainous. Is it any wonder that to some, the only recourse is to take their life? That must end!

I hope this has shed some light on the costs that are involved. Brushing it off as a simple life choice is ludicrous. A transgender person can lose a lot and even their life.

I want to finish up by just taking a moment to thank all the wonderful people who have supported me on my journey. It has been overwhelming at times to hear the support and acceptance. It gives me great hope for the future, not just for myself, but for all transgender people.

My heart to your heart, one heart, one spirit.

Emma