Costs of Surgery: Does One Need to Physically “Do It All” to Transition?

kate bornsteinDeja Nicole Greenlaw
Deja Nicole Greenlaw

Deja Nicole Greenlaw

By: Deja Nicole Greenlaw*/TRT Columnist–

A few months ago, I did an outreach at a local college as part of a panel about gender expression and identity. At one point someone in the class asked how much it costs to transition. A transman on the panel stated that to physically transition from male to female it costs about $40,000. I was amazed, and said that I was surprised that “the surgery” costs that much. He explained that he was speaking of not only “the surgery” but also facial feminization surgery and breast augmentation surgery, as well as face and body hair removal by laser or electrolysis and the cost of hormones. I must have looked confused because he then explained if one wants to do it all then it would cost that much.

I suppose it would cost that much if you want to “do it all.” I know of a few who have had all of those surgeries done, but most of the transwomen I know haven’t. I realize that there are monetary constraints on most of us to have everything done, but then I wonder, if we all had the financial resources would we “do it all?” Do we need to “do it all” to feminize our bodies? If not, then how much is enough?

An overwhelming majority of the girls want to have genital reconstruction surgery, and if they get to do only one of the surgeries, this is the one. This is the one that matters most and it’s constantly on the mind of almost every transwoman I know. This is what many deem as the defining point of becoming a woman. This is the “holy grail” surgery.

There are also some who want facial feminization surgery, FFS. I’ve heard that this is among the most painful of surgeries, as there is bone cutting involved. FFS may also include non-bone cutting procedures such as eyebrow lifting, hairline straightening and nose reconstruction. It may not be as painful as cutting into the bone but I’m sure it still hurts plenty, and if you’ve had any nose work done, I’m sure that you want to keep your sneezing to a minimum.

Breast augmentation involves cutting the skin and inserting and positioning the implants. I would imagine that this is probably the least painful of the three surgeries, but I’m sure that the addition of implants to an already fairly tight chest might hurt a bit, at least for a while.

Hair removal is nowhere near as painful as the three above surgeries, though may be irritating and uncomfortable. The cost may be not as much as the above surgeries either, but it may creep up over time.

Hormones are taken to destroy the testosterone and increase the estrogen in the body. Hormones are pretty magical, as they usually do a very good job over time and can really feminize a body. There are, however, drawbacks to taking hormones. Two drawbacks to the hormones which destroy testosterone are that one’s sex drive is decreased and the pleasure of orgasms is decimated. One drawback to the hormones which increase the estrogen is the chance of a deadly blood clot. Except for the blood clot possibility, hormones involve no pain. The cost of hormones isn’t too bad and insurance will usually cover some of it.

Two surgeries that could also help feminize the body are hip and butt implants. Strangely, I know of no one who is even thinking about them, as transwomen usually have no shape on the lower part of the body. It’s like two parallel lines straight down with no feminine curves, so I’m not sure why this part of the body is overlooked by most transwomen.

So there, in a nutshell, are the ways that you can feminize a masculine body for a price that may lead up to $40,000. Yes, it costs plenty and yes, it does hurt a lot. Does one need to “do it all?” Maybe, maybe not, it all depends on the individual and what they want, and/or what they need and/or what they can afford. I think that most of all it depends on what makes one happy. One may not need to “do it all” to be happy. One may need to just do enough. What is enough to make one happy? There is no one answer. It varies from person to person.

*Deja Nicole Greenlaw is a local transwoman who has 3 grown children and works at 3M. She can be contacted at

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2 Comments on "Costs of Surgery: Does One Need to Physically “Do It All” to Transition?"

  1. Amber Thompson | January 10, 2013 at 4:18 am |

    $40,000, cheap compared to F2M $100,000 plus.

  2. Being a transwoman of some reasonable measure of financial success, and as one who has pretty much “done it all”, I would like to make two basic observations: 1) no, you don’t have to “do it all” to transition, and 2) if you do “do it all”, it won’t be nearly enough. The sad, and rarely discussed reality, is that the state of the art in transition surgical medicine is woefully inadequate. Despite having spent something in the ballpark of $80K on transition medical expenses (which is closer to the current cost of the full plate of available transition procedures than the $40K you cite), I deeply envy natal women’s bodies every day, and acutely feel the pain of all the many ways my body does not measure up to theirs. We have been conditioned as a culture to think that genitals define sex, and it’s amazing that even trans people who have been socialized in this culture buy into that presumption. I’ve known plenty of trans women who have claimed that SRS has completely cured their gender dyphoria. I for the life of me don’t understand these women. As you have so astutely pointed out, my hips are still strait in line with my waste, and I absolutely hate it. Counter to what you say, I am unaware of any effective hip implants for transwomen that can do anything about it. In my mind and personal perception, bodily femininity is far more expressed in body shape than in genitalia, but there’s really little to nothing modern medicine can do about it. Given that doing everything isn’t near enough, how can one say that doing everything is necessary? “Everything” is simply what modern medicine has to offer. Being innately inadequate, every piece of it is simply different elements of palliative treatment of the condition. I will never be cured of the condition. Given that, you either get currently available cure as you can afford or gets your pain to a tolerable level, and then learn to tolerate the pain that’s left. That is what it means to be a transsexual in the modern day.

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