Recently, I finally got a court order from the County of San Francisco to update my birth certificate. That was $480 plus a decent amount of time. Then I dropped that, more paperwork, a certified copy of my legal name change (another $400+ piece of paper) and another $22 in the mail, shipping it off to the Commonwealth of Virginia. By early September, I should have an updated birth certificate. Then I can get a passport and an updated California driver’s license. Never mind that my Minnesota license is already correct, California wants some different paperwork and my license expires on my next birthday. Sometimes I wonder, how much did it truly cost?
It’s a trickier question than you might think. Let start with what I needed to update the birth certificate. I am able to update it because I have a vagina and that’s what the state I was born in requires. Seems a bit arbitrary, no? And I have that because my insurance was so kind as to cover my “sex transformation” (as they put it. No. Really) as long as I had all my paperwork in order. I paid my deductible ($2,000) plus some other incidentals since unfortunately I didn’t live 20 miles from San Mateo like I do now (probably another $2,000 or so with travel and hotels). I was out of work for a while after that, too, though thankfully FMLA came through for me on that, but that’s not a given. That vagina requires some minor maintenance, and will forever, but there’s worse fates that dilating, and that’s a fairly minor cost, all things considered, but it’s nonetheless a little time and money, so consider a few bucks every month or so for that as well. Prior to that, I paid about another $500 to make a consult happen. I didn’t need it as much as I needed peace of mind it provided. That, of course, is just my experience. Costs vary wildly, from upwards of $20-25k to others who’ve had similar experiences to me.
Now in order to get insurance to cover the procedure in the first place, I needed two letters from doctors. I had good insurance and lived in the Twin Cities where such a thing was less of a hassle but it’s still a hassle. Now to get those letters takes a while because there’s a degree of time required before they will give them to you. The gist is usually that you are “full-time” (which is a ridiculous term, but bear with me, there’s a lot of ridiculous jargon when you go through the front doors of the gatekeeping process like I did) for two years, which means you are living in your chosen (read: actual) gender for at least two years prior to surgery. Or maybe it’s only one? Either way, the gatekeeping process doesn’t exactly have a vested interest in pushing you along (you’re paying the bills after all). I always felt I was marking time. At best, that’s a few years meeting with doctors. Pretty frequently. Again, fortunate to have good insurance, but even with a decent co-pay I was probably spending a good $60-70 a month. Without it, it would have easily been double. Or not possible. Getting insurance to cover it in the first place was a whole to-do as well, though that only cost me time in the end. Ignoring that, that’s still conservatively about $3,000 over four years or so.
Medications don’t come cheap either. Well, spironolactone wasn’t that expensive, $5 or so, but estradiol, even when covered, ran me $28-35 for eight patches. And you have to take more estradiol at the beginning because you still have all this damn testosterone. So it was two patches twice weekly until miracle of miracles it’s no more spiro and half as much estradiol. Now through some strange act of fortune, even my estradiol is generic (all praise $7 meds) but drug prices always bounce around and it’s not given it’ll stay that way. I’m not here to project, though. I started medically transitioning in May of 2008 at which point I was probably spending about $60-70 a month on meds; after surgery that dropped significantly, but until recently I was still spending $30-35 a month, roughly. Let’s say I’ve probably spent $3,500 or so on meds the past 7 years. Pre-tax fund because, again, I won the insurance lottery.
There are lots of other things too. I never had much facial hair, and it’s nice and dark and I have fair skin, so I only had to pay for several sessions of someone shooting my face with lasers. Is that required? No, but I am guessing you’d have a hard time finding trans women who haven’t had at least some who transitioned after puberty, provided they can afford to, because facial hair is hella triggery for pretty much anyone I’ve met, though I’m sure some people care less than others. That can range wildly in price, but I would say it’s probably another $2,000 that I spent. And if you are going to have GRS, at least the doctor I went through wanted me to get some laser on my groin area as well. Again, probably spending $3,000-4,000 on that all told by the time it’s all said and done. At least. And while you might not care that much, if you are going through the traditional gatekeeping process (its own bullshit topic for another day), your doctor might. Hopefully that is getting better, but there’s a certain amount of performative femininity required when dealing with people like that. And sure, it seems stupid, but if you weren’t getting laser, they might wonder if you really want to be yourself. Which, again, is ridiculous, but these are the kind of people you’re dealing with and they wield an outsize influence on your life.
And of course, as a trans woman, welcome to the higher incidental cost of everyone giving a fuck about how you look. And with the trans component, welcome to the additional balance of trying to be yourself in a world where many might say too much femininity is just buying into toxic standards for women and not enough is you not trying hard enough as a woman. If they think of you as a woman at all. This is ignoring, of course, that maybe you wanted to do these things for a long time, but you felt constrained by the narrow norms of being socialized male in our society. There are still higher incidental expenses for women in terms of personal care. We can want that to get better and change and still acknowledge that it exists. Plus it’s an exciting time of trying to do all these things that you may have felt you couldn’t do openly before. I certainly spend more on my personal grooming now than I did before, because I want to. No one is making me. My hair doesn’t stay this color on its own, though. This is much harder to put a price on, because much of it just stems from how much more I care about how I look now because I finally look like me and that’s worth spending money on. Still, that cost is there to a degree.
By now, hopefully you are beginning to see how paradoxically interconnected it is. It helps to have a good job and good insurance, but it can be hard to get a job when your legal documentation doesn’t match your actual identity. And it can be hard to update that legal documentation without a job. You may have to out yourself in the process of employment because of that, or in an attempt to determine whether or not you will get sufficient medical coverage, even if you have no desire to be out to your employer. And even if you have a decent job at the start of actually transitioning, who knows what might happen? Financially speaking, there’s a good chance your wages will stagnate or go down even if you are the exact same employee you were before. You might even be better now that you can bring your authentic self to work, but that’s no guarantee you won’t find yourself on the way out soon enough. And there could be whole new problems that come up and make the job untenable. Then what? How much is enough? How do we justify that to ourselves? What bargains are you going to make to be yourself after a life of already making lots of bargains to not be yourself? It sure is satisfying to say none, but that is a difficult path.
Can you put a cost on truly being yourself? No, but is there a cost? Definitely. Not just in the money that you have to spend, but in how society will treat you. Even in my life where things have worked out well, it’s hard not to wonder if my male coworkers doing the same job as me are making much more (probably), if they have a better chance to move up to whatever’s next (also probably). I am sure they feel more comfortable taking chances. I do now, but there was definitely a time when I couldn’t afford to, lest my insurance change. Which is still a privilege, of course. That I have good coverage at all puts me in a different category. But it’s still a tenuous relationship. Luckily I haven’t felt stuck at a bad job because of it. But since that isn’t a given, that was a cost I had to keep in mind. It is better than having nothing at all. And we should address that as a society. But you can see how it affects how you think of things, no? Better doesn’t mean it’s as good as it should be if we’re talking overall goals. There are more important people to reach first than me. But like most things in life, it’s not a simple linear progression. We can simultaneously be working to make this better, but we should keep in mind that circumstances are statistically much worse when factoring in race, class, education. Hell, I experience it because I’m a woman and our systems are much better equipped to handle binary than non-binary folks. I may be trans, but I still experience a lot of privilege because of who I am in other ways. Lots of folks can’t just sit down and tick off the costs they’ve paid for stuff like this because they don’t have the money, insurance, and access or the systems aren’t set up for them in the first place and we aren’t doing enough to ensure that they enjoy those things.
Soon, I’ll have paid the last simple, pecuniary costs of my transition. Really, I already have in that things like new IDs and passports are incidental costs we all pay going forward as we get older. I never feel like I’m done in the sense that I’m always trying to be more me, and I already largely feel I closed that initial chapter years ago. This is more of an epilogue or an afterward. One last thing to do before a checklist I laid out many years ago is done, really, truly finished. Even if I thought I could, it’s hard to put a number on it, but it’s easy to see the costs are too high.