“I’ve met many transgender patients who have faced horrific challenges to societal acceptance, from discrimination to violence,” said Dr. Rian Maercks, the Miami plastic surgeon who performed some of Ms. Paige’s and Ms. Carr’s surgeries. “When their femininity or masculinity is natural in appearance, it protects them from the traumas they may otherwise experience.”

A possible repeal of the Affordable Care Act also adds to the urgency for many transgender people. The act made it illegal for health insurance companies to refuse coverage to patients with pre-existing conditions, and before it took effect, many carriers denied insurance to transgender people, citing “gender dysphoria” as a pre-existing condition.

Still, the Affordable Care Act has not been without its problems for transgender people, who have “all sort of related health issues that are exacerbated by discrimination,” said Kellan Baker, a senior fellow at the Center for American Progress.

In a perspective piece in the New England Journal of Medicine, Mr. Baker noted that while the Affordable Care Act made it illegal to discriminate on the basis of sex or gender identity, it does not require health plans to cover any particular service. Rather, “it prohibits plans from excluding a service related to gender transition for transgender people when the same service is covered for non-transgender people,” he said. So, for example, a carrier could not deny coverage for a mastectomy or hormone therapy for a transgender person if it would cover the service for a non-transgender individual with breast cancer or an endocrine disorder.

Insurance companies often refuse to provide coverage for many surgeries, like facial reconstructive procedures or breast augmentation, because they are thought to be cosmetic and not medically necessary. The 2015 transgender equality report found that 25 percent of the nearly 28,000 respondents had experienced a problem with their health insurance, including being denied transition-related coverage or routine care because they were transgender. Fifty-five percent of those who sought coverage for transition-related surgery and 25 percent of those who sought coverage for hormones were denied — a much higher rate than the typical rate of all claim denials, said Mr. Baker.

“Transition-related health care is not consistently covered in health care plans,” said Dr. Herman of the Williams Institute. “Health insurance is a bit of a patchwork in the U.S., and the states have control over regulating private plans that are sold within the state, as well as their own Medicaid plans.”