A new paper published in a special issue of Psychology & Sexuality has explored the costs associated with transitioning related treatment for and diverse individuals living in four different countries: Canada, Japan, South Africa, and the United States. The authors of the paper first presented their work as part of a symposium at the 2018 LGBTQ Psychology Conference: Preaching to the Choir, held in Montreal, QC.

One of the reasons it is important to examine costs associated with transition-related care is that researchers have consistently shown that transgender and gender diverse individuals are at the greatest risk of and prior to receiving gender-affirming care. Consequently, affordable access to both medical and social forms of transitioning plays a protective role, reducing mental health challenges and suicide. The paper is the first of its kind to explore the costs associated with transition-related care across a set of four diverse countries. The authors were not aiming to provide a conclusive examination of costs around the globe but wanted to pick four distinct countries to see how the costs can vary by country.

Commonalities in Transition Services Across Countries

Before looking at some of the differences and hard numbers that they report, it’s interesting to examine the commonalities they found across all four countries. Regardless of country, the authors reported that experiences of stigma, , and rejection were prevalent for transgender and gender diverse individuals accessing support through their country’s healthcare system. They also found that none of the countries examined had federal level policies, meaning that, to a great extent, the services available and their costs varied significantly based on where people lived within their country. For example, people living outside of urban centers often had significantly reduced access to transition-related healthcare services, and therefore had to incur the additional cost of traveling to larger areas that could provide such services. Finally, they also found that mental health care providers were active in assisting transgender and gender diverse individuals in accessing care, and thus they point to the importance of increased training for all mental health care providers in relation to the healthcare needs of trans and gender diverse individuals.

Name Changes

While name changes were free of financial costs in Japan, the other three countries all charged something for anyone wishing to officially and legally change their name, ranging from $13 (CAD) in South Africa to $270 in the United States. However, in Japan, some of the requirements for changing a name or gender marker were more stringent, such as including that the person undergoes sexual sterilization.

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Surgeries & Hormone Replacement Therapy

The paper focused on Ontario in Canada, as the coverage for surgeries varies from province to province. While some of the costs of GAS are covered in Ontario, certain surgeries and transition-related care are not covered. For example, voice surgery, replacement , and electrolysis are some of the healthcare treatments not covered in Ontario.

In Japan, costs of GAS range from $17,000 - $24,000 (CAD), which, until recently, were not covered at all. As of April 2018, however, some coverage is provided, such that depending on a patient’s ability to pay, they now only pay between 10 and 30% of the total cost.

In South Africa, the vast majority of the population makes use of public health, with only 18% of the 55.91 million people in South Africa having private healthcare. Although the costs of GAS are covered within the public system, in some cases, waiting lists are up to 25 years. Even within this system, there are still some costs, as most of the services are provided on a sliding scale tied to income.

In the United States, the financial cost of surgeries and treatment vary wildly based on an individual’s insurance status. Roughly 19% of transgender people in the US do not have any form of health insurance, while an estimated 51% have employer-based insurance. What is covered or not covered varies wildly between insurance policies, but in general, costs for transgender men are in the range of $20,000 CAD, and up to $35,000 for trans women. These estimates do not include invisible costs, such as the financial costs associated with related depression or job loss). Finally, for some, when they have their gender marker changed with their insurance policy, this can result in loss of coverage for previously covered procedures. For example, if a trans man has his gender marker switched from female to male, he may no longer have coverage for mammograms or pap smears, even if he has not had any gender-affirming surgeries.

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Mental health providers play an important role.

The authors conclude that healthcare providers must be aware of the financial burdens associated with transition-related healthcare and that policies must be made with consideration of the importance of these treatments to the mental and physical well-being of transgender and gender diverse individuals.

To learn more about Preaching to the Choir and the upcoming conference (July 16 & 17, 2020) in Prague, Czech Republic, click here. The abstract submission deadline is December 15, 2019.