It is daunting, but I am of the school that believes that everyone can accomplish this. I also know of people who are on Medicaid who have undergone bottom surgery. It is more of a challenge for those of limited means, but it can be done. Before Trump, GAS was considered necessary medical care for any ACA or government paid plan (Medicare, Medicaid, TriCare). It still is. That is why I was able to get my hospital costs reimbursed. Trump could not repeal the ACA, so he did the next best thing. By executive order he eliminated the national standard for access to bottom surgery and moved the decision to area medical review committees who would consider approval on a case by case basis. The problem of course is that it created a hodgepodge of standards for review. Different states and areas within a state would have committees who might review quickly or move slowly. The kinds of procedures covered, who is deemed eligible, how much is covered and when it is paid is also variable. After a year or two, those involved in transgender surgical care could not realistically continue to practice under such an unpredictable system. They never knew when, how much, or even if they would be paid. To just stay in business, they required that those seeking their services opt out of government plans before they would proceed. It is much like what is happening with abortion access after the repeal of Roe v Wade. It was a page out of the reactionary right’s playbook to further oppress us and limit our rights.
Having said this, there are solutions, just more difficult. Some surgeons still accept government and government sponsored plans. Usually these are the ones associated with large medical centers where payment and timing of it is not as much of an issue. There are also private insurance plans that cover GAS. I have a good friend who works in a window manufacturing plant at $15/hour who is married and has a severely disabled son. She took a part time job at Home Depot working some thing like 20 hours a week. After 90 days she got full insurance coverage. Her plan covered GAS and she got the surgery done. I am also told that the insurance of Starbucks covers GAS. Chronokatie, a bit of a Twitter phenom, works there and was planning GAS about 8 months ago. I have not kept up with her feed. The point is that there are solutions. The situation is not hopeless. It requires continuous digging and networking. For instance I needed a gynecologist post surgery. I started my search more than a year in advance. The only one I could come up with was a midwife—not the best fit. Most did not respond to inquiries or turned me down. By putting feelers out through a local trans chat group, a trans masc member recommended the gynecologist who did her hysterectomy. I called her and got an appointment and could not be happier. I could not find her through a Google search. She has a large trans friendly practice with knowledgeable staff. Professional and thorough. I also had been unhappy with my urologist for years. He not only was not up to date on his skills, he became increasingly inattentive as I transitioned. My gynecologist suggested a new one who is wonderful and a breath of fresh air. He is much more thorough and is up to date on the health risks of drugs that can create serious problems, but which are still being prescribed by many practitioners. He is someone that I never would have been able to identify on my own. The point is that anyone can transition if they are willing to be persistent and keep digging. It is a question of how important it is to them for their own health and well being.
I spent a lifetime saving to put me in the position to be able to afford what I really wanted. There are a lot of bad surgeons out there, and I have seen pictures that are horrifying. A big part of my surgeon’s practice is revision of others’ botched work. Much of it is a result of people going to Thailand or Eastern Europe for cost reasons, but there is a lot of bad surgery being done in the US as well. I would caution people to be careful. If you need revisions, your costs will quickly spiral out of control. The best surgeons post lots of pictures. If yours does not, I would slow down. It is a red flag.
My costs were on the high side. Besides using one of the top practitioners, being forced to travel across country and spend significant time in an expensive city, added a lot to my costs. However we have seen unprecedented inflation in the last 13 years. People think nothing about buying $500-750,000 houses. Many bought them at lower prices and now have hundreds of thousands of equity they can tap. I see kids fresh out of college dropping $80-90,000 on new American cars. These are amounts it is hard for me to get my head around. If they can afford these kinds of things, they can afford GAS. It is a matter of priorities.
The reason I shared my story was so that people considering GAS understand that surgical costs are only part of the equation. In my case it was less than 40% of the total, 22% if you include the hospital costs that were reimbursed. There are a lot of other incidental costs which are unavoidable, not to mention the months long recovery time to get back to normal routines. In particular the non surgical medical costs caught me unawares. I did not anticipate they would be so high. Surgeons do not really discuss them since they are billed separately. People need good information so that they are fully informed when making a decision. I wish you the best of luck. You are already gorgeous. Now if you can just take care of that pesky birth defect.
