The $1 Million Cost Per Person for Gender Transition

In her recent essay The $1 Million Cost Per Person of Gender Transition, former Captain in the Army Medical Service Corps and West Point graduate Pam Long explains that gender transition has many costs: financial, physical and emotional. Pam notes that legislation has been passed in Colorado and signed by Polis that lowers the age of consent for psychotherapy drugs to 12 years old and parents are not permitted to obtain their child’s mental health records with the child’s permission.
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Kim Monson Featured Articles
The $1 Million Cost Per Person for Gender Transition

Informed consent for every medical procedure should include the benefits and risks. Often risks are minimized because drugs and surgeries are very profitable, especially drugs designed in a treatment plan to be given over a lifetime until the person dies. The gender reassignment transition counseling should include the financial costs and health costs. The discussion should also protect minors from consenting to a lifetime of medical treatment dependency.

The Financial Costs of Gender Transition

There is a “soft transition” that precedes a hormone and surgical transition. Gender dysphoria counseling at $120 per visit, once a week for four years is a cost of $24,960. Facial hair removal at $120 an hour for 90 hours over four years costs $10,800. Transitioning people report additional expenses in binding undergarments to hide breasts, custom shoes for large masculine feet, and daily makeup application.

Hormone treatment for individuals will need to be calculated for the rest of their lives, starting at the age when transition begins.  “Transgender Patients: Calculating the Actual Costs” (2017 figures) reports:

Approximately 75% to 78% of individuals seeking gender dysphoria care will pursue hormone treatments, which are generally continued for the duration of a transgender patient’s life, Dr. Hopwood said. The prices for these will vary by delivery method, he continued, with oral estrogen costing $20 monthly, injectable estrogen roughly $150 to $200 monthly, and accompanying spironolactone $10 to $20 monthly. For transgender men’s hormone therapies, testosterone injections typically cost $80 monthly (but may vary based on state supply regulations), testosterone patches more than $300 monthly, and testosterone gels between $300 to $350 monthly.”

Patients pay up to $1,500 a month for prescription drugs for hormones, and additional drugs like spironolactone to reduce the risk of heart attacks associated with synthetic hormone therapy.

Surgery costs vary depending on external and internal procedures, use of prosthetics and implants, and the extent of plastic surgery. However, $100,000 is an average estimated initial cost. These surgeries are often over simplified in terms of “bottom surgery” or “top surgery,” but most often are a series of successive surgeries.  “Transgender Patients: Calculating the Actual Costs” (2017 figures) reports:

“Surgeries, on the other hand, are characterized by a larger one-time cost. These procedures are most often sought by transgender males, Dr. Hopwood said, with the most common being chest reconstructions costing between $9000 and $10,000. Whereas survey data cited by Dr. Hopwood suggest that 40% of transgender males have already had this procedure, only 3% reported undergoing a metoidioplasty ($50,000-$60,000) and 2% reported having a phalloplasty ($50,000-$300,000). Hysterectomies ($10,000) were also reported by 20% of transgender men…”

 “Breast augmentation surgeries can cost anywhere from $5000 to $10,000 and are sought by more than half of transgender women, he said. Facial feminization surgeries could be as expensive as $40,000 or as little as $3000 depending on the patient’s preexisting facial bone structure. For sexual organ surgeries, vaginoplasties ($30,000 to $50,000) were reported among approximately one-fifth of transgender women, while labioplasties ($4,000 to $5,000; sometimes included with vaginoplasty) and orchiectomies ($4000 to $6000) alone were less common. Dr. Hopwood noted that some transgender women will also seek hair removal, non-breast implants, tracheal shaves or liposuction to better fit in with the general population, although these surgeries are much less likely to be covered by insurance policies.”

Other surgeries include gluteoplasty to increase the volume in buttocks and chondrolaryngoplasty to minimize the appearance of the Adam’s apple. All of these surgeries include risks and complications, in addition to the financial cost. Surgical reconstruction of a vagina or penis can take up to 12 hours under anesthesia in an operating room and require a year of recovery time with intense pain. These procedures result in lost income from not working during transition.

Lastly, there are legal fees to change name and gender on documents that average $1200.

The Health Costs of Gender Transition

Psychological care is an additional cost of transition, in terms of finances, time, and mental health. Transgender people report ongoing stress, exhaustion, and hyper-focus on how they are perceived in public. Current Urology (2021) reports, “Of note, these patients are unique in that they are at an increased risk for suicide, mental health issues, HIV predisposition, and surgical complications specific and related to the procedures performed.”

Scott Newgent in “Forget What Gender Activists Tell You. Here’s What Medical Transition Looks Like,” warns parents against making a life altering decision for children:

During my own transition, I had seven surgeries. I also had a massive pulmonary embolism, a helicopter life-flight ride, an emergency ambulance ride, a stress-induced heart attack, sepsis, a 17-month recurring infection due to using the wrong skin during a (failed) phalloplasty, 16 rounds of antibiotics, three weeks of daily IV antibiotics, the loss of all my hair, (only partially successful) arm reconstructive surgery, permanent lung and heart damage, a cut bladder, insomnia-induced hallucinations—oh and frequent loss of consciousness due to pain from the hair on the inside of my urethra. All this led to a form of PTSD that made me a prisoner in my apartment for a year. Between me and my insurance company, medical expenses exceeded $900,000.”

“During these 17 months of agony, I couldn’t get a urologist to help me. They didn’t feel comfortable taking me on as a patient—since the phalloplasty, like much of the transition process, is experimental. ‘Could you go back to the original surgeon?’ they suggested.”

“Here is what we do know: The long-term use of synthetic hormone therapy shortens lives. Specifically, these medications are associated with an increased risk of heart attacks, pulmonary embolisms, bone damage, liver and kidney failure, mental-health complications, and more. Almost a quarter of hormone-therapy patients on high-dose anabolic steroids (such as the testosterone taken by female-to-male transitioners) exhibit major mood-syndrome symptoms. Between three and 12 percent go on to develop symptoms of psychosis.”


Other reported side effects are loss of sexual drive, loss of sensation, and incontinence.

Who promotes and profits from transgender surgeries?

There has been a dramatic rise in genital change surgeries from 500 reported in 2015 since they have been partially funded by some health insurance companies. As of 2021, Current Urology reports “There are about 9000 transgender surgeries being performed annually across the United States (US). The latest statistics indicate that 0.6% of the US population identifies as transgender.”

In most cases, health insurance does not cover the bulk of the costs, and individuals must acquire loans for gender surgeries.

Since 2014 when the Obama administration ended a 33-year ban on sex change surgeries, Medicare, the US government health program for the elderly and people with disabilities, and Medicaid, the program for people with low incomes, cover gender change surgeries. According to John Hopkins, “When determining cost-effectiveness of medical services in the U.S., policymakers consider something cost-effective if the price is below $100,000 per year of quality of life.” This exorbitant figure indicates that policy makers are captured by a profiteering medical industrial complex.

The Federalist, in an overview of the Pharma and Tech Giants who fund the transgenderism lobby with $424 million to promote a new medical and lifestyle market, provides this perspective on experimental and non- reversible medical procedures across the lifespan:

“It behooves us all to look at what the real investment is in prioritizing a lifetime of anti-body medical treatments for a miniscule part of the population. Melding this manufactured medical issue with civil rights frame entails the continuance and growth of the problem. Transgenderism is framed as both a medical problem, for the gender dysphoria of children who need puberty blockers and are being groomed for a lifetime of medicalization, and as a brave and original lifestyle choice for adults. Martine Rothblatt suggests we are all transhuman, that changing our bodies by removing healthy tissue and organs and ingesting cross-sex hormones over the course of a lifetime can be likened to wearing make-up, dying our hair, or getting a tattoo. If we are all transhuman, expressing that could be a never-ending saga of body-related consumerism.”

Minors in Colorado can consent to gender reassignment therapies and medications

Under Governor Polis, minor consent for medical treatment has passed in several areas, summarized in detail in the legislative issue brief titled “Minors’ Medical Records and Consent to Care.”

In 2019, HB19-1120 “Youth Mental Health Education And Suicide Prevention” lowered the age of consent for out-patient psychotherapy to 12 years old. Parents are not permitted to obtain their child’s mental health records without the child’s permission. This bill was presented as suicide prevention, but psychotherapy is not prohibited from counseling minors on gender dysphoria.

In 2021, the Colorado LGBTQ caucus advanced a Trojan Horse bill to erode parental rights called “Protecting Preventative Health Care Coverage.” SB21-016 was a multi-year legislative effort. Crowds of parents showed up at the Capitol in opposition to this legislation that gives minors consent for counseling, prevention, screening, and treatment for sexual health. In 2021, opposing parents were limited to online testimony. This law gives medical providers the right to “administer, dispense, and prescribe preventative measures or medications, including appropriate therapies” to minors. “Information related to care must not be divulged to any person other than the minor.” “Family planning services” and “family-planning-related services” are not clearly defined in the bill, but the bill does explicitly include STD treatment, cervical cancer screenings, contraception, sterilization services, and fertility services. Medical providers may choose to consult with parents or guardians when clients are 13 years or younger, but they are not required to consult, not even for allergic reactions or drug contraindications. Furthermore, SB016 removed the requirement that these services be provided by a certified family clinic, so minors could receive these services without parental consent or knowledge in a school-based clinic or in clinics that schools refer students to.


Minor consent for experimental and pharmaceutical medical treatment is irresponsible and unethical. It violates the principles of informed consent by giving treatment to a child who does not have the cognitive competence to understand the risks, and it omits screening for the medical history that only a parent or guardian would be able to provide. Parents are advised to set up notifications with their health insurance companies for newly prescribed drugs for their children, and to discuss this issue with administrators at their schools who may not be aware of the recent changes to minor consent. Ultimately, families assume all of the risks and costs of these treatments.



2 Responses

  1. Dear Ms. Long

    I had to scroll thru half a dozen pages of Google results on:

    Total lifetime cost of transgender

    All the other articles either mention surgeries at $10k to $30k (that’s one emergency room visit) or drugs at $30 to $100/month.

    None of then mention infections or other health problems.

    So, hopefully someday, someone will sue Google over their suppression!

    This all came about because the Gay Marriage lobby was raising millions a year and once they ‘won’ they couldn’t just quit, that same year they ‘transitioned’ to trans advocacy. The rest is history, but those a-holes have blood on their hands!

    Dr. Phil Kochan

  2. Where does the author come up with the $1500 a month for medication? Using her own supplied numbers max out of pocket cost would be $350 a month. This also doesn’t take into account this thing called insurance.

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