The Cost of Transitioning
By Jude Samson
One of the reasons that I delayed as long as I did was the perceived costs that I would have to dedicate. While the process does become costly, especially as you progress, I was surprised that it wasn’t nearly as bad as I first anticipated. So I wanted to touch on some of this for anyone who may be looking to start their FtM transition. (Please note that, unless otherwise stated, all prices are in USD and is geared more towards those without insurance or with insurance that doesn’t cover many trans-related care.) Disclaimer: Prices vary greatly whether you have insurance or not, your state, your country, your doctor. This is just general ball-park estimates.
The things I mention are not requirements for being a trans male as there is no ‘cookie cutter mold’ for what trans people should look like. This is just some of the things I’ve encountered that require money.
One of the first steps prior to starting testosterone is to begin to live and present as a male. This can be as simple as cutting your hair which is little more than a quick stop at a barber or unisex hair place. These prices vary, of course, but seem to average $12-$20 depending on what you want. I usually go for a 0 along the sides and back with a 5 scissor cut on top and a fade to blend it all together. This costs about $12-$15. I purchased a cheap (~$20) buzz clipper from Wal-Mart for some home maintenance since my sides/back grow in pretty fast.
Packing (and Briefs/Harnesses)
This could include packing so that you present the illusion of a penis/bulge or something with practical purposes (such as a multi-functional device). The simplest and cheapest options here is to use a sock. It is also one that probably will cause the most aggravation because it could unroll and move around or even appear lumpy. The next option would be to use a condom filled with gel or gak. For a recipe and some information about this check out Hudson’s FTM Guide.
Other options, the one that I currently use personally, is to purchase a packer. While some can be pretty pricey (upwards around $60 for a basic soft packer) you can get some very decent looking soft packers for as little as $13. Considering this price it’s usually a lot better option than trying to make one with a condom and gel/gak especially when you consider the longer-term and the lack of mess involved with a purchased packer. It is recommended that you wear a harness for it or boxer briefs. I normally go commando on a regular basis but have found that boxer briefs really help with holding the packer in place and to help maintain the look of the bulge you’re going for. When wearing the harness alone I have noticed that the packer tends to slip or feels like it’s a bit unruly, so I will wear the harness and the boxer briefs.
Alternatively, there are briefs more specifically designed for packers. During my initial research for these I was really disappointed to see local vendors selling them for about $60. Online, however, I have found them for as low as $34. However, as with the cheaper packers and harnesses the Tool Shed also offers cheaper briefs for about $20. Check out the Tool Shed Toys as they seem to have some of the better prices around for most of the basic getting-started items FTMs may need/want.
As I am now in a relationship with someone, there’s the need to want to both pack and play with minimal fuss. There are various options available for this but the other aspect I’m trying to include more is to stand to pee. There are a few options for STP devices available but there is the Peecock 3-in-1 which ranges from $170 to $200 depending which size you opt for. If you want the extra sensation during sex you can opt in for the pleasure kit – if you get it at the same time as purchasing the 3-in-1 it’s only $15 but if you buy it alone then it’s $19. They also have harnesses and briefs available to hold it although I’m unsure at this time if the cheaper briefs will work just as well. I’ve seen some mixed reviews on this product but it appears they’ve taken some of the negative feedback from the Gen 1 and made some improvements, so the Gen 2 seems to have some pretty good reviews although there are still some comments about the difficulty mastering the peeing aspect. There is another current option through, Reelmagik, where the basic packer is about $80 and the Penis Prosthetic is a whopping $850 (with flex rod for intercourse use). They are incredibly realistic in appearance, but $80 for something that doesn’t do anything except give you a bulge in your pants, is a bit insane. They’re a bit more limited on the sizes – it jumps from 4.5 inches to 6 inches whereas other vendors tend to give you the 5.5 inch option, which I tend to be more interested in.
The next area and perhaps the one more often sought after over packing is the process of binding. While you can do this for extremely low cost using gauze, a little bit of medical tape, and an ace bandage it is not recommended for prolonged use as it can begin to cause physical harm. If you have someone in the medical field who can snag you a binder it may be a good option, and I used this when I was starting out. However, I was unhappy with how bulky it was where it closed because it used eye hooks, then a zipper, then velcro over the zipper. I purchased this full, one-piece body suit from Underworks and found that the operator wasn’t very helpful when it came to inquiring about the fit as someone who was a pretty curvy female wanting compression, so I did the best I could with figuring out my size. Over time, however, it seems to have lost its elasticity and compression abilities because now it seems to be giving me ample cleavage rather than compression. Even initially, when it would compress, the one draw back I found was using the bathroom. While there is a zipper to open around the butt area for going number two you need an stand to per device or be able to remove the binder almost entirely to pee. Alternatively, over time the rear zipper has begun to slip open and it’s uncomfortable when it does and awkward to find a place to go zip up again. I’ve found it easier to take the binder down off my shoulders and pull it down to use the bathroom even though it’s a pain in the ass to pull on/off. I did like this design for two purposes. First, it eliminated the need for the harness and the briefs since it was all one-piece it included a pouch for your penis or packer already built in. I also liked that it was one piece because one of the biggest issues with the mid-drift binders was that it rolled up from the bottom constantly and this full-suit design stopped that from happening. It really provided support and slimming all over, which was good pre-T since I was still curvy.
More recently I came across reviews for the double t air 7 long cut binder although it was priced at about $90. Unfortunately the company either is no longer in operation or they no longer make that particular binder. Since I’ve lost weight and I’m starting to work out I’m going to look into binders of similar design to the air 7 – something like a tank-top but a little longer that can be easily tucked into the pants. So figure about another $40-50 investment.
\**Please note before we proceed that if you are currently undergoing or thinking of undergoing hormone replacement therapy with testosterone that it is strongly recommend you do so under the care of a physician. There can be many dangers and health risks if testosterone is not administered and monitored properly. The hormone levels discussed below are particular to myself as each individual is different.*
Now there are many different options for testosterone ranging from subcutaneous shots, intramuscular shots, gels, surgical pellets/implants, patches, and so forth. Depending on where you are located, what your dosage is, and which method you select the prices vary greatly. Give SEVERAL pharmacies a call and read them your prescription and ask what the best options are and what they’re prices are. I take testosterone cypionate 200mg/mL and started with a 1mL vial, which Wal-Mart had for about $16 plus the cost of insulin syringes, alcohol swabs, and gloves (as I do SubQ injections). They gave me a big box of syringes which range between $25-$40. The prescription I have is for a 10mL vial which is about $160 at Walmart but mid-way through my prescription someone told me the 10mL vials are about $90 at bulk stores like Sam’s Club or Costco. However, I saw an ad for a site called goodrx.com where you type your prescription in and it gives you the lowest prices and where. When I entered my prescription I found that Walgreens has it for $45. Unfortunately late for my first prescription but hopefully useable on my follow ups.
Because I couldn’t afford the $160 in one chunk Walmart let me break it up into ten 1mL vials which is helpful right now with a lot of financial stresses going on.
Obviously the initial 1mL vials were just fine when I was at 12mg doses and even not too bad when I upped to 25 doses but now that I’m just increasing to 38 the smaller vials are, obviously, going much quicker. I had to lower it to 30mg in order to get about 3 doses per vial. So that’s one trip to the store ever three weeks to a month and even though I was given 10mL at once in the prescription, because they split it up I can’t any 1mL vials in less than one month so if I increase my dose any further I wouldn’t be able to maintain enough vials so on the next prescription I will likely go to Walgreens.
More often than not, however, your best bet is to go through Strohecker’s Pharmacy where “compounded” prices are about $50 and non-compounded are $99 which includes the shipping, needles, and swabs.
Initially I anticipated the testosterone to be very expensive since I don’t have insurance and, even if I did, some don’t cover it. But I was pleasantly surprised to find that to get going initially wasn’t that costly.
Of course, before getting the testosterone I had to have an appointment and get lab work and that cost about $160, which wasn’t that bad back when I started. I went through Planned Parenthood and paid cash for the labs. I am scheduled to have another visit with more labs to test my lipids and testosterone levels next month and will average a visit about every three months.
This is not an easy task, as one could imagine in our post-9/11 world. I haven’t fully investigated this because it is something I cannot do immediately given the costs involved and some of the legalities, although the laws and requirements are starting to change. Primary documents like your SSN and Passport and, in some states, birth certificates, need only a physician’s letter (here’s a template) wherein they vouch that you had “clinical treatment.”
According to Transequality, Clinical Treatment is: “The new policy recognizes that people’s medical needs vary, and that treatment options must be decided by health care professionals on an individual basis. You are entitled to a passport reflecting your current gender if you have had the clinical treatment determined by your health care providers to be appropriate, in your individual case, to facilitate gender transition. No specific treatment is required, and details of your treatment need not be provided. In fact, NCTE encourages you and your doctor to only state in the letter that you have had the clinical treatment determined by your health care providers to be appropriate. Details about surgery, hormone treatment, or other treatments are unnecessary and not helpful.
“The State Department will issue a limited, two-year passport with an updated gender based on a physician’s letter stating that the applicant “is in the process of gender transition.” We believe there is no reason for a transgender person to apply for the limited passport. However, if your physician will not state that you have had appropriate treatment, this option is open to you.” (Transequality)
Name change – This costs about $200 and the rules vary from state-to-state with some states requiring that you post an ad (additional costs) in the newspaper for approximately 7-10 days, others require you to be fingerprinted, others require notarized affidavits from citizens of the county in which you reside. Typically this is process is filed with your local civil court and you need to appear for a hearing. This is often a good first step because most of the other changes you will need to make can be initiated using the court documents of approved name change. Note, you can get your gender changed with a physician’s note, as mentioned previously, but they will NOT change your name without a court document saying it’s been approved to the new name.
Birth Certificate – Once again we’re dealing with an issue that changes depending on which state you’re in. Prices vary according to state but seem to range between $20-$40.
Passport – This can cost for just replacement about $60 if you’re changing gender only with a previous passport or $140 for a new passport/book & card if you don’t have a prior one. **THE PHYSICIAN LETTER PROCESS DOES NOT INCLUDE NAME CHANGE ON YOUR PASSPORT, IT IS FOR GENDER ONLY. If you want the passport to reflect your new name you need to have court documents.**
Social Security Card – The simplest process would be to have your physician write a letter (template provided) Perhaps the most refreshing part here is that this process is free as best as I can tell. However, once again, if you need to change your name here as well you will need the court documents.
This is difficult to determine because there are various kinds of surgeries and different doctors in different states charge different prices. Some will do lay-away plans while others aren’t as lenient. Top surgery can run as cheap as $4,000 to as costly as $15,000 plus expenses for living during recovery.
There are several different kinds of bottom surgery options as well and this gets even more complicated. Which doctors perform these surgeries as it’s not a common surgical procedure? Do they take insurance? Lay-away? Care Credit? Which surgery do you want? Some of them are a one-day surgery some are done over multiple stages with skin grafts and extended recovery times. I will provide a far more detailed account of surgeries and potential costs in a separate article.