After making the decision to transition from male to female in 2009, Allie Gray, of the South Hills, says she made a grim promise to herself – one that she no longer plans to keep. “I told myself a few years ago that if I hadn’t had (the surgery) by the time I was 30, I would kill myself” but now, she says, “I find myself less and less thrilled by the prospect of dying.” From findings in a study of the National Transgender Discrimination Survey from October 2010, of the 7,000 respondents, 41 percent of transgender and gender nonconforming people had attempted suicide, compared to 1.6 percent of the general population.
Nearly half of those surveyed reported postponing medical care due to the inability to afford it, at 48 percent, with 28 percent replying that they postponed it due to discrimination. “I still have not had the surgery because I’m poor,” says Allie.
And while transitioning would help someone better match their biological sex to their gender identity to curb the discrimination, surgical procedures can cost thousands of dollars plus the hundreds of dollars to have that gender become legally recognized.
“Cost is a big factor,” says Dr. Draion Burch, DO, of UPMC Magee-Womens Hospital, who also practices at UPMC McKeesport and eight community offices in and around Pittsburgh. “Top” surgery can cost between $5,000 and $10,000, while “bottom” surgery can cost between $20,000 and $25,000, he says. Although every patient is different and some don’t want surgery, others resort to black market or foreign alternatives for things like hormones or silicone injections when they can’t afford them through doctors, Dr. Drai says. About 10 doctors in the Pittsburgh area practice some kind of transgender care, including hormone therapy, hysterectomies, or “top” surgery to remove or construct breasts, he says.
Sandra Soloski, program director at Persad, says the organization that serves the LGBTQ and HIV/AIDS communities along with others like the GLCC, Project Silk and Garden of Peace Project, try to offer as many “trans competent” health-care and businesses as possible, so that someone can find a trans-friendly electrolysis center, for example.
“Costs vary so much according to where someone finds their comfortable identity,” she says. “Often we see so many different shades of expression and identity.”
The group also participates in quarterly community meetings at UPMC Children’s Hospital that started a few years ago to address community needs, like the Children’s Gender and Sexual Development Program founded three years ago.
With the program, families have a place to begin young transgendered people on their way to transition early, Dr. Drai says. And, although medications like hormone blockers are costly, they have a much lower price tag than surgery. “I think it’s amazing, it shows a lot of growth here in Pittsburgh,” he says. “They’re just healthier and happier when they transition early.”
In June, the Pittsburgh Post-Gazette reported that UPMC Health Plan has not had any company ask for coverage of transgender services, but would “entertain a request.” Highmark Blue Cross/Blue Shield plans to offer the benefits to its own employees next year, but does not cover the services in basic coverage to smaller companies, according to the Post-Gazette.
Dr. Drai is optimistic about health insurance, though, for the future.
“I think eventually insurance companies will be more comprehensive,” he says. “ It takes time, but I think it will happen.”
Up from 49 major U.S. employers in 2009, 340 offer transgender-inclusive health care coverage in 2014, according to the Human Rights Campaign’s Corporate Equality Index.
In the National Transgender Discrimination Study, three-quarters of transgender women reported that they had some desire to have surgery at some point or already had, while the majority of transgender men wanted to have, or have already had, chest surgery and a hysterectomy. The study points out, however, “it is impossible to know how many would desire or utilize surgery if it were more financially accessible.” Travel expenses, whether to referrals for California doctors like the ones Persad recommends for certain surgeries not available in Pittsburgh, can also become costly, Soloski says.
“Finances are often a stressor as people wait to go further in their transition,” she says, which also can strain other factors the transgender person might be dealing with like lack of a support network or mental health conditions.
Even with the financial means and social support, working through the legal steps to have a name changed to a preferred gender can be frustrating.
Allie decided she wanted to share the steps she took to legally change her name through the court system in Pittsburgh in order to benefit others.
“It was obnoxious, it took a long time and at the time it cost a lot,” she says, adding that a friend helped financed the few hundred dollars tallied between the $127 court fees, $5 to $25 for background checks, $10 for a notarized document copies and between $13.50 and $30 to reissue a driver’s license when Allie wrote the blog post in 2012.
Fees to advertise the name change can sometimes be waived, and some other court costs can be waived with low income, but in general, legal costs are burdensome, says Michael Silverman, executive director of the Transgender Legal and Education Defense Fund.
The organization began the Name Change Project a year ago after serving 1,500 people in New York City with pro bono work from about 1,000 volunteer lawyers at more than 30 law firms before expanding to Pittsburgh as one of its now ten additional cities.
Two-thirds of the participants are people of color and two-thirds earn less than $10,000 per year with some of those two populations overlapping, Silverman says.
“For these populations, particularly for people who are poor and people of color, access to the justice system is difficult,” he says.
The Name Change Project has planned a training session and reception on Oct. 23 at BNY Mellon to garner more aid from the legal community.
“The hope is we’ll be able to get more lawyers involved and meet the needs of the transgender community in Pittsburgh because we’re lagging behind,” Silverman says.
More and more need means more and more transgender people are coming out and are able to express their gender more openly, which is encouraging, he says.
Persad can help those in need apply for scholarships that fund transitioning, Soloski says.
Collaborative opportunities like the community meetings at Children’s Hospital are encouraging, she says.
“I’m optimistic when it comes together in that way – it might take some time – but there are signs of life,” Soloski says.
