Claire: I probably have spent upward
over $200,000, maybe $300,000, in just medical.
It is expensive just to try to be yourself.
[Narrator] Claire is among the estimated
1.4 million transgender people living in the US,
where even patients with health insurance
can face six-figure bills.
There are surgeries like top and bottom,
which can cost over $50,000 each,
hair removal, which costs hundreds of dollars a month,
and a slew of other expenses that most Americans
never have to think about.
Lex: Let's really dig into it.
So, like, let's talk about surgical binders
that you might need coming out of surgery.
Let's talk about... Emmett: Prosthetics.
Lex: Prosthetics, let's talk about
clothing that is comfortable,
time off. Claire: Food.
Lex: Yeah, it's so
many expenses... Garnet: Who's going to take
care of you when you can't work.
[Narrator] The reality is that being trans
comes with all kinds of costs.
If you're trans, your gender identity
doesn't match your gender recorded at birth.
And this can lead to a form of emotional pain
commonly called gender dysphoria.
Garnet: It feels like you're trapped in a flesh prison.
Just extreme discomfort, almost self-hatred.
[Narrator] For decades, doctors tried to alleviate
dysphoria through counseling.
But it was...
Dr. Joshua Safer: An abysmal failure.
We have suicide attempt rates
of 40% among transgender people.
And so we know that that's a failed strategy.
[Narrator] And that left doctors with two strategies...
Safer: Changing the brain to match the rest of the body,
or changing the body to match the brain.
[Narrator] And when you think about it...
Safer: It becomes pretty clear that the mucking around
in your brain is gonna be the more invasive thing.
[Narrator] So people like Garnet, Lex, Claire, and Emmett
opt for strategy two:
changing their bodies to match their brains.
This process is complicated, long, and sometimes painful.
But for many trans people, it works.
Claire: Being able to transition literally saved my life.
My worst day, me, now, as transitioning,
is better than my best day
I ever had in my old life,
when I presented male.
I'm able to walk out this door
and just be able to exist
without fear, without compromise.
[Narrator] But that doesn't mean everyone can afford
these procedures.
Claire: And it becomes this to the point where
you can drown in debt from it.
[Narrator] How much you pay for healthcare
largely comes down to insurance:
whether you have it, and what it covers.
An estimated 14% of trans folks are uninsured.
And for them, a single gender-affirming surgery
like vaginoplasty can cost over $50,000.
But even if you do have insurance,
you might still have to pay for care out of pocket.
That's partly because some insurance plans
simply don't cover trans-related surgeries.
Even though that's illegal in virtually all cases
under anti-discrimination laws.
But there's another reason,
and it's that many insurers don't consider certain
procedures, like facial feminization or breast augmentation,
"medically necessary."
They call them "cosmetic" instead,
and "cosmetic" tends to be code for "out of pocket,"
which is partly why people like Claire
end up having to empty their savings.
Claire: They just came down with a hard no.
"It is cosmetic."
[Narrator] That was in 2019, when Claire tried to get
insurance to cover a scheduled breast augmentation.
Claire: Which now means that if I want to get
that procedure, which I feel I need
just so I can feel more comfortable with myself
and just to be able to stand in the mirror
and look at myself,
now I'm gonna have to pay out of pocket for that procedure,
and that procedure ranges anywhere
between $12,000 and $18,000.
[Narrator] And Claire, she's just one of many.
In one survey, 55% of trans people reported
being denied coverage for gender-affirming surgeries.
And that has consequences that extend
beyond financial and emotional stress.
Safer: Let's just say, for example,
facial feminization surgery for a transgender woman,
that might be a very necessary surgery.
But if a significant point for that individual is to be able
to walk down the street and be treated appropriately
according to her gender identity,
then having a feminine face is gonna be enormous
both for how she's treated and, frankly, for safety.
[Narrator] And even if insurance does cover your procedures,
there are plenty of other expenses that most people
never have to think about.
If you're a trans man, for example,
you could invest hundreds of dollars in binders.
Lex: Let's talk about binders, right?
It's this thing that you put on so that you can
bind your chest and so that your chest is not so visible.
So for a lot of transmasculine-identified folk
or trans men, it's super important to, like,
not have your chest visible.
Also it's, like, a matter of safety,
because I could be well into my transition,
and I still have my chest that can, you know,
sort of, like, out me.
Each binder could cost, like, $40.
[Narrator] And then there are packers, prosthetic penises,
which can cost hundreds of dollars each.
Lex: You know, cis guys don't have to
pay for their penises, right? So.
Emmett: They get it for free.
Lex: Yeah, it comes with the package, you know,
whether you like how it looks or not.
[Narrator] Trans women, on the other hand,
have a different list of expenses.
Claire: So the most expensive thing
for a trans woman is hair removal.
[Narrator] Especially if you do electrolysis.
Claire: It's about $75 to $150 per session,
just for your face.
And you can be doing this for anywhere
between three to seven years.
Garnet: Yup.
Claire: Just to get a reduction.
[Narrator] And then there's something that both trans men
and women have to buy.
Emmett: Because my body changed so much
when I started hormones, like,
I grew out of my clothes.
Lex: Oh yeah. Emmett: So I had to basically
buy a whole new wardrobe.
[Narrator] So that's just it.
Even without medical procedures,
trans people might spend thousands of dollars
just to be themselves.
And unfortunately, many of them don't have
that kind of money to spend.
The unemployment rate in the trans community
is about three times higher than the national average.
Plus, nearly a third of all trans people, including Lex,
report being homeless at some point in their lives.
And the Trump administration
may be making these issues worse.
In 2017, Trump announced a ban on trans troops
serving in the military,
which is, of course, a form of employment.
And in 2019, the administration wrote new rules
that will make it easier for healthcare providers
to deny treatment for trans people
if it violates their religious or moral beliefs.
But that's not to say the US hasn't made any progress.
In 2002, for example, 0% of Fortune 500 companies
offered trans-inclusive healthcare coverage,
while today nearly two-thirds of them do.
And a number of states, like New Hampshire,
have enacted various pro-trans laws.
But no matter how the US continues to change,
for better or worse, there's at least one thing
that seems to always stay the same,
and that's the unshakeable resilience
of the trans community.
Emmett: Trans people are beautiful.
Trans people are resilient.
We've existed for a long time.
We're gonna keep on existing. That's what we do.
Garnet: Oh my God, hugs!
Lex: Wait, wait, wait.
Claire: So this was awesome.