A Comprehensive Guide to Bottom Surgery Costs

Medically reviewed by Nicole M, RN on October 15, 2024.

Bottom surgery refers to procedures that reconstruct an individual’s natal genital tissue to relieve gender dysphoria and allow them to experience greater gender congruence. The overall costs of surgery––the procedure itself, the preparations for surgery, the time off work needed to recover and more––often comprise the greatest barrier to medically necessary gender-affirming surgery. This guide gives a comprehensive overview of the costs of what some call FTM bottom surgery (metoidioplasty, phalloplasty, etc.) and MTF bottom surgery (vaginoplasty, vulvaplasty and labiaplasty), insurance coverage, as well as grant and financing resources.

What influences the cost of bottom surgery?

The costs of bottom surgery vary from procedure to procedure. If you would like to get an exact quote for your surgery, we encourage you to request a free consultation with Dr. Ley (she/her/they). Dr. Ley is the only trans woman of color in the United States who is a board-certified surgeon and offers a full spectrum of gender-affirming surgeries: bottom surgery, top surgery, breast augmentation and body contouring. 

Procedure Type

For many patients to achieve their goals, they may need to undergo bottom surgery in multiple steps through multiple, staged procedures with their own individual costs. For example many phalloplasty patients are interested in undergoing additional procedures like the construction of a scrotum with testicular implants, a glansplasty or mons resection. The complexity of the surgical technique can also increase the cost. Most notably, we see this with metoidioplasty or phalloplasty that are interested in gaining the ability to urinate out of the tip of their penis. To accomplish this goal, Dr. Ley must perform a primary urethral lengthening alongside a vaginectomy, which will add an extra cost to the surgery. 

Pre-Operative Costs

One candidacy requirement for certain bottom surgery procedures like vaginoplasty and some types of phalloplasty, patients may need to first undergo hair removal in areas that will be used as skin grafts. At this time, the GCC does not offer electrolysis or laser hair removal. However, some health insurance plans with gender-affirming healthcare benefits may cover the costs of hair removal for bottom surgery. Additionally, due to high complication rates, many bottom surgery procedures have BMI limits. Sustainably losing body fat to qualify for surgery may involve other costs.

Location and Travel

Many of our trans, non-binary and gender non-conforming community members do not live near gender-affirming surgical practices whose surgeons are board certified. For this reason, many patients have to travel to access medically necessary care. Travel is another expense to consider in assessing the cost of bottom surgery. You may want to stay in the area for recovery and to be able to attend follow-up appointments. Lodging, food and taking yourself can add up, so we provide a free and downloadable travel guide for patients who come to GCC from outside San Francisco and the Bay Area. 

Additional Expenses

Beyond the cost of your surgery, there can be additional expenses from anesthesia, hospital stays and post-operative care. Costs such as hospital stays, post-operative supplies while in the hospital, and occupational therapy will be included in your upfront quote for surgery. These costs cover needs such as dilator kits for vaginoplasty or occupational therapy to recover arm movement after an RFF phalloplasty. What will not be included in your quote are the costs of medications and travel. We have compiled a free travel guide of trans-friendly resources for patients who have to come into the San Francisco Bay Area 

Procedures and Costs

This guide can only provide estimates, and we suggest discussing a more concrete price in a free consultation. The amount you pay for the procedure depends on your unique surgical plan. For instance, a simple metoidioplasty will cost less than metoidioplasty with urethral lengthening. Similarly, a labiaplasty revision with more extensive clitoral hood and labia reconfiguration can be more costly. You can generally expect the following for the cost of your procedure. Please note that the following are general estimates that will vary depending on your unique surgical plan. 

Cost of Feminizing techniques/“MTF bottom surgery”

Cost of Masculinizing techniques/“FTM bottom surgery”

 The following are GCC policies:

• The GCC only performs the phalloplasty procedures for patients with insurance coverage. In other words, phalloplasties are not available to cash-pay patients.
• The following procedures are available to patients without insurance coverage: metoidiolasty (simple or with primary urethral lengthening), scotoectomy, veginectomy groin flap phalloplasty and minor adjustment or revision procedures. In other words, you do not need insurance coverage to undergo them with the GCC.
• The GCC does not perform hysterectomy. We recommend undergoing a hysterectomy 8-12 weeks prior to metoidioplasty or phalloplasty.
• Additionally, we recommend that you do not undergo a scrotectomy prior to a vaginoplasty or vulvaplasty, as scrotal tissue is used for creating a vulva.

Insurance Coverage

Many insurance providers cover the costs of gender-affirming bottom surgery. In many cases, the most important documentation that patients need to submit in order to secure insurance coverage are support letters from a licensed mental health professional. Some insurance providers may ask patients for two letters instead of one. In some cases, the second letter can be from a mental health professional (some require that the provider have a doctoral degree), but may also be from another healthcare provider such as a primary care provider or endocrinologist. 

Your primary care provider may also need to provide a referral to a surgeon, especially if your surgeon is out of network. Each individual plan will have unique complexities, and it may be best to reach out to your insurer for information. 

Coverage at GCC

Patients that have requested a free consultation with a GCC surgeon will be connected to our free insurance consierge service. Our insurance team will help you figure out if your insurance provider covers bottom surgery and guide you through meeting their coverage requirements. At the GCC, we have a 90% success rate of securing coverage for our patients. You can view our insurance approvals, both simple and complex, here.

Financial Assistance

You may still face financial barriers when seeking out bottom surgery, for reasons ranging from insurance denial to post-operative costs. There are many resources and options to help:

Grants and Scholarships

We have partnered with Point of Pride and Genderbands to provide financial assistance for surgeries. These organizations expertly assess need and choose applicants who will then be considered for surgery at GCC. These grants may not cover all of the costs involved in surgery––such as your personal travel expenses or medications for recovery.

Crowdfunding Platforms

Mutual aid is a tool that many people use to raise funds from their community for surgery. Platforms such as GoFundMe and YouCaring help individuals receive donations and create campaigns.

Non-profit Organizations

Organizations such as the Transgender Law Center not only help with legal transition but also help with navigating finances around gender affirming care. 

Additionally, Quest House in Oakland offers housing ranging from $100-$150 a night that caters to transmasculine individuals recovering from gender-affirming surgery.

Financing options

There are several third party lenders that offer low-interest loans or payment plans for medical care. At GCC, we recommend Care Credit as a respected lender. We do not offer post-operative payment plans, and expect patients to fulfill their full financial contribution six weeks prior to their surgery date or risk rescheduling or cancellation. 

Summary

When planning for bottom surgery, cost is one of the biggest factors to consider. By understanding insurance coverage, surgery costs and financial options, the process can be less daunting. When financial concerns are addressed, it leaves room for you to celebrate taking a step towards your more authentic self.

References

1. Wright KN, Jonsdottir GM, Jorgensen S, Shah N, Einarsson JI. Costs and outcomes of abdominal, vaginal, laparoscopic and robotic hysterectomies. JSLS. 2012;16(4):519-524. doi:10.4293/108680812X13462882736736