The Cost of Transitioning

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Changing one’s physical gender to match their mental one has many costs. Here in Manitoba, the cost of the gender affirmation surgery (previously known as gender reassignment surgery) is covered by Manitoba Health because it is essential to our well-being. The stipulation is the surgery must be done at GRS Montreal – the only clinic in Canada licensed to do such surgeries – and one must pay out of pocket to get there, usually by air. After returning home, travel costs are reimbursed once receipts and letters from the clinic in Montreal are provided.

Since the surgery and travel to Montreal are paid for, it appears there are no more costs. However, the province only provides coverage for orchidectomies (removal of testicles), penectomies (removal of the penis), vagioplasties (reconstruction of the vagina), mastectomies (removal of breast tissue), hysterectomies (removal of the uterus), oophorectomies (removal of the ovaries) and phalloplasty (the creation of a penis).  If a person wants breast implants, facial feminization surgery or trachea shave (thinning of the Adam’s apple), they must pay for those themselves. Facial hair removal is now covered by Manitoba Health, but only if it’s done at the clinic of the only doctor licensed to do so and there’s a long waiting list to get in. Anyone who does not want to wait must pay for electrolysis and/or laser hair removal themselves.

Image courtesy of Stuart Miles at

When a person transitions, they must live as their targeted gender for at least one year before they are allowed to have gender affirmation surgery. At the time I started my new life in 2010, surgery was required before we were allowed to change the gender code on our birth certificate. Since I wanted my name legally changed right away, I had to pay $30 for that and then another $30 a year later to change my gender code. Manitoba Vital Statistics now allows the gender code change without the surgery, on the condition that a letter from a mental health care professional is provided with the application, so people today can have both done at the same time.

There is a $10 charge to make any changes to a Manitoba driver’s license. Fortunately, in return for providing a letter from a mental health care professional, Manitoba Public Insurance allowed me to modify my gender code at the same time as my name. Changing a Manitoba Health card has no cost per se, but it must be done in person with a birth certificate. Therefore, because they are only open 8:30 a.m. to 4:30 p.m., Monday to Friday, I had to miss work twice and spend long wait times in their offices in order to get my name and then my gender code changed to match my birth certificate. I had no passport at that time, so no change was required for me with that.

In order to transition successfully, one must be on some type of hormone replacement therapy (HRT). It may be pills, injections or transdermal, whether by patch or gel, and must be taken for the rest of our lives. So, for those who are not part of a private health insurance plan and have to pay out of their own pocket, it can get costly.

Before surgery can be performed, a person must have a letter from a mental health professional. If seeing a psychiatrist, like I was, costs are covered by Manitoba Health. But those who have to see a psychologist and who don’t have a private insurance plan must pay out of their own pockets, and we all know how pricey therapists can be.

Then there are clothes. When I first started my transition, I pretty much only had male type clothes. I had some of my cross-dressing clothes, but most of it was not for everyday wear. Since I had a closet to fill and had very little money, I would get my clothes at various thrift shops or low-priced department stores. I would buy pretty clothes that made me feel good. However, because my body was constantly changing with the feminization of my hips and breasts, clothes I bought at the beginning of my transition only fit me for a short time. With every season, I also had to restock clothes for the changing weather. My summer clothes of 2012 did not fit in the summer of 2013, and so this went with every change of season. For at least five years, I had to keep refilling my closet, and in order to keep costs down, I had no choice but to do my shopping at thrift stores or any place I could find quality, inexpensive clothes.

By now you must have an idea of the monetary costs we face in order to live a safe life, but the biggest price I paid was the loss of my family. When I told my wife I had to transition in order to stay alive, she accepted it, but said I had to leave our home. From what I’ve seen, 75 to 80 per cent of marriages break up when one person transitions. It’s hard when the person who you felt would be there for you through thick and thin throws you out when you need them most. I lost the home we were fixing up together and was no longer living with my golden retriever. Pet lovers will understand this loss. I have two sons, one who still comes to see me, but one who does not accept my transition and who I have not seen since 2012. I still contact him on his birthday and all the holidays, but he does not reciprocate.

Another cost we have to face is the change in our identity. For 48 years, I was known as Richard (or Rick) and had built a life as that person. I had many experiences and was not happy – I suffered from depression all of my life. That was who I was. When I changed into Rikki, I became someone new. I loved this new person, but I did not know who she was. I had to go through puberty again (though it was accelerated with the HRT). I am happier as this new person, as my brain is in a body that has the proper body parts, but because I have only been this person for seven years, I still have a long way to go to find out who I am. Fortunately, I was able to keep my job and maintain the respect I have always had at work, but many trans people who transition at work or school lose their positions and/or get bullied.

Changing a person’s physical gender to match their mental one is an expensive endeavour that is not done on a whim. Besides the large amount of money I had to pay, I have lost my wife, a son, my home and my dog. But it was something I had to do to survive because the alternative to this was suicide. When you see someone talk down a trans person, tell them that they are not doing this to get attention and explain the costs we have to pay just to have a happy life.

rikki_muffywasfluffyRikki Dubois is a transgendered Winnipeg writer. She has two sons in university and is living with her partner, Charlene, and their black Pomeranian named Tux. Her book Muffy was Fluffy helps children understand what it means to be transgendered. Rikki is available to help those who have questions about gender dysphoria and other gender-related issues. Visit her website for contact information or for more examples of her written works.


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