10 Ways to Pay for SRS - updated!
Sometimes without your own money!

Great News !! ~~ Medicare ban on sex reassignment surgery lifted !

Sex reassignment surgery—the ultimate goal of most trans people. Surgery is often expensive and SRS is no exception. Even the cheapest in Thailand is going to cost thousands of dollars after airfare, hotel and miscellaneous expenses. Unfortunately, many of us don't have well-paying jobs, graduate degrees, savings, nor the ability to borrow that kind of money. Some are disabled and unable to work.

How can we get something we want more than the world?

The cost of SRS varies significantly depending where you go and which surgeon you see. If you're on a budget I recommend checking out overseas prices, which are typically cheaper. Thailand has been a popular choice, but there are many other countries. Click here for links to overseas surgeons (I also recommend seaching online).

Dr. Harold Reed in Florida offers discounts for needy trans persons! To find out more click here!

1. Insurance. If you have health insurance try to have hormones and surgeries covered. Some insurance companies have exclusions for gender identity related procedures, claiming SRS is "cosmetic," "elective" or "experimental." However, some insurance does cover SRS. Check your insurance manual, or HR, to see if gender identity procedures and medications are excluded.

Medicaid is increasingly covering SRS!

If you checked out the link above then you read the story of a FTM who forced Medicaid to cough up over $80k for his gender surgeries! If you're disabled, or low-income, I recommend following his path and trying to have Medicaid cover your surgery, just as any medically-necessary procedure. If denied, use the appeal process. Don't just stop at the first denial!

Another option is moving to California. As far as I know, their public health insurance (Medi-Cal) will cover SRS. Also, anyone who is an employee of any campus of the University of California will be covered. Obviously, getting the latest information from the appropriate social service agencies before making the decision to move is essential.

If you can work, Medica insurance in Minnesota covers SRS, as well as gender therapy and hormones. That will require moving to Minnesota, but if it gets your SRS why not?

Medica Insurance: Adult Reassignment Surgery, Utilization Management Policy 

Apparently, Minnesota's public assistance covers SRS. Contact Minnesota's social services to find out about their current policies.

There are ways to get around insurance exclusions. Sometimes hormones can be covered if your doctor uses hormone imbalance, or some other non-gender identity related, diagnosis. Gender identity counseling can be often covered if your therapist uses an anxiety or adjustment disorder diagnosis code.

This is from Blue Cross/Blue Shield: Our Medical Affairs Department indicated that it is generally accepted among professionals that an adult with gender identity disorder who experiences anxiety and stress as a result of the disorder should be treated. Mental health services billed with an anxiety or adjustment disorder diagnosis code would be covered under the mental health benefits available on the plan.

Free hormones. You can sometimes get free hormones from a doctor by asking for samples. Doctors often get free samples from drug manufacturers. I once was given a grab bag of different types of estrogen from a doctor that lasted for months!

Some provinces in Canada (I believe Alberta does) pay for SRS, but from what I understand it's becoming more difficult. It also may be difficult to become a Canadian citizen if you don't live there. If you want to try. There are websites that have information and how to apply. Check for the provinces that still pay for SRS.

As with any insurance denial I recommend appealing the decision. If all your administrative options are exhausted think about going to court!

There's a need to educate our public officials and representatives about trans issues. I think a lot of inactivity in securing transgender rights, including insurance coverage of SRS, is due to lack of education and the dissemination of accurate information. Politicians usually appreciate hearing from their constituents; the challenges and discrimination we face. In the political world the squeaky wheel gets the grease.

2. Work. If you're able to work and make good money this should be a no-brainer, though some people say they can't find a job, or are just too lazy to work their butt off for awhile. When questioned, I usually find out they can't find employment either because of a bad job market in their area, or there are few jobs that match their qualifications. If your passability is an issue you may have difficulty finding a job due to discrimination. In this case, the answer is move somewhere there's a better job market and/or a trans-friendly area with gender identity anti-discrimination statutes. Then I'll hear, "I don't want to sell my house" or "I don't want to move where it's cold." Then you don't want your SRS enough.

"I can't afford to move..."

There are ways around this. Find someone with a garage, basement, or a space where you can store everything but your essentials then drive, take a bus or train, to somewhere with a better job market. When I moved to Oregon 20 years ago, I had one suitcase with a few changes of clothes, some plates and silverware. I rented a studio apartment before I moved so I'd have a place to live when I got there. The next day, I canvassed the city with resumes and got a job in three days. Check the area's job market you're considering and, if you can, find employment before moving.

US Jurisdictions with Laws Prohibiting Discrimination on the Basis of Gender Identity


Barter is the oldest form of money. You might not be able to pay for SRS through barter (who knows, maybe you can!), but there are other things, like electrolysis, that you may be able to. Does your electrologist have a computer? Can you work on computers or do website design (also ideas to start a business)? Does her office and/or house need regular cleaning? (I designed a website for one electrologist and cleaned the apartment for another, in trade for electrolysis.)

  • The costs of medically-necessary gender identity procedures, i.e. SRS, facial feminization surgery, etc are tax deductible.

3. Student Financial Aid

If you have a low-paying job that just keeps you afloat most colleges have grants, student loans, assistance programs and scholarships. Contact your local colleges for info. There are other federal sources (see links below). Both the medical field and computer systems, such as network administrators, pay well. There are specialty schools, like Apollo College, where you can get your tuition paid for by a PELL grant, or student loan, and in a relatively short time be trained for a job. Some of them allow you to work from home, though I'm not sure of their efficacy. I have a friend who's going to nursing school, due to loans and financial aid not a dime out of her pocket has gone to tuition.

Federal government grants

Don't be tempted by online offers, or TV commercials, that claim you can get free money from the government by buying a book or pamphlet. The information is available free on the Internet. The Federal government rarely makes grants to individuals, except scholarships. But a scholarship could be your ticket to SRS!

Sources for scholarships and student financial aid

Advisory Committee on Student Financial Assistance
Federal State and Other Sources

4. Start you own business. Do you have a talent, or are very knowledgeable about something, or can do physical work? Find a service or product that's needed in your community and offer it. Notice I said need, not want. For example, people who drive cars are going to need gas and repairs. I'm not suggesting opening a gas station, but auto repair is a possibility. Avoid products people may not need (MLM, or network marketing, is notorious for this), like vitamins and herbal supplements.

Promote your business

Write a short ad for your business, post it in publications; have business cards and flyers printed, then wait for customers to call or email you. There are online offers for free color business cards, like Vistaprint (you only pay for shipping). Business cards can also be printed with your computer and printer. A catchy business title and a well-worded ad are important. Look at ads in your area of expertise for ideas.

Don't be concerned if you get no response to your ad for a few weeks. It takes an ad three weeks before people start seeing it. That's why you see the same advertisements month after month, even year after year. Target your ads to your prospective clientele. The larger the circulation of the publication the more people will see your ad, though they be more expensive. Once you start getting customers—especially if you're good—you'll likely get more business through word-of-mouth.

I started a housecleaning business twice that way. I also ran a business ferrying people, who came to Dr. Meltzer for surgery, back and forth from the airport to the hospital and around town and put people up in a spare bedroom in my home. I charged for boarding as well as $15 per trip (most gave me $20). I got a lot of free meals at nice restaurants when they wanted to get out of the hospital!

In a few months, my housecleaning ads and word-of-mouth referrals got me more houses than I could handle. When that happens contract out your work by hiring workers. For example, charge the customer a certain rate, say $20 an hour, pay your workers $12 an hour and pocket the profit. Soon you'll have a crew of workers while you sit back and manage your business.

If you can contract your workers you won't have to deduct taxes, social security, worker's compensation, etc. from their pay. Check with the IRS for current contracting terms. Usually, contractors use their own tools and work on their own schedule.

Run an eBay business. Put up some flyers, ads on craigslist, etc. telling people you will sell their unwanted items. You do the photography, listing, collect the money from the winning bidder and ship the items, then split the profits with the owner 50/50.

Another possibility is becoming a Realtor.

  • The SBA provides loans for businesses. They have special programs for women.

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