Planning for Gender-Affirming Care - Part 2: Hair, Lips, Nails, and More

This piece was shaped by the generous input of transgender and gender diverse friends who’ve navigated this firsthand. Thank you for trusting me with your stories. You can find Part 1, covering gender-affirming surgery, here.

When people think of gender-affirming care, surgery tends to dominate the conversation. But not everyone wants to go under the scalpel, and even those who do often rely on a whole ecosystem of other affirming practices like: hormone therapy, hair removal, voice work, mental health care, a whole new wardrobe, and legal transitions.

While also necessary, these forms of care are still unfortunately most often paid out of pocket. Here’s a breakdown of some of the most common gender-affirming expenses beyond surgery so you can plan with more clarity.

Hormone Replacement Therapy

Hormone replacement therapy (HRT) is one of the most common forms of gender-affirming care, but access has become increasingly restricted in recent years due to evolving federal and state policies.

Starting in the 2026 plan year, new federal rules finalized by the Centers for Medicare and Medicaid Services (CMS) will prohibit Affordable Care Act (ACA) marketplace plans from treating gender-affirming care (such as hormone replacement therapy and surgeries) as an “essential health benefit”. This means insurance companies on the ACA exchanges will no longer be federally required to cover gender-affirming care as a core benefit, and many plans are expected to exclude it or charge significantly more out-of-pocket.

Additionally, there is a federal law pending that would permanently ban Medicaid from covering any transgender healthcare, and would also prohibit ACA marketplace plans from covering transgender care as an essential health benefit.

• Insurance coverage: As of today, coverage for HRT varies by state, insurer, and plan. Not all medication types or administration methods (such as injections, pills, or gels) are included; appeals and denials are increasingly common. Some states mandate coverage, but many do not.

• Out-of-pocket cost: Without insurance, testosterone and estrogen can cost anywhere from $20–$100+/month, depending on medication type, region, and pharmacy. Needles, syringes, and sharps containers may incur additional costs.

• Medical monitoring: Routine labs and provider visits are standard for those on HRT. Whether these monitoring costs are covered depends on the specifics of your insurance plan as well as in-network participation.

Mental Health Care

Therapy is often a core component of gender-affirming care, whether it’s to process your identities, navigate relationships, or heal from the stress of navigating transphobia.

• Coverage: Many insurance plans cover mental health, but finding gender-affirming providers in network can be challenging or require lengthy waits.

• Cost: Typically $100–$350/session out-of-pocket. Some therapists offer sliding scale options.

• Virtual care: Great for rural areas or access-limited regions, just make sure to confirm your therapist is licensed in your state.

Voice Coaching

Voice training can have a huge impact on gender euphoria, personal safety, and daily comfort. Unfortunately, it’s rarely covered by insurance unless prescribed and coded as medically necessary, and even then, coverage is inconsistent. Some people find free resources sufficient, while others will benefit more from professional coaching.

• Private voice coaches: Will often charge $75–$200/session, depending on experience and location.

• Speech therapists: Those with clinical credentials may be able to bill insurance if coded appropriately.

• Online: YouTube tutorials offer free vocal exercises for gender non-conforming folks, and there are even low-cost AI voice trainers like Genderfluent.

Hair Removal

Hair removal can help trans and gender diverse folks create a more comfortable and affirming relationship with their bodies. But like voice coaching, it’s usually not covered by insurance unless required before bottom surgery.

• Laser hair removal: faster and generally cheaper, but it works best for those with high contrast between hair and skin tone. Typical cost: $100–$300/session, depending on the area treated.

• Electrolysis: works on all skin and hair types, but it’s slower, more painful, and more expensive. Costs often run $60–$150/hour, with full treatment requiring dozens of hours.

Cosmetic Surgeries

While unlikely to be covered by medical insurance, procedures like facial feminization, facial masculinization, or body contouring can be critical to feeling seen and safe in your body. These procedures can involve significant out of pocket costs, including travel, consultation, and recovery time.

• Facial Feminization Surgery (FFS): includes procedures like brow reduction, jaw contouring, rhinoplasty, and tracheal shave. Costs can range widely from $20,000 to $50,000+ depending on the number of procedures and the surgeon.

• Facial Masculinization Surgery (FMS): may include jaw implants, cheek augmentation, or forehead reshaping. Costs are generally in a similar range to FFS.

• Body contouring: Liposuction, hip enhancements, chest sculpting, and other similar procedures.

Legal Documents

Changing your name and gender marker can be both deeply affirming and legally protective, but it can also be surprisingly expensive once you add up all the steps. LGBTQIA+ legal aid clinics may offer help with paperwork.

Common expenses:

• Court filing fees: $150–$450 depending on your state.

  • California residents: If you cannot afford the filing fee, you can apply for a fee waiver on court petitions for name/gender change.

• Other potential fees: Notary, fingerprinting, or newspaper publication (required in some counties).

• Updates to ID & records: Expect costs for updating your name and/or gender marker on some documents like a driver’s license, passport, birth certificate, etc.

Gender-Affirming Products and Services

• Binders, packers, gaffs

• Hair styling

• Cosmetics

• Personal training

• Clothing

• Non-gendered products for menstruating bodies

• Shaving supplies

Mutual Aid and Community-Based Help

Community-based resources and small grants are a crucial support for many trans and nonbinary people, especially for non-medical affirming supplies. They may provide:

• Direct mutual aid and microgrants

  • GenderBands offers grants for surgeries, HRT, electrolysis, clothing, and name change fees among other options.

  • Trans Lifeline offers funds for legal assistance, including immigrants and recently incarcerated individuals

• Gender-affirming gear

  • The Queer Trans Project periodically offers free “Build a Queer” boxes with supplies that range from binders to cosmetics.

• Peer Support Groups

  • Trans Lifeline runs a national M-F peer support hotline in both English and Spanish. You don’t need to be in crisis to call.

Final Thoughts

In an ideal world gender-affirming care would be both accessible and affordable.

Until then, if you’d like help mapping out a financial plan for getting the care and support you need, feel free to reach out.

Disclaimer: This information is for educational purposes only and doesn't constitute financial advice. Consider consulting with a fee-only financial planner for personalized guidance.