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The Cost of Being Trans.

Updated: Nov 10, 2023

We investigate the financial burdens affecting the transgender community and lay out best practices for how organisations can step up their support for trans employees.

An illustration of a pink wallet, with notes and coins spilling out of it and a card with the trans flag on it in the pocket. In the background is a dark blue grid with green and pink graph lines going up and down..

Across the globe the transgender community is facing discriminatory laws and rising levels of hate crimes while fighting for equal rights, healthcare access and legal recognition.


This Trans Awareness Week, we want to shed a light on a lesser discussed issue plaguing the trans community: the financial burden of being trans. In this article we are providing best practices on how organisations can step up to support their trans employees by listening, auditing, and working within internal teams and external consultants to ensure benefits and healthcare packages are inclusive and equitable for trans employees. In fact, from our most recent client survey 70% of organisations said “Creating and/or adapting benefits for marginalised groups, especially the trans community” was a top priority in the next 12 months.


What is the "Trans Tax"?

The “Pink Tax” refers to the phenomenon that products targeted specifically towards women are more expensive than their equivalents which are targeted towards men. In recent years this terminology has been borrowed to describe the unique financial disadvantages faced by other minority groups, such as the “ADHD Tax”.


Trans people are facing a heavy financial burden across the world, for example the cost of transitioning in the US regularly costs upwards of $100,000 even with health insurance. What makes up the Trans Tax varies person to person based on individual needs, gender identity, location and accessibility. Below is a non-exhaustive list of costs that trans people may face while transitioning.


  • Updating your name and gender on legal documents and identification.

  • Buying new clothes, make-up, binders or prosthetics so you can express your gender identity.

  • Counselling and talk therapies to help process the emotional upheaval of transitioning.

  • Monthly hormone prescriptions and blood tests every three to six months.

  • Gender affirmative cosmetic procedures such as laser hair removal and fillers.

  • Surgical procedures to ease gender dysphoria (see: Top Surgery, Bottom Surgery, Phalloplasty, Vaginoplasty) can be extremely costly, often requiring a gender dysphoria diagnosis from a psychiatrist, surgical referral letters, hospital and surgeon fees, supplies for recovery, as well as a loss of income from taking time off work.

  • Ongoing costs to freeze eggs or sperm in order to preserve fertility which may be affected by hormone replacement therapy.


The sad reality is that in the face of these exorbitant costs many trans people cannot afford to access the care they so desperately need, especially when the community is already facing inequalities across employment. Research by McKinsey shows that trans people are twice as likely to be unemployed as cis people and even when they are in employment cisgender people make 32% more than their transgender coworkers, even when the latter have a similar or higher level of education. The compounding impact of facing discrimination in employment, combined with the financial burden of healthcare and the rising cost of living, means that many trans people struggle to cover basic necessities like housing and transportation.


It took a while before I could financially face the idea of spending a large sum of money on top surgery. I also set up my own business at the same time as starting my medical transition and was definitely more cautious with investing in my business because my bills were higher as a result of spending money on private prescriptions. I think finances have been a huge reason why I didn’t transition until later in life. When I started transitioning it was during lockdown and for the first time, I wasn’t spending money on keeping busy to distract myself from being trans so I had a relatively high amount of savings. - Jamie Lowe


Addressing Financial Realities.

Avenues to access trans healthcare vary widely across the globe, so attempting to address the financial burden on transgender people is a complex issue and highly contextual to different countries. In this article we are primarily focusing on the US, UK, and EU.


In the US.

91.2% of adults in the US have health insurance, but only 78% of transgender adults do. This number drops to 68% when we look at transgender adults of colour specifically. When we consider that most Americans have health insurance through their employer and that many in the trans community are struggling with unemployment, it becomes clear how for many trans Americans, transitioning is simply out of reach.


Even with health insurance, many transgender people still report being denied coverage for gender affirming care or struggling to cover their deductibles and copays - a 2020 study found that the out of pocket costs for transgender individuals accessing hormone replacement therapy through Medicare ranged from $72 to $3792.


In the UK.

While trans people in the UK should be able to receive access to gender affirming care for free through the National Health Service, waiting lists for a first appointment at the country’s gender identity clinics are currently up to 87 months long (that's over seven years).


While some trans people are resorting to private healthcare in order to transition, the associated costs are out of reach for many - the last National LGBT Survey found that 60% of trans people in the UK make less than £20,000 annually, which isn’t so surprising considering that that 1 in 3 UK employers admit they wouldn’t hire a trans person.


Coming out later in life, I felt I had a lot of catching up to do, and so I felt going private was my only option – especially given the toll it was taking on my mental health. To date, I’ve spent thousands on my medical transition, and I’m at the point where I can no longer fund any more personally. I’ve had to put buying a house on hold to fund what I have so far. It’s also impacted my ability to go out, go on holiday etc. All I’ve done is work non-stop to get to where I am. Now, I have no choice but to wait for the NHS service to get to me in the queue. It’s because of these waiting lists that I took NHS England to the High Court, to challenge the long waiting times. - Eva Echo

In the EU.

Access to trans healthcare varies widely across the EU in line with individual countries' public health insurance systems. Malta and Spain are currently leading the way for trans healthcare in the EU by depathologizing the process, allowing trans people to access care without needing to be diagnosed with gender dysphoria. The Maltese Prime Minister has also announced plans to pay for gender affirmative surgeries.


Some countries like France and The Netherlands are in a similar situation to the UK, where gender affirming care should be provided under public health insurance but trans people are being forced into private healthcare by lengthy waiting lists. Countries like Georgia, Russia and Slovakia provide virtually no coverage for gender affirming care.


Whether using public or private health insurance there are often arbitrary (and transmisogynistic) distinctions drawn about whether procedures are medically necessary or “cosmetic” - a trans man in Belgium can access a mastectomy through public insurance but a trans woman wanting to augment her breasts would have to pay for her surgery out of pocket.


For a broader oversight into the accessibility of trans healthcare in different European countries check out Transgender Europe’s Trans Health Map.



How do we lessen the financial burden on trans people?

Employers are in a powerful position to support transgender staff by doing their part to understand and help alleviate the Trans Tax. We Create Space is proud to partner with organisations in developing these strategies through our trauma informed, intersectional programmes and experts.


In the absence of state-funded trans healthcare, it’s so important for employers to show they value their employees – especially given that we spend so much of our lives at work. Gender-affirming care allows employees to bring their full selves to work, meaning they will be more productive and confident. From taking time off for appointments (in the way they’d allow time off for other employees for other matters) to anti-discrimination policies, the protection of trans+ employees is vital in creating a more progressive and inclusive workplace culture, which will only attract more future employees. - Eva Echo

1. Survey your trans employees and listen to their feedback

No one is better informed about the needs of your transgender employees than themselves! The field of transgender healthcare can be incredibly complicated, so surveying your employees about what they really need is an essential first step.


Using an external consultant like We Create Space to develop, implement, and report back survey findings gives trans employees the opportunity to speak with neutral experts who can influence the organisation. This removes the burden on trans employees to educate leaders about the discrimination they experience. If you currently don’t have any transgender employees but would like to attract more diverse talent, an external consultant can gather relevant data from trans professionals in your country to inform changes to your benefits package.


It is essential that surveying is done mindfully and with the creation of psychologically safe environments as transgender adults report lifetime depression at twice the rate of cisgender adults.

2. Build allyship into every decision.

Empowering and training all leaders and decision makers to be better trans allies is vital to ensuring trans people are considered and heard. Allyship Activation programmes support the leaders who are supporting others through skill building, continuing education, and practise woven into their daily jobs. Overtime, more organisations have become inclusive allies, in 2002, 0% of Fortune 500 companies offered trans-inclusive healthcare coverage, but this figure has increased to almost two-thirds by 2019.


3. Close the trans pay gap.

Ensuring that your trans employees are being paid fairly is essential but in order to collect relevant data to identify any pay gaps, your organisation will first have to make trans employees feel safe enough that they are happy to self-report their gender identity. Setting up an LGBTQ+ ERG, hosting trans centred webinars and workshops and celebrating events like Trans Awareness Week help foster a sense of belonging for trans employees. Psychological safety has to be built into the business holistically, especially when it comes to trans employee self identification and understanding how their data is helping make real change.


We know bringing cultural principles to life for employees can be difficult when you are trying to grow your impact and business. It’s why we recommend having a strategic annual plan custom built to support action over idleness to ease the burden for teams of all sizes.


4. Build a benefits action plan.

Using your survey results and feedback as guidance, identify areas of weakness or inequality in your existing company benefits. Working with an external consultancy of experts like We Create Space will ensure your new benefits are following industry best practices and creating meaningful impact for your employees. It’s important to consider how employees can access these benefits through both in person and digital methods.


If you offer private health insurance to employees, you should be auditing your provider for trans-friendliness, competency and inclusion. In places like the UK, offering private health coverage is not common, so having a plan that covers gender affirming care is a major opportunity for employers to stand out and exercise their support of the trans community.


If offering health coverage is outside the capacity of your organisation there are still plenty of other ways you can improve benefits for trans people navigating their transitions, such as egg and sperm freezing, fully paid medical leave and flexibility around working hours.


5. Ensure staff and potential employees are educated about your benefits.

There’s no use having a trans-inclusive benefits package if the information isn’t readily accessible to employees. According to research by McKinsey transgender employees are 1.5 times more likely to find it difficult to understand a company’s culture and benefits. During recruitment a transgender candidate may not want to out themselves by asking about whether health coverage is trans-inclusive, so offering this information up front ensures you’re putting your best foot forward. Having members of a LGBTQ+ ERG to help disseminate this information and inform new staff members is a great way to increase engagement for both new and existing employees.


If you need help starting, growing, and/or empowering ERGs at your organisation, we’ve developed programmes like Queer 365 to drive change and elevate marginalised groups all year long.


With Gen Z being reported as the “queerest generation ever, there will be more and more demand for trans-inclusive benefits as they continue to enter the workforce. By offering trans-affirmative benefits organisations have the opportunity to become hugely attractive to transgender employees, leaders in their industry, and foster a diverse, fulfilled workforce. We Create Space is on a mission to improve the lives of LGBTQ+ people around the world and want to help your organisation do the same, get in touch with us today at hello@wecreatespace.co.


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