After the initial euphoria of getting the surgery scheduled more practical concerns arose for me. Namely, the cost and how to work around the request Dr. Brownstein had for a letter from a mental health professional. Historically trans people have always existed, however, with the first sex reassignment surgeries in the 50s, doctors had to come up with standards to apply for trans people before any body modification was done. Along the same lines, a diagnosis was created for gender dysphoria in the DSM. Thus, for a long time, before a trans person was allowed to make any sort of change they had to be in either a doctor’s or psychologist’s care and be diagnosed with a mental disorder. Not wanting to be diagnosed with a mental disorder (or at least another one) I wanted to avoid the entire situation wherein I had to receive a letter from a therapist in order to have chest surgery. I should clarify that chest surgery is considered genital surgery, which falls under the past criteria of a surgery requiring a letter (there is a fair amount of published information about the history of all of this, and I’m sure it is better written, should anyone be interested in further exploring the topic). After speaking with Dr. Brownstein, he thankfully waived the letter requirement leaving only the hurdle of figuring out how we could afford to pay for the surgery.
Dr. Brownstein included a pamphlet for a surgery loan in the initial materials he sent us after we contacted his office for more information. M took charge of contacting the surgery loan people after we scheduled the surgery because she has a “real” job and would be a more appealing candidate to loan people. She worked with them over the phone for a few days until they came back with the offered interest rate. This rate was higher than any of the credit cards we have and also had a “service charge” that would have added up to be almost $2000 more than the surgery cost had we taken the full time to repay the loan. Upon hearing this news, we decided to pay using credit cards. We are very leery of credit cards and have only had them since we moved to San Francisco. The decision to put the surgery on credit cards was not made lightly, and then we found out all of the payment details-there are five separate payments to make to various people and places involved in the surgery. One of them, the first, could be made with personal check and was for a relatively small amount. The second and third payments, both due no later than three weeks before the surgery, had to be paid with cashier’s checks. The same is true of one of the two payments due the day of surgery. The final payment is the only payment that can be applied directly to a credit card. At this point, we weren’t sure what we could do, and asked people about their experiences in situations like this. M’s coworker said that there are things called access checks which are checks you can write from a credit card to whomever. The tricky thing about access checks is that they usually have phenomenally high interest rates. Knowing we would have to open another credit card account to help pay for the surgery, we researched and found one that has a 0% interest rate for a year on all transfer balances and access checks. We applied for that one, and were able to pay part of Dr. Brownstein’s fee by writing an access check to ourselves, depositing it into our bank account and then getting a cashier’s check from the bank.
Our experience in trying to deal with the stress of paying for this, and our ability to pay for part of it out-of-pocket has reinforced the idea that surgery or hormones are not accessible to those who can’t afford them. The ability for a trans person to modify their body, if that is their wish, comes at great cost.