Helping gender-dysphoric people feel comfortable in their bodies makes no one much money; turning them into lifelong patients is highly profitable. In the US, puberty blockers cost around $20,000 a year. Cross-sex hormones are cheaper, but taken for decades. ‘Top surgery’ – breast implants for transwomen and double mastectomy for transmen – costs at least $10,000. Vaginoplasty costs $10,000–30,000; more for someone whose missed out on puberty and hence has child-sized genitals, since skin will have to be harvested from elsewhere. ‘Bottom surgery’ for transmen starts at around $20,000 for
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