Trans: When Ideology Meets Reality

by Helen Joyce

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 metoidioplasty, which takes advantage of the clitoral growth caused by testosterone to create a small pseudo-phallus. Phalloplasty costs as much as $150,000. For reshaping facial features to look more typical of the opposite sex – shaving bone from the jaw, nose and brow for transwomen and building them up for transmen; plumping up or slimming down lips; altering the eye sockets – the sky is the limit. And the rise of novel gender identities is creating new, lucrative possibilities. The US has a few doctors willing to satisfy the fantasies of men who want vaginas but not to sacrifice their penises. In ‘penile preservation vaginoplasty’, skin is taken from the scrotum, and perhaps also the abdominal lining, to create a neovagina. Other non-binary surgeries include ‘gender nullification’: the removal of all sex organs, and perhaps the nipples and navel too.