That’s the price tag the makers of the new documentary “The Cost of Gender” place on total male-to-female gender reassignment in the United States. These figures come from a variety of studies conducted by health care professional such as Jaime M. Grant, Ph.D., Lisa A. Mottet, J.D., Justin Tanis, D.Min., and Mary Ann Horton, Ph.D. The costs are a combination of $23,000 average for gender reassignment surgery, plus $36,000 average for lab tests, hormone therapy, and other miscellaneous medical needs. Most health insurance plans won’t cover these costs, which has resulted in a trend of “medical tourism” to Thailand where surgery can cost as little as one-third of the price in the United States.
“The Cost of Gender” is a documentary short that explores Thai gender reassignment options by speaking with past and potential patients, doctors and transgender advocates, some from abroad and some from right here in Seattle. The film is a production by The Seattle Globalist, a social action news publication. It’s a collaborative effort from Seattle Globalist editor Sara McCaslin and Austin-based filmmaker Dacia Saenz.
“One of the unique challenges of this project was finding people who were ready to talk about it,” McCaslin told The Capitol Hill Times a few days after she and Saenz premiered “The Cost of Gender” at LUCIDLounge in the University District on April 2. The filmmakers found a willing and vocal subject in Reverend Carla Robinson, currently a priest at St. Mark’s Episcopal Cathedral here in Capitol Hill.
Rev. Robinson has been a priest for decades, beginning in the Lutheran tradition and serving in various churches in the Olympia area, then coming to Seattle and joining its Episcopal community in the years when she began to transition from male to female. Though the Episcopal Church has historically divided itself along social issues such as gender and sexuality, Capitol Hill’s Episcopal community at St. Mark’s is LGBTQ-friendly.
“The Cost of Gender” takes place over the course of approximately a year, ranging from 2012 through 2013. By the end of the film, Rev. Robinson has yet to visit Thailand to undergo gender reassignment surgery, though she enthusiastically plans to make the trip as soon as finances allow. McCaslin and Saenz also speak with Morgana Love, a transwoman from Mexico City who works as an opera singer. Love agreed to appear in the film not long after she completed her reassignment surgery with Dr. Preecha Tiewtranon, one of the leading gender reassignment specialists in Bangkok, Thailand.
“Thailand has a highly visible trans community and trans culture,” McCaslin said. “It’s very refreshing as a Westerner coming in.”
Dr. Tiewtranon, who is one of two Thai doctors to appear in the film, has performed thousands of gender reassignments over the past three decades, taking what McCaslin referred to as “a holistic approach” to the complex process of transition. “The Cost of Gender” depicts a special celebration Dr. Triewtranon held for Love after she recovered from her surgery, an example of his encouraging style of patient care.
According to his own guide to the gender reassignment process, roughly 90 percent of Dr. Tiewtranon’s patients come from outside of Thailand. In the case of his patients from the United States, he cites cost as the leading reason for the “medical tourism” trend. On average, Dr. Tiewtranon’s practice charges $8,000 for gender reassignment surgery. Most health insurance providers in the U.S. will not cover gender reassignment because they classify it as “elective” surgery, the same category as cosmetic rhinoplasty, breast augmentation and rhytidectomy (face lift surgery).
As of January 2012, the City of Seattle has offered health insurance coverage for transgender-specific care. The change in policy came about largely thanks to the efforts of the Seattle LGBT Commission. Commission spokesperson Hill Wolfe appears in “The Cost of Gender,” as does Emerson Sekins, who also participated in the 2011 talks with the City of Seattle on behalf of the Seattle Commission for People with DisAbilities, then under the pre-transition name of Erica Sekins. McCaslin called Sekins,
“…one of the people who was instrumental in bringing trans-inclusive insurance benefits to city workers and university students.”
“The Cost of Gender” is currently available online at CostOfGender.com. It will also continue to screen throughout the city, both in private screenings and at public events. It appeared at the UNCENSORED Global Health Conference at the University of Washington last weekend and is set to screen in Capitol Hill at the Ingersoll Gender Center as well as at the Translations Transgender Film Festival this May, presented by Three Dollar Bill Cinema and screening at the Northwest Film Forum.