Top Surgery

I knew from very early on that Arlo was planning on having top surgery as part of their transition process. What I did not know was how both difficult and expensive that process can turn out to be.

In the UK the NHS will pay for most non-cosmetic surgeries without any need for health insurance or patient costs, it’s a fantastic system that ultimately has saved millions of peoples lives. However the NHS is hugely underfunded and therefore they have to priortise emergency procedures over routine operations. So although all gender affirming surges are provided by the NHS the waiting list is incredibly long. In the UK the process for top surgery requires you to see a gender specialist at a Gender Identity clinic who will diagnose you with dysphoria and then complete a referral letter which can be given to the surgeon – a surgeon won’t operate without this letter and there is no other way of obtaining it. If the gender specialist is unsure about your identity or believes there may be something else causing your distress which is not dysphoria they will require you to have a period of counselling and more follow up sessions with them – this happens sometimes for binary trans people and most of the time for non-binary people. If you’re successful in receiving the surgeons referral letter you’ll have a consultation with a surgeon so they can decide which surgery is best for you, then you’ll be allocated a surgery date with an NHS surgeon – and all of this is cost free.

However an underfunded service means long waiting times (and the UK government is only making more cuts to this service despite a rising population!) In our area the waiting time for an initial appointment at a Gender Identity Clinic is 3 years. Followed by a 6 month wait for counselling, another year wait for the second appointment with the gender specialist. A 6 month wait for a consultation with a surgeon, and then a year wait for a surgery date. In total, in our area, the average wait for top surgery is 6 years – by which time Arlo would be 27. The idea that anyone could live with crippling dysphoria for 6 years seems insane to me! Arlo’s chest dysphoria gets worse by the day as I watch them grow more and more unhappy with their body – and so we abandoned the idea of going through the NHS and instead chose to use private healthcare.

Going privately is a very similar process – including the therapy and follow up sessions unfortunately – but the waiting times are drastically reduced, meaning Arlo could have top surgery this time next year! The only downside is we now are tasked with raising £8,000 in 12 months. For an average couple I can imagine this would be very difficult, for a recent graduate in an entry level job and a university student (Arlo and I) this is proving to be very difficult.

I’ve created a huge spreadsheet detailing every expense for the next year and every single piece on income and financially it’s very tight. We’ve borrowed money from Arlo’s parents, I’m attempting to obtain the biggest student overdraft possible, Arlo is making and selling t-shirts alongside their full time job, I’ve obtained some part time work alongside my degree, and failing all of that we’re looking into a 0% interest credit card.

I always used to wonder why glasses were so expensive, they’re like a tax for people without perfect eyesight. Turns out the cost of transitioning is the tax for trans and non-binary people. Of course Arlo’s luck means they have to pay for glasses and transitioning.

Of course I remind myself that Arlo and I are very fortunate, being a couple and sharing resources naturally means it’s easier or us to save money. Alongside that we have somewhere to live, we run two cars, have always been employed in decent jobs; and we have family that can lend us money and would bail us out of financial ruin if needs be. However there are many trans people living pay check to pay check who find it almost impossible to raise the money for their transition (there are over 25,000 fundraisers for top surgery on Go Fund Me), and so for everything Arlo and I have we are very grateful.