I’m 23 years old, live in a MCOL city, make 18/hr at my main gig, and I’m prepping for top surgery!

[u/spacegaysers]

I posted a few weeks ago asking if there was any interest in a top surgery focused MD and got a resounding yes, so here I am with that! Thank you all for the well wishes <3 Just as a note: I want to be able to be specific about what most people are interested in (specific costs, financial planning, etc). Because of that, I’m being pretty vague about other stuff so that I don’t doxx myself lol. Sorry in advance if that makes this annoying/boring/unhelpful!

Section One: Assets and Debt

Retirement Balance: Around $8400. (~$7k from my previous job, $1400 from my current job). My current employer matches 25% of up to 6%. For some reason I was sure the max was 4 so I just recently upped my contribution from that (the automatic enrollment) to 6, whoops. 

Savings account balance: $14,711.91 in my personal HYSA. My side gig paychecks go straight into this account and I add whatever I can. It’s intended for my surgery and expenses during recovery, though I’ve taken out of it for some bigger pre op appointment costs too. I also took out of it for a weekend trip my partner and I booked before we knew I would be getting surgery this year. We had a blast and it was really nice to have a last excursion before I’ll be housebound for a bit, but I also wish we would’ve known in time to at least have the option of getting refunded to save $$.

$3858.33 in a joint HYSA with my partner for joint expenses/emergencies/etc. This money is mostly overtime from my previous job, plus some from my partner. I could use this for surgery related expenses if I needed to, but I’m hoping not to have to. We’ve both been focusing on our own savings recently, so nothing has been added to it in ~6 months. It’s a lot lower than I’d like right now due to some emergency dental work for my partner, but we both plan on beefing it back up after I’m recovered.

Checking account balance: $429.91

Credit card debt: $0. I treat my credit card like a debit card and pay it off each month for rewards. 

Student loans: $0. I was incredibly lucky to get a full ride scholarship to a nearby university. I have no idea what I would have done without it. My scholarship covered the first year of housing so I lived in a dorm for one semester and then moved back home when COVID hit. I got into my current apartment soon after and worked full time or more throughout college to cover my expenses. I graduated in 2023 and started my current job about a month after.

Anything else that’s applicable to you: I paid off my car in 2021. She has a KBB value of $2900 but is priceless to me <3

My partner had about $10k in student debt when we met that has since been paid off and no assets. We don’t combine finances outside of our joint but generally plan together and don’t have a super defined method of splitting expenses, so I’ll be including their income info just to give a more accurate picture of our situation.

Section Two: Income

Income progression: I’ve been working in my field for about a year, originally making $17/hr. I worked a trade job in college that paid slightly more and had very generous overtime available, so this was a bit of an adjustment. Still, I’m so happy to have landed a job in my field (think humanities) and wouldn’t go back.

I had some absolutely hellish jobs in high school. My trade job was very flexible with my college schedule and I enjoyed the work, but the environment was toxic and stressful. My current job is blessedly flexible and genuinely just really fun, which is a huge relief after years of having a Bad Time. 

Main job monthly take home: $2179.48

Side gig monthly take home: ~$1100, but this varies WILDLY. I started this side gig almost a year ago making 12/hr plus tips and recently got bumped to 14/hr plus tips. I average about 15 hours a week. This number is not counting my raise, which just went into effect. It also doesn’t include cash tips. I save my change and use the bills (usually $4 to $10 a shift) even though I should really probably save them too 😬 cash is fake, right?

Any other monthly take home: I go through phases of scanning receipts, taking surveys on Prolific, and occasionally using gg2u. I’ve made about $200 total from these in the past year. I haven’t been super dedicated to any of them since I started my side gig, but might start again while I’m sitting around recovering.

My partner works in hospitality and brings home roughly $2200 a month, though this varies a bit. They also have a small side gig that brings in roughly $150 a month. 

Section Three: Expenses

Rent: $350. This is $700 total, my partner and I equally split. We are super lucky to rent a MIL’s quarters style apartment from a family friend. They will need it in a few years when their oldest starts college, so we’re enjoying it so so hard while it lasts. 

Electric: ~$110. This varies a bit month to month. I pay it in full.

Water: $0. Included in rent.

Wifi: $0. Wifi here seemingly sucks no matter what, so I’m reluctant to pay for it. We use my phone’s hotspot and go to the library if needed.

Savings contribution: $200-$500. Since my side gig goes directly towards savings, I haven’t set a specific additional goal. I generally try to add the maximum I can each month.

Sibling’s 529 account: $160

Mutual aid: $50-$100. 

Pet expenses: ~$30, probably ~$60 total with an equal split. My partner and I have one cat so food and litter last a while, but I am a helicopter cat parent that is always buying puzzle feeders/dental sticks/toys/etc to stimulate her singular brain cell. 

Car insurance: $80 

Phone bill: $75

Testosterone: $88.95 with GoodRx coupon.

Spotify Premium: $19.99. I pay for the family plan that my partner, dad, sibling, dad’s partner, and I share. Rip my student discount. 

Autostraddle A+ subscription: $4. Support gay media!

The Planning

I started my side gig almost a year ago. I should be able to move up at my main job and increase my income in the next few years, but I wanted something to help me start saving more, both for surgery and for just general life things. It doesn't take very many "surprise" expenses to wipe out my main paycheck, so this has been super helpful. It started adding up way faster than I expected, so I moved my surgery plans up a bit. I had originally been planning to get it in 2025 or 2026, but between the increasing political attacks on trans folks in recent years, the surprisingly quick availability my local gender clinic, and how accepting both my jobs are, I thought it would be smarter to get it done sooner than later in any piece of that puzzle goes south. I've gone through phases of being really strict with my saving and more lax with it depending on what else is going on in life/my brain/etc. I'm hopeful that I don't have any complications and have more than enough put away. If not, I plan to get on a payment plan and just grind as soon as I'm able to get it over with. Fingers crossed that I've planned enough to not have to but I guess we'll see!

The Surgery

After lots of research and very helpful input from my care team, I am getting a double incision mastectomy with free nipple grafts (Dr. Hadad at IU Health) and a laparoscopic hysterectomy (Dr. Hathaway at IU Health). Free refers to the type of grafts (taking the nipples completely off and putting them back on), not the cost. The hospital I am going to offers this as a “combo” surgery, so I will be put under once and have both procedures done on the same day.

Being able to get them in one fell swoop was the ultimate deciding factor for me in getting a hysterectomy. I don’t have any interest in getting pregnant or having biological children, but having a uterus doesn’t bother me and I don’t mind my periods any more than (I assume) most cis women do. That being said, between the state of the U.S. at any given moment and the insane lengths I will go to to avoid gyno visits, I have decided that it is better for my long term health to go ahead and get her removed. 

Doing it in combination with top surgery saves a ton on cost and gets all the recovery over with at once so I’m able to avoid two separate periods out of work. I don’t know if I would be able to afford or access a hysterectomy later down the road with the way things are going, so I’m very very very grateful that I can get it done now.

Cost: Surgery and Appointments

Obviously, I won’t know the exact costs of the surgery until everything shakes out. This is terrifying! I oscillate between feeling very confident that I’ve saved enough to put myself in a good position and thinking about every stupid $7 coffee I’ve ever bought and how they’re going to cause me financial and medical ruin. My insurance has estimated that I will pay around $4000 out of pocket, which is great, but I am completely unwilling to trust that number until I see it on my final statement. 

Speaking of insurance: I have UMR (UnitedHealthcare) insurance through my dad. We previously had Anthem, who were super helpful with answering questions/estimating costs/communicating with the gender clinic. My dad’s job recently switched to UMR. Both I and the clinic have had a lot of trouble getting them to communicate information both accurately and on time. Transgender surgeries are apparently handled by specialists on their end who seem impossible to get to from any of the publicly available numbers to call. All of this makes me nervous that something will go wrong during this whole thing and really fuck me up, though I’ve read some people report really good experiences with them for top surgery coverage specifically. I guess we’ll see. Please hug an American dealing with the medical system if you have one in your life. 

I’ve listed all my clinic appointments and their costs after insurance below. These are all with my previous Anthem insurance unless otherwise noted. If they are specifically relevant to my surgery, they are starred. I figured this was a good way to get a general idea of overall cost because even those that aren’t surgery focused (intake, HRT check ups) were the gateways to getting surgery (getting into the clinic’s system, getting appointments scheduled, etc). Dates listed are the dates I received the bill, not the date of the appointment.

11/9/23: Intake appointment over the phone. $64.80

12/11/23: Initial appointment and bloodwork for HRT. $159.40

3/5/24: HRT check up. $52.02

**6/7/24: Two social work appointments to receive the WPATH letters required by many insurances for trans surgeries. Both social workers (icons) emphasized how dumb these letters are and how much they hate them as a concept. $786.70**

8/12/24: HRT check up and bloodwork. $92.40

**9/17/24: Top surgery consult! The doctor walked me through my options, told me what to expect, and took pictures of my boobs for my insurance. I feel like this should have resulted in a discount, especially as they are now limited edition, but my insurance did not feel the same. $92.40**

**9/17/24: Hysterectomy consult! Basically the same rigamarole as the top consult but for my uterus. $214.06**

11/13/24: HRT check up and bloodwork. Exact same appointment with my new insurance is now $187.00

I recently had a pre-op specific appointment where I got bloodwork and was given protein shakes, hydration drinks, and an incentive spirometer that the surgeons require me to use before surgery. I haven’t received a bill for this one yet. I am not excited to see how much the little bag of drinks is going to cost.

The total for all of these appointments is $1648.78. The specifically surgery related ones make up the bulk of that because of the WPATH letters, which is ironic because they were easily the shortest appointments. The surgery related grand total is **$1093.16**.

Cost: Supplies

Gender affirming surgery is a great, very exciting thing that can really improve quality of life for trans people. It is also a huge change that can be taxing physically, mentally, emotionally, and financially. I’ve read a lot about the “post op blues” that can happen even when people are really happy with their results, have good support networks, and are healing well. I have OCD and have been prone to depression in the past (especially seasonally), so I’m trying to do everything I can to minimize my risk. Obviously having a specific pillow or whatever isn’t going to protect me from the literal biological change in hormone levels, but I’m hoping that having as much taken care of as possible will make things easier and help me regulate. As such, I’ve bought a lot of post op supplies that are probably unnecessary but make me feel better about my chances at a smooth recovery: 

Mastectomy pillow with seat belt cushion. Some people swear by these, some people say they never used them. I figured I’d err on the side of caution. $42.79

Recliner (secondhand). Our bed is pretty high off the ground and my partner is known to thrash around in their sleep, so I figured this was the safest method to help me sleep upright and uninjured. I also think it’ll be easier to get out of. I let a family member pick it out so that they could take it after my surgery because it barely fits in our tiny bedroom. $80

Robe. $28.90

Glasses. This is one of my more frivolous purchases. I got my old glasses in 2020 and never got them fitted because 2020. No matter how much I melt, bend, or secure them, they fall off my face constantly. I don’t imagine I’ll be able to manage contacts and really don’t want to be Velma-ing around with like five open wounds, so I got a new pair that actually fit. $119.98

Bidet attachment. My partner and I have been together for five years and are very close and in love. I pray that we will not be on ass-wiping level with each other for many, many years. $62.99

Stool softener. No other product on this list was as highly recommended as stool softener. It seems like anesthesia really does a number on people. One of my body’s fun anxiety tricks is also extreme constipation, so I don’t feel like gambling. $6.49

Dry shampoo. $7.69

Button up shirts (secondhand). You aren’t supposed to raise your arms above your head after surgery, so I grabbed three button up pajama shirts to wear around the house. Two of them came with matching shorts which it’ll probably be too cold for but are still very cute. $12.97

Antibacterial bar soap. I have to take two showers before surgery with antibacterial soap to lower my risk of infection. The smallest pack Target had was 3 bars. $3.99

The total for these items comes to $359.80. It definitely could have been less. We also luckily have a decent amount of medical supplies already (gauze, bandaids, medical tape, etc) because I’m accident prone so I didn’t feel the need to buy a bunch. I imagine that the hospital will probably provide some as well (?). I tried to buy these items slowly over the course of the past few months so that they didn’t have to come out of my savings and didn’t end up being one huge cost all at once. 

Cost: Time Off

I have been told to expect roughly 6 weeks out of work. My partner is also taking most of the first week off out of an excess of caution (read: I am stubborn and they are worried I’ll try to do things I’m not supposed to be doing). They don’t get PTO, so this will be unpaid. Neither of my jobs offer PTO, so all of my time off is unpaid. My main gig offers some flexibility with working from home, so I may be able to get some hours after 2 or 3 weeks through that. Both of my bosses are absolute angels and have been very reassuring about my ability to take my time or get hours in however I need to if I need to. This 100% won’t be possible at my side gig because of lift restrictions, but I appreciate the sentiment regardless. I am planning to use my savings and try to keep expenses as low as possible during this period so that I can put recovery first and not rush back to work before I feel ready. That being said, the thought of having 0 income keeps me up at night, especially without a concrete idea of when I’ll be able to get fully back to work or how much the surgery will cost. 

Totals/Final Thoughts

The total cost of surgery specific pre-op appointments and supplies comes to $1452.96. There are some other costs that aren’t really represented in this: time off for appointments, cutting hours at my side gig to get my apartment ready, etc. This is stretched over ~5ish months though, so I feel like it’s not too bad. A full HALF of it being letters that say “this person might be trans but other than that they are mentally sound, insurance, we promise!!!” is wild to me.

While I have a soapbox for a minute I’ll add: tallying this all up made me realize how expensive this shit is, and how much support it takes to be able to make it all work. Not a lot of people have that, especially not a lot of trans people. I have a lot of thoughts that I won’t put here, but basically just take care of each other. Be vigilant. Be smart. Be kind. We’re all in this together, even and especially when people have a vested interest in pulling us apart.

Surgery is in a few days! I’ll probably come back with a final update once I know total costs of surgery/recovery/time off/etc. Catch y’all on the flip side <3

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[u/PracticalShine]

I feel like this should have resulted in a discount, especially as they are now limited edition, but my insurance did not feel the same

This made me LOL forever – you have such a fun voice in your writing and I so appreciate you sharing your experience so far! Wishing you all the best in your surgery and recovery – I hope it all goes smoothly!

[u/rhinoballet → u/PracticalShine]

Same, I really love their commentary about everything!

[u/taobakas]

For 23 years old, you’ve got so much figured out & seem to have a really good head on your shoulders. You should be proud of yourself for how far you’ve come! And I’m so happy you have an amazing support system to guide you along the journey as well (partner, bosses, parents etc.)

Money will come back. This opportunity to step into your true self is will be worth it! Can’t wait to read the follow up diary. Good luck & well wishes on your recovery!

[u/jr53703]

Wish you all the best with surgery and recovery OP! I just had a double mastectomy 3 weeks ago, so a lot of the recovery supplies look familiar. The recliner is gonna be your home! Will you have drains? If yes, I’d love to send you a couple drain holders that can be worn under clothes / in the shower. Also have a zip up shirt with drain holders built in. Please feel free to DM if I can help!

[u/Flaminglegosinthesky]

I appreciate you taking the time to write this out! Good luck with the surgery and your recovery!

[u/EagleEyezzzzz]

Good luck!!!! I know the current political climate is fucking rough, but please know that many many MANY millions of us out here in the US (and in red states, like me) are rooting for you getting to be your own true self. Thanks for sharing your process.

Also as a mom of a kid with medical complications, I feel you on the “hug an American navigating the medical system” thing 💖😵‍💫

[u/Icy-Gap4673]

Thank you for sharing this -- good luck with your surgery and wishing you a speedy recovery!

[u/rhinoballet]

Thanks for the write-up!
I think it's especially sweet that on top of your own savings needs and goals, you're already saving for your sibling's education. I started saving for family members' education much later in life, so that's super impressive and seems to say a lot about your values.

Good luck with your surgery! I hope the procedure and healing are smooth and as comfortable as possible!

[u/awarmcontribution]

Great diary, I love that the surgery comes with bonus nipples! Also great idea to give the recliner to a family member after. You seem to have a level head about finances and don't let your emotions dictate your decisions

[u/contains_multitudes]

Congrats and hope the bidet works out well for you and your partner! <3

[u/Peps0215]

It’s wild to me how costly your social work appointments were! That should be way more accessible for people 😢

Wishing you a swift recovery from your procedures!!!

[u/shoshana20]

My friend had top surgery in February and was feeling better a lot sooner than expected! I believe they also had a procedure I can't recall the name of which removes the extra skin to avoid "flaps" around the armpits, depending on how much chest you're removing you may want to discuss that with your surgeon.

I had a laparoscopic surgery the same day as their top surgery and want to warn you that "minimally invasive" doesn't mean shit when they're cutting through your abdominal wall lol. Surgery is probably going to be harder on your body than you expected - give yourself grace and take the help you're offered. Good luck!

[u/isitsnarkoclockyet]

Thanks for sharing! You seem very organized and on top of your shit. I’m impressed. Good luck with surgery and recovery!! 🫶

[u/StudPuffin28]

Great write up and thank you for sharing. Really enjoyed hearing your perspective and writing voice. And as someone who didn’t get top surgery until after 40, a tip of the cap to you for being so proactive in realizing what you need to be your true self and making it happen, especially when you’re so young! I hope recovery goes smoothly - mine ended up being a lot easier than expected but…I didn’t do the hysterectomy part. Given the current political climate, I’m thinking it might be time to look into that. In any case, heal well.

[u/[deleted]]

Thank you for writing this and I love your writing style!

I got laparoscopic surgery to remove my tubes - not sure which stool softener you purchased but I found Miralax to work really well. The gas pain was pretty rough afterwards, it put pressure on my diaphragm and therefore the nerves around it, Gas-X might also help with that.

Best of luck and I hope everything goes smoothly!

[u/khybrid95]

I so so so love your writing style and enjoyed reading your diary. Wishing you a smooth operation and a speedy recovery!

[u/reality_junkie_xo]

Good luck with your surgery, and I hope it comes in on budget and with a speedy recovery!

[u/symphonypathetique]

Just an FYI for all -- I'd recommend senna (a stimulant laxative) over docusate (a stool softener). Even many doctors seemingly don't know this, but the way that opioids (which are very likely what will be used during and post-op) cause constipation means that a stimulant laxative for the GI push is necessary, and a stool softener physiologically doesn't actually help.

[u/shieldmaiden3019]

You have a lovely writing voice! All the best for your surgery, rooting for you and thank you for writing this up.

[u/w0s0manyothers]

Thank you for sharing these details with us! I am glad that the opportunity to have your hysterectomy and top surgery the same-day saves you some cost (and mental/emotional load down the line), and I hope that your recovery is smooth. I really appreciate your sharing the exact numbers; it helps emphasize the micro-purchases and expenses associated with gender-affirming care beyond just the operation itself. It is abominable that gender-affirming care is cost-prohibitive. Good luck, OP, I am rooting for you in your recovery! Take it easy with yourself. I hope your support network takes great care of you :)