Gender-transition surgeries can cost tens of thousands of dollars, depending on the procedure. Puberty blockers can cost about $4,800 annually, and feminizing hormone treatments combined can cost more than $3,000 annually per person.
The gender-reassignment surgery market was worth about US$701 million (C$970 million) globally in 2023, according to
Polaris Market Research. Another estimate, by
Grand View Research, puts it at US$2.1 billion in 2022 and projects it will reach US$5 billion by 2030.
“A rise in awareness and acceptance of gender-affirming health-care services among younger generations is projected to spur product demand,” Polaris said in its report published January this year. It estimates a compound annual growth rate of 12 percent in the market from now until 2032.
Alan Cassels, a B.C.-based drug policy researcher and author of the book “
Selling Sickness: How the World’s Biggest Pharmaceutical Companies Are Turning Us All Into Patients,” has spent decades examining how the pharmaceutical industry’s interests interact with health care. He told The Epoch Times he’s worried about the boom the gender-transition industry is seeing.
“Pharmaceutical companies have so much vested interest in promoting the sale of their treatments, they also get into the promotion of the ‘disease,’” he said, describing a general phenomenon he has observed in the pharmaceutical industry throughout his decades of research. Often, conditions that don’t require medication are nonetheless treated heavily with drugs—each of which has side effects and may be detrimental to the patient in the long run, Mr. Cassels said.
“My reading of the literature is that children that have questions about their gender, it’s something that they typically grow out of,” he said. Researchers at the Dutch University Medical Center Groningen
recently published research showing most youth grow out of gender dysphoria.
They conducted a survey of thousands of youth starting at age 11 and asking the same questions approximately every three years until the age of 25. The number of youth wishing to be the opposite sex decreased from 1 in five to one in 1,000 by the end of
the study, which was published in the peer-reviewed journal Archives of Sexual Behavior in February.
“I’ve studied rational drug policy, and the purpose of providing coverage for drugs always has to be done for appropriate conditions,” Mr. Cassels said. “You don’t give an anti-depressant to someone that doesn’t have diagnosed depression. You shouldn’t be giving drugs that are for high cholesterol to someone who has normal cholesterol.”
When it comes to medical treatment of gender dysphoria, he said, the main question is whether such treatment is appropriate for the patients, especially young patients. “Any dollar spent on a treatment that isn’t needed is a dollar wasted,” he said.
It is difficult to put a precise dollar figure on the market in Canada. The Epoch Times contacted multiple gender clinics to inquire about precise costs of treatments but did not receive replies as of publication. Most provinces and territories, which cover some of the costs of gender-transitioning, also did not respond with requested information about spending.
We were, however, able to put together estimated costs using publicly available information.Puberty Blockers: About $400 Per Month
The most commonly prescribed puberty blocker, Lupron Depot, costs about $400 monthly per patient,
according to B.C.’s Provincial Health Services Authority.
B.C. PharmaCare also lists two Lupron Depot products as being covered that are up to about $420 each, with a “special authority” request filed by the prescribing doctor.
Lupron is
approved in Canada for the treatment of precocious puberty (when children start puberty at an exceptionally young age), endometriosis, prostate cancer, and uterine fibroids (growths in the uterus). However, the drug is prescribed off-label for
treatment of gender dysphoria, to delay puberty and the developmental changes related to a youth’s biological sex.
Lupron is made by Chicago-based company AbbVie Inc., also known for its products Botox and Humira. The company’s net revenue for Lupron was US$783 million (C$1.08 billion) in 2021, according to its annual
investor report for that year. Lupron revenue is absent from its subsequent annual investor reports.
Texas Attorney General Ken Paxton started investigating AbbVie and other pharmaceutical companies in 2021 “to determine whether these manufacturers of puberty-blocking drugs deceptively advertised and promoted hormone blockers for unapproved uses without disclosing the potential risks to children and their parents,” according to a press
release.
The company did not respond as of publication time to Epoch Times inquiries about its Lupron product and concerns about puberty blockers, including those raised by Mr. Paxton. Mr. Paxton did not respond to an inquiry regarding the current status of his investigation.
The UK recently stopped providing puberty blockers as a “routine treatment” for young people with gender dysphoria. It commissioned pediatrician Hilary Cass to conduct an independent review of gender services for youth, and the
final Cass Review was published on April 10. It casts doubt on the use of puberty blockers, saying studies on their impact and effectiveness are limited.
“For most young people, a medical pathway will not be the best way to manage their gender-related distress,” a
summary of the report said.
Hormone Treatments: Up to $3,000 Per Year
Male-to-female transitioning often involves the use of both estrogen (usually injected) and anti-androgens, which suppress testosterone. Sometimes progesterone is also included in the regimen, for more rapid feminization and breast development.
Estradiol is a commonly prescribed estrogen product. It can cost up to $200 monthly, or $2,400 annually.
The maximum daily dose is 8 mg, according to a
2019 report on gender transition by the Canadian Pharmacists Association. At the maximum dosage, that could cost about $70–$200 monthly, based on the cost of 1 mg tablets as listed by BC PharmaCare (30 cents per tablet) and online drug sellers such as
Canada Drugs Direct (83 cents per tablet) and
Canadian Pharmacy World (60 cents per tablet).
While all provinces cover the cost of certain gender-reassignment surgeries, coverage of hormone treatments varies and may only be conditionally covered or not covered at all, according to information
compiled by Global News.
Canada is seeing an increasing number of private insurers covering gender-reassignment procedures. For example,
Sun Life and
Desjardin advertise “gender-affirmation” packages. Ottawa
announced last year that all federal employees would be covered up to $75,000 for gender-transitioning treatments.
Estrogen comes in various other forms, such as a transdermal gel that costs up to about $150 monthly, according to 2018
information compiled by ACT, a Toronto-based advocacy organization focused on HIV/AIDs.
A commonly prescribed anti-androgen called Spironolactone costs about $15 monthly, although ACT lists the cost up to $40. At $40 monthly, that would amount to $480 annually. A common progesterone called Medroxyprogesterone acetate costs about $200 annually. Estimates are based on the maximum dosage given by the Canadian Pharmacists Association and cross-referenced with BC PharmaCare coverage prices.
When you combine the costs, a male taking estrogen ($2,400) and an anti-androgen ($480) together could spend $2,880 annually. If you add on progesterone ($200), that’s more than $3,000 on hormonal treatments.
For female-to-male transition, testosterone enanthate is injected intra-muscularly and costs up to about $30 a month, according ACT. But other forms can cost far more. A transdermal gel costs about $200 monthly and a testosterone patch costs about $300 monthly, according to ACT.
Surgeries: Up to $85,000
Gender-reassignment bottom surgeries cost $23,500 on average for vaginoplasty and $85,000 on average for phalloplasty, according to figures provided to The Epoch Times by Alberta’s health ministry.In the United States, vaginoplasty costs over US$50,000 and phalloplasty costs over US$130,000 per person in some instances, according to
a study of costs published in the Journal of Law, Medicine and Ethics in 2022, based on 1993
–2019 figures. The study noted that these surgeries are “frequently multi-episode procedures.” The same study put out-of-pocket hormonal treatment costs at about US$3,800 for 2018.
A double mastectomy, one of various types of female-to-male (FTM) top surgery procedures, costs some $8,000
–$9,000
at the McLean Clinic in Mississauga, Ontario. The cost varies across Canada based on FTM top surgery methods, the clinic’s website says, ranging from $4,000 to $12,000.
Basic top and bottom surgery costs are generally covered by provincial health plans, but a slew of other surgeries generally aren’t. They include facial feminization, vocal surgeries, deduction of the Adam’s apple, and laser hair removal.
Individuals who identify as transgender discussed their costs in a Reddit group called TransOntario in 2022. One user reported an
expense of $107,000 for facial surgery. Liposuction for body contouring costs about $4,000 in smaller areas and $10,000 in larger parts of the body, according to the McLean Clinic.
A boy starting puberty blockers at the age of 12 and continuing with hormone treatments and bottom surgery through to the age of 22 could spend a total of nearly $59,000 according to these estimated figures.
A girl starting puberty blockers at 12, taking hormones, and getting top and bottom surgery by age 22 could spend more than $110,000.
In addition, various supplies are sold to transgender youth, including devices for women to be able to stand to urinate, for example.
The latest
Statistics Canada data on the nation’s transgender and non-binary population comes from the 2021 census. It found that one in 300 people in the country aged 15 and older identified as such. Almost two-thirds of the people who identified as transgender or non-binary—more than 100,000 people—were younger than 35.
“For the pharmaceutical industry, it’s financial,” Mr. Cassels said. While many doctors feel they are helping youth, he said, it’s also a profitable industry. “People can make significant parts of their livelihood by doing this kind of work, right? So it’s obviously profitable to do it.”
