Trans writer Juno Dawson on the price of facial feminisation and other surgeries, and why she decided they were worth it for her
A couple of weeks ago, I was asked to give a speech at a fundraising event at The Marlborough Theatre, Brighton, in my capacity as An Inspiration. This ticketed event, featuring a raft of local drag kings and queens, would raise money for trans or non-binary people who might be struggling to cover the cost of surgeries.
A disclaimer: not all transgender people have, or want to have surgeries. They are just as trans and just as valid as I am, but I was not one of those people. I wanted my outsides to as closely match my internal vision of self as possible. It’s very difficult to quantify what a woman is supposed to look like, but some of my features – my Adam’s Apple for instance – were distinctly masculine. And to get rid of those ‘male’ features, I have opted to have a fuck-ton of surgery.
Consequently, I am happier with my body than I’ve ever been, so I totally appreciate why many other trans people want surgeries. Those operations have made my life better, simple as that. Both in being comfortable to pass a mirror and, moreover, being comfortable on the bus or train, free from the lingering stares of rude people. It’s really nice to not have kids ask their parents “is that a man or a woman?” In that situation, you have to laugh gaily and say it’s fine. It is not fine, it’s soul-destroying if you’re pouring your heart into living as a woman. For that reason, I fully understand why Mr Inglefield, the surgeon who did my facial feminisation, performs, on average, three such operations per week. These procedures usually involve reshaping parts of the face sensitive to testosterone: brows, jawlines, hairlines and prominent noses.
But back to my speech at the Marly. Being An Inspiration is quite trying and there’s only so many times you can rehash how sad you were as a child. So I decided to do something I’ve never actually done before: work out the total cost of my transition so far. Like, financially. Emotionally, I’m in the black: any harassment or temporary turmoil is easily cancelled out by the joy of being my most honest self. But in terms of money…well. Here we go:
"Why am I disclosing this? Talking about money is crass. But it's also important."
I’ve had approximately fifty laser hair removal sessions to kill off my former beard at £45 a time = £2,250. A nose job cost £2,350. Facial Feminisation procedures came to £9,014. A private hormone prescription was £350 for a three-month supply. My NHS prescription costs have been £256 while botox and fillers were £800. That brings us to a total of £15,020 over the last four years. Apparently, the reason this millennial can’t afford a flat isn’t avocado on toast.
Now let’s check some privilege. The savvy trans person among you might note those surgery costs are a little cheap. They are. As I fall into the very niche category of ‘semi-famous trans women operating in the media’ I was offered certain discounts and cut-corners to feature on ITV’s TV show Transformation Street. As detailed above, I absolutely wasn’t ‘given freebies’ but the regular cost – especially for the facial feminisation procedures – would ordinarily have been higher. So the first privilege was my status. The second was that – thanks to a book deal and a loan from my father – I was able to afford even the discounted rates. I was lucky, and it bears repeating that there is no set ‘cost of transition’. That is the cost of my transition. A lot of trans people don’t want surgeries to alter their appearance. Some people want a few. Some people want a lot.
Either way, I’m sure you get my point: surgical transition is expensive as fuck. Why am I disclosing this? Talking about money is crass. But it's also important. I worry about those who do want surgeries but can’t afford them. Pretty much every procedure listed above is NOT covered by the NHS. Only the laser hair removal would be covered, but I wanted to start that process while I toiled on the year-long waiting list so opted to go private. That was also true of the £350 I spent on acquiring hormones privately during that agonising wait. And the year I waited isn’t even so bad; in some parts of the UK, patients can expect to wait up to three years to be seen by a gender specialist. Gender confirmation surgery would only be available several years into the transition process.
But it’s all vanity, right? It’s all elective, right? To that I would belt out a resounding ‘fuck you’. When I first told a trans friend I was about to announce my transition, she told me, in all seriousness: ‘Congratulations! Make sure you’re pretty!’ Physical attractiveness, of course, weighs on the mind of all women. It is a symptom of the patriarchy. You’ll note I haven’t accounted for things like cosmetics, clothes and haircare because I shudder to think... However, it’s also the case that transgender women are judged by slightly different standards. Being able to blend in when out in public is vital to our safety and freedom from harassment. It’s absolutely not just about vanity, beauty or sex appeal (although great if they’re a side effect), it’s about feeling able to leave the house in daylight hours. It is about mental health.
"With each procedure, I have felt less terrified to be in public. My mental health, a little bit at a time, has improved."
With each procedure, I have felt less terrified to be in public. My mental health, a little bit at a time, has improved. If the NHS is serious about tackling mental health problems for everyone, I’d urge those in charge of the purse strings to consider funding cosmetic procedures for trans people. I mean, not botox and fillers, but I know both trans women and men who been told they can’t get funding to augment the most obvious gendered features: breasts; Adam’s Apples; very masculine facial features, and those people are struggling. Statistics for trans people and mental health problems make for bleak reading.
We also know through successive Stonewall reports that trans and non-binary people might struggle to find paid employment. It’s a vicious circle: If you don’t feel confident to be in public, many public-facing jobs are ruled out, which limits the potential to pay for surgeries that make you more confident in public. I wonder if all this is creating a two-tier transgender world dividing those who can and can’t pay for what I feel is life-changing medical care. And in America, where there is no NHS, the situation is even worse, and it's commonplace for trans people to hold fundraising events or start GoFundMe pages. (I’m seeing this practice becoming more regular in the UK too. I’d urge you to give wherever possible.)
It really isn’t about vanity. It’s about survival. I'd like it if we lived in a perfect world, post-gender, where people's gender is not policed, and I know a lot of trans people – with and without surgery – that are fighting for us to get there. But we're not there yet. That’s why I’m happy to share the reasoning behind my various nips and tucks, in the hope that it’ll raise awareness about access and affordability regarding surgeries that could be hugely beneficial for some trans people.
Those kids who tell me how inspiring I am on Insta deserve to know that I most definitely didn’t ‘wake up like this’. I used to judge myself very harshly against other trans women, especially at the start of my transition. I used to beat myself up because I wasn’t ‘passing’ as well they were. I felt like I was failing. I don’t want people looking at me and feeling that way. I look the way I do because I’ve undergone painful surgery and many months of swelling and bruising. And finally: another reason for sharing these very personal details is that it also provides a satisfying response to those who think being trans is a ‘trendy whim’... £15K is hardly an impulse buy at the checkout, is it?