Medical costs of detransition

Depending on previous treatments, detransition may involve various interventions: stopping cross-sex hormones and, if necessary, restarting the body's own hormone production or beginning hormone replacement therapy; breast reconstruction after mastectomy (with relatively limited options); or complex revisions of genital surgery.

Possible interventions

Depending on previous treatments, detransition may involve various interventions: stopping cross-sex hormones and, if necessary, restarting the body's own hormone production or beginning hormone replacement therapy; breast reconstruction after mastectomy (with relatively limited options); or complex revisions of genital surgery.

Limitations

Many changes following hormone treatment are partly or completely irreversible (voice changes caused by testosterone, secondary hair growth, continued beard growth after laser treatment or electrolysis, genital atrophy, and loss of fertility).

Coverage

Coverage of detransition care through the basic health insurance scheme is not explicitly regulated in the Netherlands; in practice, care is covered under regular medical indications. Since 2022, international professional associations have paid more attention to detransition care as part of the standards of care.

By treatment

After breast removal, reconstruction is possible using implants or the patient's own tissue. The shape can be restored, but sensation and the ability to breastfeed cannot. A voice lowered by testosterone does not become higher on its own; speech therapy provides limited help, and voice surgery has variable results. Beard growth can be treated with laser or electrolysis. Breast growth caused by oestrogen does not disappear after stopping treatment and can only be removed surgically. Anyone who has had their ovaries or testes removed will require lifelong hormone replacement from an external source. transitieschade.nl describes what this permanent dependence on medical care means in practice.

Who pays

In the Netherlands, medically necessary treatments are covered by the basic health insurance scheme, even when they result from a previous transition. Hormone replacement and check-ups are covered as usual. For restorative surgery, the distinction between medically necessary and cosmetic treatment is less clear, and the insurer decides on each application individually. Hair removal is not automatically covered after detransition. In countries without mandatory health insurance, detransitioners often have to pay the costs themselves.

Gaps in care

There are no treatment guidelines for detransition, and little research has been conducted into what works best. The Cass Review advised the English health service to establish a separate care pathway for detransition, because many people do not want to return to the clinic that previously treated them. See medical consequences of detransition, side effects of stopping hormones and support after detransition.