Part 1: The how-to

My son (FTM) has been transitioning for several years and completely passes as male. His hormone replacement therapy (HRT) treatments started before Texas Gov. Greg Abbott and the Republicans scared off or shut down a lot of gender-affirming clinics and have continued in the gray area, in which they can continue treatment but not take on new patients.

As parents, my wife and I have been supportive, enrolling him in gender-affirming care and providing counseling and therapy for both him and ourselves. My son had begun developing breast tissue prior to starting HRT and so has been binding for years. Obviously, for a good while, he has wanted top surgery to remove the developed breast tissue and thus end the constant stress and expense of binding.

Some may not agree with our parental approach to top surgery, so proceed with awareness.

We as parents understand that most effects of hormone treatment are reversible or minimized if the person decides to stop treatment. This gives parents — as well as the child — a lot of flexibility to determine the future while being supportive and proactive.

Surgery is irreversible, and so that decision must be made with much greater confidence. That being said, my wife and I decided that our son would be responsible for providing his own top surgery. We gave our permission, but the actual cost and logistics needed to be our son's responsibility.

It is important to us that our son owned his transitionary steps. We know some won't agree with us on this — so be it. We did not want his transformation to be a gift but a milestone in his journey, something he made happen. In consulting with his therapist and psychologist, we agreed it would be beneficial if this step was something our son accomplished himself.

And so he began the search for a provider. Our insurance was willing to cover the procedure as medically necessary. But we could find no providers anywhere in this country who would accept our insurance. Every one of them asked for up-front payment.

Our insurance company was unable — or unwilling — to help us find someone. They suggested we have the procedure done out-of-network, and they would cover it if we could get the provider to fill out and submit a one-page form. None were willing.

And the costs were between $16,000 and $18,000 up front. That's not something a high school or college student can afford.

In addition, many of these doctors had wait-lists of six months to two years to even have an initial consultation. For those familiar with the stress of gender dysphoria, months and years add massive burdens to mental health and well-being.

Medical tourism
So my son began looking further out for other alternatives. This brought him to the idea of medical tourism.

If you aren't familiar with it, medical tourism is where a person travels to another country to have a medical procedure performed, spends time there to recover, and then returns home. Not surprisingly, this is mostly an American phenomenon, as many other countries have much more accessible and affordable care, even for "elective" procedures such as top surgery for Transgender people.

According to an NPR article from March 2023, more than 780,000 Americans participated in medical tourism in 2022, experiencing drastically reduced costs compared to equivalent procedures in the United States.

My son researched various connecting agencies designed to match patients to providers in Mexico. Ultimately, he found someone he felt was compatible, available, and supportive. Emails and phone calls were exchanged, followed by initial virtual consultations that led to scheduling a date for surgery.

Let me take this moment to elaborate on the state of Mexico's healthcare system. IT provides no-cost access to healthcare for citizens. But this does not prevent or exclude private treatment, so Mexican citizens who want a higher quality of care than the government provides might opt for private providers at their own expense. It is this sector that also accommodates medical tourists.

So, to be clear, this is still a for-profit medical practice. It is not charity or a government service, and it operates like any other for-profit business. A payment up front is required to show commitment and to secure a space.

For my son, this was in the form of a nonrefundable wire transfer of several hundred dollars. He needed to work with our bank to facilitate the transfer, as there are several security steps involved, and wire transfers to Mexico have specific rules and requirements.

Once approved and accepted, the remaining payment for the procedure is expected either in advance or on the day of the procedure. Credit cards are preferred, but other forms of payment are accepted, depending on the provider.

In my son's case, this payment covered everything — pre-op consultation, surgery, anesthesia, and all post-op care, even after we returned to the United States. This included daily updates to the surgeon on healing progress and multiple follow-up visits. Where this would have cost over $18,000 in the United States, the fee for this private service in Mexico was $3,800.

Recovery houses
But this is only half the process.

At this point, we have provided for the procedure, but we're also in a foreign country, and we don't want to navigate airports and customs with fresh cuts and blood drains. So we needed a place for him to recover and heal. This is where the "recovery houses" enter the picture.

These are facilities — sometimes hotels, sometimes just homes — that are rented out as safe and staffed spaces where medical tourists can safely recuperate and heal with daily care. Costs run from $80 to $120 a day as of June 2023, and that includes all meals, sanitation, room cleaning, laundry, transportation to and from airports and medical appointments, and on-staff or on-call nurses with direct contact to your doctor for the entirety of your stay. In our case, I was an additional person, and that was an extra $30 a day, which included all meals and transportation.

I try to imagine what this kind of care would cost in the United States, and I don't think there even is any equivalent. It's not a hospital room, but it's not just a hotel room, either. I can't imagine a similar service in the US — three healthy meals a day, on-call nurses to manage your bandages and medications, staff to clean your bed and clothes, and a driver to take you to and from all of your appointments? How much would that be here?

Like the for-profit doctor, this is also a for-profit enterprise and requires nonrefundable payment up front for the entire length of the stay. While some may be tempted to save some money and cut the time in the recovery house short, just remember that healing is a roller coaster, and just because you feel really good one day does not mean you are ready to travel. I would recommend following the doctor's advice on how long to stay in town in the recovery house, even if it's a few days more than you think you might need. Most complications happen within the first 10 days to two weeks, and you want to be available to your doctor to address anything that might happen.

A two-week stay in a recovery house is an additional $1,400 or so, bringing our base cost for surgery and recovery to around $5,200. The recovery house is not an expense you would have if this procedure were to be performed in the US, but this total is still far below the $18,000 estimate to have same procedure domestically.

Other expenses
And, of course, you must factor in the cost of flights to Mexico. As of June 2023, Texas to Guadalajara — where my son had his procedure — was about $350 per person, coach, with a flight time of about three hours.

As for the travel aspect, if you can afford it and you have the time, Global Entry will save you huge headaches and lines getting between the US and Mexico. When entering Mexico through customs, "medical tourism" is a valid reason to give customs agents; they are familiar with it and understand.

You must have a passport; just a US driver's license is no longer enough to travel to Mexico. It can take months to get a passport, so plan ahead. It is my personal opinion that everyone should have a valid passport anyway, as it supersedes any other form of ID the US provides.

An interesting fact for Transgender people: My son was able to get his passport in his identifying gender, opposite his birth certificate, even though he can't get his state driver's license in that gender, because Texas.

Uber and Airbnb work in Mexico quite well. There are many Uber drivers, and we rarely had to wait more than a few minutes for a ride anywhere (when we wanted to go somewhere that wasn't a doctor's appointment). And it is cheap; most drives only cost us a few dollars. Have your Uber app updated and ready, and you can get anywhere easily.

A note of caution: There is a delivery app that is quite popular in Mexico called Rappi, but it does not accept US-based credit cards or accounts at this time, without extensive and expensive verification steps. Avoid it until it accepts US credit cards. This limitation is not advertised on the site or app; I found out through trial and error.

I don't know about other medical tourism areas in Mexico, but where we were, our recovery house was within easy walking distance of two convenience stores, three pharmacies, and multiple cafés and restaurants. It was wonderful for us, since I was able to walk and get any supplies we needed with ease. Check with your proposed recovery house about what is in the area, because sometimes a little snack or a short walk can make a recovery day much better.

As far as money, most places take credit cards and mobile payments easily. Just let your credit card company and your bank know you are traveling. Cash is mostly unnecessary unless you want to tip. Tipping is less expected than in the US but is appreciated. No one got offended any time we did not tip, and often our Uber driver would drive away before we had the chance to tip. The minimum wage in Mexico is about $13 an hour, so tipping is not necessary for anyone's survival, and if you're on a strict budget, you can get by without tipping. We did choose to leave some chocolate for our nurse and staff as recognition, and I tipped our driver at the end of our stay. But that was a personal choice and not expected.

I hope that our experience gives some clarity into what to expect if you or your Trans loved one are considering medical tourism. It was overall a very positive experience.

This article was about the logistics and the details; in part 2, I will explore our experience from a more cultural and emotional point of view.

Thank you for reading and thank you for supporting your LGBTQ+ people.

Courtesy of the National LGBT Media Association