I Can’t Afford Gender Reassignment Surgery and It’s Affecting My Marriage

Dear GoodTherapy.org,
How do I learn to cope with the fact that I may never be able to afford gender reassignment surgery? And my wife is straight, and the issues have killed our sex life. —Transitioning
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Dear Transitioning,

Thank you for the question, which is simple yet full of complexity and turmoil. The way I understand your situation is this: you are a female to male transgender person and you would like to, anatomically, complete the process of becoming a man, but you are unable to afford the procedure. Your relationship with your wife is suffering due to the challenges inherent to this situation. There are many more questions I would like to ask you, but I can certainly provide some thoughts and suggestions based on the information at hand.

I will assume that you currently live your life as a man. Surgery is typically the final step in gender reassignment, so I imagine you are now probably male in appearance, hormones, and psychology. You say that your wife is straight, so I can infer that your wedding pictures probably portray a dress and tuxedo, husband and wife. The only missing piece at this point, to put it bluntly, are the genitals.

Your frustration with the high cost of the surgery is completely understandable. To be living in every way as a man but to be unable to complete the final step is incredibly difficult. I imagine you have done thorough research about clinics around the world that provide this type of procedure and the related costs. If you say it is beyond your budget, then that is a fact that may be unchangeable. It is very disheartening for an economic issue to keep you from feeling like a complete person.

In some ways, your question focuses more on dealing with disappointment and heartache than with issues around being transgendered. You deeply desire to have something that you are just not able to get, at least at this point in your life.

In some ways, your question focuses more on dealing with disappointment and heartache than with issues around being transgendered. You deeply desire to have something that you are just not able to get, at least at this point in your life. Everyone can relate to this kind of turmoil. How do people accept reality and handle intense sadness? Life is full of it, and everyone looks for ways to move beyond pain and live the best life they can. It is often the deepest suffering that turns hearts toward spiritual seeking or religious solace. Others find interests or passions to delve into, such as pursuits that help others in need, or hobbies to challenges their bodies or minds. Some people engage in counseling or psychotherapy to process their emotions and achieve a new understanding for the next phase of their lives.

Often when life presents us with a seemingly insurmountable obstacle, it can be a good time to step back and take stock of our present situation and long-term goals. I have to wonder about your relationship with your wife. You say that these issues have killed your sex life. This confuses me, because she married you as you are, correct? Did she not have full knowledge of your transgender nature before you tied your lives together? Did you both enter into the union with the condition that someday you would have male anatomy? Contracts with conditions are always tricky. And although postponing sexual intimacy is a somewhat outdated concept, there are certainly couples who uphold this practice, and perhaps you are one of them. The answers to these questions would provide useful information for understanding the particular strain your marriage is experiencing.

In any event, I am understanding that you believe your lack of male anatomy is the thing that is ruining your sex life. However, there are many factors at play in a satisfying sexual relationship: giving and receiving physical pleasure; self-esteem and confidence; emotional bonding and support; mutual trust and caring. Since it seems likely that you did have sexual intimacy prior to being married, I imagine you found ways to satisfy one another physically. There are certainly lots of alternatives to an anatomic penis, even for a “straight” woman. I believe the devastation to your sex life is probably more closely linked to the expectations you both hold for your relationship and for the spoken and unspoken “contracts” you made upon marrying.

One or both of you is very upset by your lack of full male anatomy. You may actually be more bothered by it than she is, which could certainly drive a wedge between you and cut off your communication and sharing. You may be making assumptions about what she thinks of you, believing that the shame and self-loathing that you feel toward yourself is actually coming from her. Or she may have disappointments and frustrations of her own that are preventing her from engaging in physical intimacy with you. I wonder how often and how fully you communicate your thoughts and feelings with one another.

You may be finding yourself unlovable and assuming that she loves you less because of your anatomy. Perhaps it isn’t a solely economic issue—undertaking this type of surgery is enormously impactful. Maybe there is a part of you that is not 100% ready to finalize the transition? If not—if the barrier is purely financial—it is you and your wife’s problem jointly, the kind of problem covered under the “for better or for worse, for richer or for poorer” clauses. In an ideal situation, you would undertake the challenge together and support each other until a resolution is achieved.

This brings me back to my previous point about how people cope with life’s trials and disappointments. Another way of handling sadness is by turning to the people you love and trust and sharing the burden. The fact that this challenge is coming between you and your wife rather than bringing you closer together says to me that your communication and emotional honesty might need strengthening. Optimally, a person’s spouse is the one they go to when they don’t know what else to do and their world seems bleak and unkind. I wish for you and your wife to find solace with one another and together find a solution to the challenge you are both facing.

I am concerned that this problem may be threatening your stability and psychological strength. I strongly encourage you to reach out into your community for support and/or counseling. I imagine that throughout your gender transitioning process you have been given referrals to counselors, clinics, LGBT centers, and other places that offer understanding, support, and guidance. Please know that counselors answering suicide and crisis lines are trained to be nonjudgmental and aware of all types of situations that people face. You can even make contact with someone online to discuss your challenge in as much detail as you choose. When you speak with a counselor, you can discuss your transgender situation, or you can just focus on the general challenges of dealing with disappointment and overcoming emotional distance from your spouse.

I do not know where you live, but if you are in an intolerant part of the country, do reach out via phone or internet for help from someone with empathy for and understanding of your situation. GoodTherapy.org is a great resource to help you get started. The fact that you have reached out for help in this forum is a great sign that you are taking action to help yourself and your marriage. I believe that all problems have solutions, and when we start to look for those solutions, the universe conspires to give us what we need.

Please know that even if you never accumulate the funding necessary for your surgery, your relationship can survive if you both find a way to reconnect with the love, acceptance, and commitment that brought you together and led you to permanently bind your lives. Honest communication and deep sharing are an excellent route to that end. If you are not able to make this happen on your own, do seek assistance from a therapist who can support and guide you both with strategies to strengthen your emotional bond. Sex is an important factor of a relationship, but trust, respect, and deep caring precede the most satisfying sexual sharing. I hope that you and your wife can reawaken this so that your partnership will thrive no matter the state of your anatomy.

Best wishes to you both.

Karen Kochenburg
Karen D. Kochenburg, MSW, LCSW, is a licensed clinical social worker in San Jose, California. Her areas of interest and expertise include transpersonal psychotherapy, LGBT issues, adolescent psychology, spiritual development, clinical supervision/mentoring, nonviolent communication, and conflict resolution.
  • Leave a Comment
  • Cindy Keranen

    Cindy Keranen

    June 9th, 2012 at 4:11 AM

    I agree with Karen on the bulk of her statement s here, but I do have some reservations.

    I hold a BS degree in psychology, and I am a transsexual myself. I have to strongly disagree with Mrs. Kochenburg’s point of view on this topic. It is not a matter of self-acceptance, or the acceptance of others; it’s an issue of balance. The mismatch of anatomy and psychology cannot simply be accepted and moved on with. I am told every day I am beautiful and have even been offered modeling opportunities, but I have never felt attractive.

    For someone who does not feel attractive their sex life will almost always suffer a loss of intimacy as a result of deeply held personal inadequacies. This is the reality of the situation. While there are ways to better the situation, the issues still stand. If surgical remedies were not necessary why would we have them?

    There are ways to make it better, but without surgery it will never be cured for a “true” transsexual. Surgery is the definitive cure.

    There are a handful of organizations out there who are willing to help if you meet the necessary requirments. I know of a few who have been assited by these groups. Also, there are many insurance companies which cover a large portion of the procedures. I recommend some researh into the matter before giving up on your needs. There is help.

    Best wishes.

  • Misunderstood


    August 4th, 2012 at 4:44 AM

    Cindy would you be willing to share a link to those organizations that could possibly help in this situation? I am in a very similar situation and am really at the end of my thoughts on how to handle it day to day.

  • Wondering


    May 15th, 2015 at 9:31 PM

    Wait. Never in the person’s question did they mention their gender. There are many assumptions here. In my experience (as a transman) , my first impression was that this is a transwoman speaking. However, I cannot know this for certain (the “my wife is straight” is my only clue– however, this is my ASSUMPTION) due to the lack of the information. I think also that the assumptions here about the person disliking sex because of their “lack of” male (or whatever) anatomy is highly offensive. Transpeople can enjoy all kinds of sex. The person never mentioned WHY there is a problem. Assuming leads to trouble. All of this advice could easily harm someone.

  • Jenny C

    Jenny C

    December 25th, 2017 at 12:12 AM

    Just got done reading your aspect of the human mind and the studies of others that haven’t been thru the life of not knowing what is right or wrong with their own gender. If you are male and was treated like a girl growing up then all you know is that you are a female and vice versa. When you find out what sex you are and not confused then you wonder of the aspect of who you really are. I am a male and my dad beat me all my life and then when I was 13 my babysitter raped myself time and time again. Bad memories but I have gotten by those…….. So today I am 50 and transgender was treated like a girl might as well be a woman. Thank You Jenny

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