Transgender advocacy is welded into Kamala Harris’s campaign for US President. Her choice of Tim Walz was interpreted as a strong signal to the LGBTQI+ movement, partly because he made Minnesota a “refuge” for trans people.

The participants in a Zoom call convoked by Trans Folks for Harris recently were confident that she would support them.  

“We have so much power,” said activist Charlotte Clymer. “We have way more power than they think, that’s for damn sure. And when we use that power, when we organize together and have each other’s backs, we can do great things.”

If trans folks do have power, part of it is surely due to the poorly appreciated fact that trans medicine is a big, powerful, and growing industry worth billions of dollars. So it’s not just the minuscule number of trans people who are involved, but a myriad of investors, corporations, doctors, nurses, and support staff as well.

A trans entrepreneur told Forbes magazine in 2020 that the potential market is immense. “Trans-tech is a budding industry with an enormous opportunity,” said Robbi Katherine Anthony. “Our estimates place the average cost of transition at $150,000 per person. Multiply that by an estimated population of 1.4 million transgender people, we’re taking about a market in excess of US$200 billion. That is significant. That’s larger than the entire film industry.”

This is just pie-in-the sky hype aimed at attracting venture capitalists. But the trans medicine industry is huge.

Last month the American Principles Project published an eye-opening study of the facts and figures for trans medicine, “The Gender Industrial Complex”. It had commissioned a market research company, Grand View Research, to estimate the cost of the drugs and surgical procedures involved in transitioning, the estimated current and future revenue growth of the market, and the most significant players.

After reading the report, it's hard not to conclude that “the gender industrial complex” is a factory of cruelty and misanthropy. “The prevention, delay, or whatever pharmacological and especially surgical disruption of the process we call puberty is a crime against humanity. It’s horrible what we do to kids,” one surgeon who used to work in trans medicine told the authors of the report. “The surgeries, the revisions, and all that stuff—it’s big business.”

Some of the findings of “The Gender Industrial Complex” include:

• While the total cost of transitioning varies widely by individual, lifelong use of cross-sex hormones could cost up to $300,000 or more per person, while a full surgical transition could cost more than $150,000.
• The potential health effects of undergoing transition are numerous, including increased risk of cancer, nerve damage, chronic pain, sexual dysfunction, mental health issues, and the need for additional surgeries.
• A number of transgender surgery providers, including Cedars Sinai, the Regents of the University of Michigan, the Mount Sinai Health System, and several others, were each estimated to bring in over $100 million in revenue in 2022 from these practices.
• Pharmaceutical companies Pfizer and AbbVie lead the way in hormone production, with 2022 revenues of $74 million and $51 million, respectively, from those products.
• Total revenues for transgender drugs and surgeries in 2023 were estimated to surpass $4.4 billion. And by 2030, the market is expected to grow beyond $7.8 billion.

The APP points out that these projections could be very conservative. In 2020 an LGBT think tank, the Williams Institute, estimated that there were about 300,000 minors who identified as transgender. If that is correct, the market for paediatric transitions alone could be as high as $37 billion.

Transgender transitioning is not just a matter of a few visits to a doctor and a few injections. It’s a lifelong commitment to regular medication and a long series of surgical procedures.

The report estimates that a male transitioning to a female will have to spend between $87,300 and $410,600 over a lifetime, assuming that he is on puberty blockers for five years and on feminising hormones for 60 years. The surgical component includes:

• $20,000 to 50,000 for facial feminisation surgery
• $6,000 to $12,000 for breast implants
• $10,000 to $40,000 to create an artificial vagina
• $5,000 to $8,000 to remove testicles
• $5,000 to $9,000 for voice feminisation surgery
• $3,500 to $7,000 for shaving the Adam’s apple

For a female transitioning to a male, the lifetime cost ranges from $66,500 to $605,500. The surgical component includes:

• $15,000 to $50,000 for a double mastectomy
• $9,500 to $22,500 for a hysterectomy
• $20,000 to $150,000 to create an artificial penis
• $6,000 to $10,000 for chest masculinisation surgery
• $4,000 to $6,000 to create an artificial scrotum

These operations are not like removing a wart or whipping out an appendix. They are complex procedures which often have painful complications – which involve more visits to the surgeon.