A Trans Person’s Guide to Job-Hunting, Insurance, and Retirement

This is an article that originally was posted on Bloomberg and was written by Ben Steverman. You can see the original here.

“You’d be surprised at the thing that will jump up and bite you.”

Leslie McMurray’s retirement account didn’t survive her transition from male to female. The 58-year-old had to spend almost $70,000 on medical treatment, including electrolysis to remove hair from her face. “It’s hideously painful,” she says, “and costs as much as a Hyundai.” An additional $100,000 went to living expenses, when her transition abruptly ended a 35-year career in radio and TV. She finally found a nonprofit job paying less than a fifth of her old salary. McMurray also lost a 33-year marriage, a 4,500-square-foot house in the Dallas suburbs, and most of her possessions.

“And,” she adds, “I’ve never been happier.”

Much is demanded of transgender people, from the emotional to the physical. Less talked about is that living in one’s true gender also requires financial grit, as transitioning can have economic consequences that are harsh or bewildering or both. Success starts with the right attitude, McMurray says, four years after her transition began. “Understand it’s going to take a long time,” she says. “It’s not an easy thing to do. Get good advice and a good therapist. Go through the process. Don’t be in a hurry. Get it done right.”

You may not want or need the full treatment, which usually starts with hormones, then can include facial surgery and voice therapy, and only sometimes ends with gender-reassignment surgery. If you do, insurance can help. A record 60 percent of the country’s largest employers offer trans-inclusive health-care benefits, according to a survey of 851 corporations by the Human Rights Campaign, up almost sixfold from 2011. New regulations, scheduled to go into effect next year, also require insurance plans on the Affordable Care Act exchanges to offer transgender health coverage—though this area of care is jeopardized by the election of Donald Trump, who’s pledged to repeal Obamacare.

Even if the status quo remains, coverage can be confounding. “Insurance is a complex and dark maze for a lot of people,” says Jillian Weiss, executive director of the Transgender Legal Defense & Education Fund. Trans-inclusive insurance policies may cover hormones and final “top” and “bottom” surgeries, but not other recommended treatments you may need to look and feel like your true self. “They’re not covering the things you really need to survive and thrive,” says Alaina Kupec, 47. She works for a large pharmaceutical company that thought it was offering trans-inclusive health insurance. Then her insurer denied her claims for electrolysis and facial feminization—and she lost three levels of appeals. “I pushed the system,” she says. “I didn’t take no for an answer.” Finally, her employer agreed to pay for the treatments her insurance company wouldn’t approve.

Keep track of everything you spend out of pocket on your care. The IRS lets you deduct medical expenses on your taxes if they exceed 10 percent of your income. (It’s 7.5 percent for taxpayers 65 and older this year.) It can take years to medically transition, but because of both taxes and insurance-deductible rules, it might make sense to schedule as many procedures as possible in the same calendar year.

A growing number of companies publicly pledge not to discriminate against lesbian, gay, bisexual, or transgender workers. But that may not help you, especially if you have a low-ranking position. “The question is whether it filters down to the factory floor,” Weiss says.

If you’re hoping to switch careers, transitioning could complicate the process. “The job interview will be going great, and then at some point they will realize we are trans,” says Drian Juarez, program manager of the Los Angeles LGBT Center’s transgender economic empowerment project. “We are hypersensitive to those clues that let us know that someone has ‘clocked us.’ All of a sudden we see their body language change.” Even if you go “stealth” during the interview, a background check or your references could inadvertently out you as trans.

Minor discrepancies can put you in a bureaucratic maze—and even make it difficult to access your own money

Twenty states—and many local governments—ban workplace discrimination against transgender employees and applicants. In places that don’t, federal law offers no explicit protections, but courts and the Obama administration have said trans people are protected under the sex discrimination provisions of the Civil Rights Act of 1964. Under President Obama, the U.S. Equal Employment Opportunity Commission has been handling more complaints from trans people—183 were resolved in the 2015 fiscal year, according to commission data, up from 74 two years earlier. Nonprofits and private attorneys are also taking more cases. There’s no telling what the Trump administration’s policies will be.

Changing your name and gender on every government ID, bank account, vehicle registration, credit card, library card, and frequent-flier program you’ve ever signed up for can be laborious. But going through the hassle can ultimately make life a lot easier.

Allison Scott, a 42-year-old transgender woman in Asheville, N.C., says she’s been told: “It’s just your name on a piece of paper. It’s not a big deal.” She says that “shows there’s zero understanding” of the true importance of one’s name. The consequences of mismatched paperwork can be trivial or life-threatening. An outdated ID can broadcast that you’re transgender to everyone who sees it, from bank tellers to nightclub bouncers to the police. “If there’s an ‘M’ on your driver’s license, guess what jail you go into?” McMurray says. And it’s tough to get admitted to a hospital with the wrong information on your insurance card.

Even minor discrepancies on financial accounts or insurance documents can send up a red flag, putting you in a bureaucratic maze to get the right treatment or gain access to your own money. “You want to make sure every crack is filled,” McMurray says. “You’d be surprised at the thing that will jump up and bite you.”

Along the way, don’t assume people know what they’re talking about. That goes for human resources people, financial advisers, government clerks, insurance company employees, and anyone on the other end of a customer service line. You might need to make yourself an expert on insurance treatment codes, for example, or on your state’s rules for changing your name and gender on government documents.

You may need to call again and again and again, knowing you could be the first transgender person an employee has ever dealt with. But you’re not alone. About 1.4 million American adults identify as transgender, the Williams Institute at the University of California at Los Angeles estimated in June. That’s 0.6 percent of the adult population, twice the estimate from a decade ago.

Earlier this year it took eight calls for Andrew Nardella, 35, to get $2,500 out of an old retirement account listed under his former name. Every time he called, employees and their supervisors told him something different about the proof he needed. He finally got the money when, desperate to pay for food and rent after a move to New York City, he accused the account provider of discrimination. Scott says she’s been battling for 18 months to update her 401(k). It still lists the wrong name.

Whatever happens, don’t get discouraged. Not everyone will be unfriendly. Gwen Fry, 56, is a former Episcopal priest who now cleans houses for a living in Little Rock. She lost her job at a local church after transitioning two years ago and hasn’t been able to find other work. Through all that pain and difficulty, she says, one of her “smoothest experiences” was changing the name on her bank account at a local branch. “They were very gracious and respectful,” she says.

And there’s hope. Aiden Yang, 23, had no trouble getting his insurance to pay for “top” surgery in September. His employer, a large technology company, devotes an HR person specifically to help trans employees navigate the insurance bureaucracy.

“It sounds like there were trailblazers at my company who made it a lot more normal,” Yang says. He’s overheard co-workers—who don’t know he’s trans—saying transphobic, homophobic, and sexist things. Still, he’s making plans to come out at work. “I feel that being trans is part of me,” Yang says. “I’d rather be out and be visible, because I think it’s necessary.”