Living in a small city in southern Mexico, traveling for top surgery was my only option. This is the reality for the vast majority of transgender people living outside of major city centers—in the US, 50% of trans folks receiving gender-affirming surgical care must travel to access it. This kind of travel isn’t an exception—it’s the norm, and the healthcare system treats it like a footnote.

In the months leading up to my top surgery, as I went through the process of choosing a surgeon and planning my trip, I frequented Facebook groups and subreddits specifically for people seeking masculinizing chest surgeries. I watched patients post photos of healing nipple grafts asking if the dark color was normal, share stories of being unable to reach their surgeons, or describe emergency departments that seemed unsure how to treat them, or even unwilling to do so.

I was lucky. My partner was able to meet me at the hospital and spend the night with me there before he had to return home. We had the funds available for me to stay at a post-operative care home near the hospital afterward, with 24/7 nursing service and healthy home-cooked meals provided, so my partner didn't have to take any time off work. Aside from some graft loss on one side, I had no complications. My drains came out during my very first follow-up appointment after only five days.

When I flew home two weeks after surgery, I felt incredibly vulnerable. I needed help getting my carry-on bag in and out of the overhead bin, and I clutched my mastectomy pillow for dear life. I could not imagine having traveled any sooner. But this is the reality for many transgender people who cannot afford to spend weeks or even months away from home, and as such may face complications far from their surgeon, may struggle to find adequate support systems for their post-operative care.

Today we're looking at the issues trans people face when traveling for surgery, and how healthcare professionals can better prepare and support their patients through post-operative healing when their surgeon may be several states away.

According to research analyzing over 86 million patient records, every patient from West Virginia, Wyoming, South Dakota, Mississippi, and Delaware traveled out of state for gender-affirming surgery. The median distance traveled for this care in the US is 191 miles, with 36% of patients traveling out of state. For genital surgeries, 49% of patients cross state lines.

Dr. Dahlia Rice, a board-certified plastic surgeon, saw this access problem firsthand when she started practicing in Wisconsin. "There was no transgender surgery being done at all except for in Madison," she recalls. Dr. Rice calls medical tourism "a double-edged sword.” 

“Sometimes it's necessary because it fills a void,” she tells me, “but at the same time, it can be a huge burden." This is especially true when patients return home after surgery and later develop complications, but can even show up in routine post-op care. Rice describes surgeons who tell patients to simply go to the emergency department for drain removal after returning home. "That's an expensive drain removal," she notes. 

Emergency departments are not designed or equipped for routine post-operative procedures. What gets framed as a simple handoff—“just go to the ER”—often means hours-long waits, clinicians unfamiliar with gender-affirming surgical aftercare, and hospital bills running into the thousands for procedures that should take minutes in a surgical clinic. And beyond the question of ability, healthcare providers often shy away from what might be perceived as “interfering” in a surgeon’s work. 

Ilan Norwood, a public interest attorney in New York City, traveled to Austin, Texas for his phalloplasty procedure. He made the choice to travel in order to access a specific surgical technique with minimal staging. He was already familiar with his surgeon, and he had the added benefit of family nearby. Rather than renting an AirBnB and hiring a nurse or health aide, he was able to stay in his sisters’ home, with his mother, sister, and wife taking turns with caregiving.

Norwood planned to stay in Austin for two months. His surgeon told him he could go home after a month, but that if he wanted to ensure he had access to his surgeon until he was in the clear from the most common complications, the ideal timeframe would be to stay two months. This turned out to be an excellent decision.

At week five, Norwood developed a fever and severe pain. His care team rushed him to the hospital. A small seroma in his abdomen had become infected when a UTI from his suprapubic catheter spread, forming an abscess. "I was very scarily ill. And at one point was even septic," he remembers. Thanks to quick action from his surgical team, they located the abscess and treated it. "It was a very scary, big complication," he notes, but it was also easily treatable.

Norwood’s ability to stay near his surgeon for weeks, with stable housing, family caregivers, and flexibility around time off from work, represents a best-case scenario—a privilege that is largely out of reach for most trans people. Before leaving Texas, Norwood called a New York City hospital to ask if they could handle phalloplasty complications. Their response: "We can't do surgery on you...because we don't want to go into someone else's work...different surgeons have different techniques, but we can certainly see you if there is a problem.”

This concern is real, Dr. Rice confirms. "The moment you touch [someone else’s] patient, you're also liable," she tells me. This means doctors are extremely cautious about involving themselves in the work of another surgeon, especially someone they do not know and have not worked with before. As such, Dr. Rice generally won't perform surgery unless patients can stay nearby during the critical healing period.

With half of trans genital surgery patients crossing state lines, coordination between surgical centers and home providers isn't an edge case—it's core to post-operative care. Yet many healthcare systems haven't built infrastructure to support these handoffs.

Dr. Rice maintains a professional network specifically for coordinating care. "When it comes down to communication...if the doctors are able to talk to each other, then that helps," she says. Her approach includes multi-page post-operative instructions with medication schedules and drain care protocols, but she emphasizes availability above all. "I tell my patients, I'd rather have you call me in the middle of the night...so that you don't have to spend all night stressed out if [something you are experiencing] is normal or not. And then we can easily catch [any complication] before it becomes a really big problem."

She's built partnerships with trans-sensitive lodging options and works with insurance companies to coordinate home health aide coverage. When patients need follow-up care at home, she reaches out to their local providers and makes herself available for consultation.

But individual surgeon efforts can't fix systemic problems. "The system is [not] set up… to support our most vulnerable patients," Dr. Rice says. Meaningful solutions would require intentional coordination between surgical centers and home providers—shared protocols, clear liability pathways, and paid post-op support. For now, patients continue to make impossible calculations about how long they can afford to stay, how much help they can access, and what risks they're willing to take for life-saving care.