My name is Sian and I am crowdfunding for gender confirming surgeries.

Note that the goal on this page isn't the final goal, just the first stage of the goal: GoFundMe does this thing where they add a bit more to the goal when the first part is reached. The final goal is £20,000, and I'll explain why below.

Who do you think you are?

I’m a writer, and I write as Sian Ingham.* I live in the UK. I doubt you’d have heard of me, but if you have it’s almost certainly by my former name, under which I published the book We Don’t Go Back: A Watcher’s Guide to Folk Horror, which was for a while a very modest hit among fans of cinema and classic TV, and which gathered a couple of award nominations. If you like tabletop games, there is a very passing chance you might be familiar with my work for the publishers White Wolf and Green Ronin, for whom I’ve contributed to well over 50 games and supplements over the last 20 years. My new book Atlantis Through Time was published by Crossed Crow Publishing in July 2026.

(*Ingham isn’t my legal surname anymore. I am keeping it for my published work because continuity.)

I am an active part of Citrus Housing Co-operative, a small but growing organisation that is dedicated to creating safe and affordable housing for disabled and marginalised people in the UK. This has been the main use of my time in the last two years.

Why do you want money?

I’m trans. I came out as genderqueer in 2018, began pursuing medical transition in 2023, and began hormones in July 2024. My pronouns are they/she. I am under the Welsh Gender Service here in the UK.

In Britain, you can (currently, who knows how long for though) get some gender confirming surgeries on the NHS, specifically bottom surgery; transmasculine people can also get top surgery. I’m hoping to get bottom surgery soon — the estimated wait for me is about three years, so “soon” is a relative term.

I’ve been on HRT since mid-2024 — the picture of me below is my official headshot, taken before I began transitioning medically. The bodily changes below the neck are satisfactory (in fact, some feminine characteristics I had already before the HRT, a thing that got me bullied in the locker rooms as a kid, have only accentuated). I definitely don’t need top surgery at all.

But above the neck, that’s a different matter.

Why is this so hard?

The UK is by a considerable distance the most dangerous environment for LGBTQ+ people in Western Europe. Legal recognition for trans people is among the shakiest in Europe. The Lemkin Institute for Genocide Prevention has issued a Red Flag for the rights of Trans and Intersex people, and the Council of Europe has repeatedly included the UK in its list of countries where the rights of LGBTQ+ people are in danger, alongside Bulgaria, Hungary, Georgia, and Russia.

It's deeply embedded in British culture and funded by billionaires. Around the time I started this, a British billionaire threatened Amnesty International with legal action for producing a report on British anti-rights groups, forcing them to take it off their website. It shocks people in other countries to know that both the left and the right repeatedly question trans rights in the UK: you are as likely to find shockingly transphobic content in the Guardian as you are in the Daily Mail. They don’t call this place TERF Island for nothing (In fact, making this and sharing this is going to earn me hate and is going to absolutely wreck my social media algorithms forever. I am risking a lot).

Trans healthcare here is underfunded, understaffed and scrutinised ruthlessly by a hostile press and forbidding social structures.

The NHS — even the Welsh Gender Service, which is the best provider in the country by no small distance — does not provide these gender-confirming surgeries, and while even in the US, some health insurance providers would mostly cover this, here in the UK, even private options for gender-confirming surgeries are entirely inaccessible. The only option for a British trans person seeking gender-affirming care is paying full price for private procedures overseas.

And so, this exists. It exists only for the procedures that can’t be done on the NHS.

What exactly do you need? Because that is a LOT of money.

OK, look, yes, This is a HELL of an ask.

But, real talk. How do we define “Need”?

Will I die if I don’t get these things done? No.

Will I live a better, safer life if I do get them? Yes, I will.

The fact is, I have never been able to cope with this face.

I’ve never known what to do with it. Not even as a kid. I think you can see that from the rare photographs of me that exists.

There is always discomfort there. There’s always the sense that I don’t know how to live in that face.

I have never wanted to look like a man. Even as a child, I was drawing pictures of myself as a woman; in the 90s, as a student, I was writing critical work on literature that positioned myself as a critic and opponent of masculinity; when I wrote fiction for White Wolf in the 2000s, I inserted a version of myself as a woman into several books. For years, my author photo on several of my books had my hand hiding my face. It took well into the 2010s for the penny to drop, and for some years after that, I got it into my head that it was simply too late to do anything about it.

It might be hard to see what the problem is, looking at me.

This is the official headshot I send to publishers or people who interview me. It was taken in 2024, just before I started HRT. I can’t really bear to look at it, but it’s the least offensive and most recent picture of me I have. It is literally only here because I have to share a picture. I don't have any more recent pictures.

And, look, you can look at my face, and see a perfectly ordinary face. I can’t. It’s not my face. And as the bodily changes from the therapies I’ve been having have become more extensive and my body at large has, bar that one frustrating thing, become what I need it to be, the dissonance with these features has become more and more extreme.

I can’t sleep at night without imagining owning a different face. I can’t look in a mirror - I shave by touch, even, because I just can’t stomach my reflection, and that's why I usually have a shaving cut somewhere.

The first time I saw myself filmed was in 1994. I was 18, and it shocked me to my core. I’d always imagined myself as something epicene and graceful, and what I saw was this. And all I could think was, this is not my face. Over thirty years later, it still isn’t.

I don't have a photo album. I don't keep photos of myself. I never have. I have never seen a picture of me that is a picture of me. I cannot bear to see photographs of myself.

It's always been like this, honestly, and as a result, I realised recently, my life is largely undocumented. I haven’t gotten to keep those memories.

What does the face I imagine look like? It just needs to be softer.

Please understand: I don’t want to look like a fashion model. I will never be pretty, and don’t want to be — that’s a young person’s game, and I’m too old for that. If I can go for dignified, I'll settle for that (my gender goal is "Reverend Mother" and IYKYK).

I am under no illusion that I will ever pass, and actually that’s all right too, because there is a revolutionary element to this. Until recently, I could hide. The changes to my body have made that impossible, and these surgeries will help me to live authentically and openly.

This is the worst time to be overtly trans in the UK. But I'm sick of hiding.

I recently saw a trans person describe a situation identical to mine (without any reference to me, or even knowing I was watching, I should add) as the worst hell they could imagine, the worst possible outcome of a trans person’s life. The thing that scared her more than anything else in the world was the prospect of having of having left it so late that they ruined their chance to live a real life, with their youth and looks gone. They said they couldn’t live like that. They said they'd rather die than end up like that. Like me.

I keep thinking about that.

It turns out that plenty of us live as other people’s worst nightmares (and if I’m your worst nightmare, I advise you to bless your luckiest stars, because you don’t have that many problems). I would prefer to prove them wrong, though.

I want to live, and I want to document my life, and I want to take a photo of myself with a face that’s mine.

Risk

Whoever I see for this, there's going to be risk. Every single prominent provider of gender surgery, anywhere in the world, has stories attached to them of life-changing magical success and hideous failure. But in the end, that’s plastic surgery, isn’t it? You see loads of celebrities who look amazing, and from time to time you see stories of the richest, most beautiful people in the world having their plastic surgery botched. So my job is to find the best one I can and accept the risk.

OK, so let’s talk logistics and cost breakdowns

I have accepted that whatever happens, I’m going to have to travel.

As I said, it's not just hard to get this sort of care in the UK, it's impossible.

There are no surgeons in the UK who are accessible to me. Transgender care in the UK is heavily gatekept and for various reasons (age, time in transition, body weight), I cannot hire a British surgeon. And even if things were different and I could be accepted as a patient, the cost would be higher than anywhere else in the world.

I have spent the months before starting this getting quotes.

Thailand:

Thailand would be the cheapest, and I even talked with a clinic there. They offered $5,900 US (£4,400), for full sex reassignment surgery. But having spent a bunch of time asking people in the community, I think I will have to rule it out. While Thailand is a really good place to go for SRS, it is not really a good place to go to for facial fixing, for the simple reason that surgeons there are expert in working with the facial features of Thai people, and not so much with Europeans.

France:

Closer to home, France is, according to the community, very good. But the situation in France pretty much exemplifies the freelancer’s mantra of “You can have fast, cheap or good, but you can only have two.”

As I understand it, French health service laws cap the prices of private surgery in public hospitals, meaning it’s relatively inexpensive, and the recommended surgeons have great reputations. But they’ve also got really long waiting lists, even for private surgeries. I could potentially be waiting for years. Even the consultations can take more than a year to get to.

Spain

Spain is the most expensive (after the UK ). Quality is high.

I’ve had personal recommendations from people (including a friend who came back from her own procedures an absolute knockout, like completely transformed). I have spoken to FacialTeam in Marbella, Spain, who my friend went to.

Here’s what the consultation I had suggested:

• Forehead/brow feminisation: €11,800

• Jaw/chin feminisation: €9,800

• Hospital fees: $3,800

• General anaesthesia: €2,350

• Post-operative care, transport in Spain and accommodation: €3,846.50

• Material costs and CT scans: €2,000

Optional to this are procedures which I requested a quote for but which could be left out:

• Lip lift: €2650

• Platysmoplasty (neck, underside of chin): €8,350

Services also include free of charge correction, should it not go right.

This would come to €44,596.50 (or €33,596.50 without the options). Including travel on a plane to Malaga from Heathrow (and travel to and from home to London), it’s reasonable to round it up to €45,000/34,000.

At the time of writing (early July 2026) this is roughly £39,000/29,000 (or for my American friends, $51,500/39,000).

That's a hell of an ask. I would like to try Spain, but I don't know if this is a raisable sum.

Argentina

Buenos Aires is where American trans women often go, and I spoke to the clinic of Javier Rossi, who comes about as recommended as any of them.

They’ve suggested different procedures. There’s more here that’s cosmetic, and I’ve been told I can choose which ones I want. They haven't given me a complete breakdown, but their list came to $17,800 US (about £13,300)

It looks like this:

• Forehead reconstruction.

• Orbital rim reshaping (that's the bony ridges around the eye sockets.

• Brow lift (to make the eyebrows match the new shape of the forehead and orbital rims).

• Rhinoplasty (to push the top of the bridge where it meets the forehead so it matches the new forehead shape. (They also offered to make my nose more “buttony”, but my nose is the one part of my face I think is fine, seriously.)

• Lip lift.

• Chin and jaw reconstruction.

• Medical fees and costs including general anesthesia and 1 night hospitalization in private room

• Bedside bilingual sitters in the hospital to better communicate with the nurses.

• Daily visits to the hotel or apartment I’d be staying in after the surgery (I have to find my own accommodation, but they gave me an exhaustive list of every place to stay in the area. This is a big extra cost though.)

• All medical appointments and checkups.

• Pre-surgical tests and 3D CT scan.

Standard post-op medication

• Bilingual assistant + transportation for my arrival/departure and every medical event

• A local paid up phone SIM.

On top of this they offered me some other stuff, and said they can offer one of them for free:

• Bilateral upper blepharoplasty (altering the skin to fit the new shape around the eyes) $1,700 US (£1,270)

• Facial lipofilling (fat transfer, subject to availability of fat on donor areas of the body like abdomen, waist or inner thighs) to upper lip (to make it fuller), to cheeks (both the apples and the cheekbones), and to the circles under the eyes: USD 1,700 US (£1,270)/ To upper lip alone: $900 US (£675).

• Segmental laser liposuction of the neck, under-jaw and jowls: $2,500 (£1865)

They offered me hair transplants too, but I have declined that. Taking on all of those would be another $5,040 (about £3760)

So the whole lot is a grand total of roughly £17,060 (but one of the cheaper extra ones I can have for free if I can get my deposit down quickly, so it might be a little less).

A return plane ticket to Buenos Aires and accommodation costs will round that up to probably just over £20,000.

The decision

I'd really like to go to Spain, because I know that they're good. But I will settle for Argentina. It's still a lot of money, but it seems somehow raisable. I need to raise a deposit for the Argentina quote very quickly, though, so that's my first goal.

Ethics

I appreciate that there are some questions. I mean, I've had them myself. For example:

"Wait, there’s genocides happening, there are people being sent to prison for literally holding up signs saying genocides are bad, disabled people in the UK are now facing homelessness, de facto incarceration and in some cases euthanisation, and here you are asking for money for plastic surgery?"

And yes, thank you, Imaginary Straw Man (and yes, you can be a cis straw man too if you want), that is a good point. This is fair. What is the life of one middle-aged queer when there’s all this happening that you could also be funding? But here is the thing. If you’re of the opinion that I’m doing a wrong, please give money to someone whom you feel deserves it more. Help someone.

Anyone.

I’m a person you could help, and trust me, I’m going to be grateful for every copper coin that comes my way, but if you don’t help me, help someone else.

"OK, but what about all the other trans folks who can’t get their gender affirming care? Why should you, with most of your life behind you, deserve this when so many other younger people don’t get to?"

Again, that’s right – it’s not fair, is it? And I know that. This is why I want to talk about what I want to do with the money from this crowdfunder.

I will use every penny to fund gender affirming care and the logistics necessary to receive it. If I don’t make the target in the window I have set myself (one year), I will either still use what I get to reach some way to a result, or If it isn’t enough for anything and it stalls, as I fear it might, at something like £9.67, two shirt buttons and half a dozen death threats, I pledge that I will donate the monetary profits of unmet goals towards gender care for another trans person.

And if by some vanishingly unlikely miracle this goes viral and I get more money in this funder than I need, every penny of any excess will go to supporting trans healthcare for others who are trying to raise money for it.

Hell, blue sky thinking, if you raise me a million pounds I will entirely fund the twenty-five other people that I will be able to afford to help.

I’m just one of many. We’re out there. We need it.