It depends on a lot of things...
My last calculation had the total outlay for four years around $29,000 of which $20K was GRS, and no future expenses beyond a lifetime of endo monitoring ($50/year) and HRT ($600/year).
Because I'm the sort of person who keeps track of these things anyway, the cost of transition for my wife *without* insurance :
laser - $2000
endocrinologist - 4 visits yearly, $150 per visit and $400 for lab work done every visit ($2200/year)
ultrasound to check liver function, once - $5000
therapist - $100 per visit, 1 visit per week ($5000 per year)
HRT, patch - $50/month generic, $150/month brand name ($600 or $1800 per year)
GRS - $20,000 US (it was $18K Canadian, but the exchange rate was in their favor)
plus about $500 total to get all the necessary documentation for name and gender change and pay the various fees to send in the applications.
As it happens, insurance actually did cover the therapist, ultrasound, endocrinologist and HRT. My employer's insurance plan specifically excluded *only* GRS, while paying for all other transgender care. Could be worse.
Actual cost there per year : $1200 for the therapist, $120 for the endo and about $200 for lab work after the insurance paid their share, $600 for patches ($50 copay per month), and I think $50 for the ultrasound.
Similarly, she had paid time off for the full month, and travel expenses were about $1000 for a place for me to stay in Montreal and maybe $200 in tolls/gas/snacks.
And as others have said, HRT becomes a routine ongoing expense; I discontinued the Pill and she took up using HRT simultaneously, even, so the net change to the budget was nearly zero.
