An Arizona law signed in March by Gov. Doug Ducey limits access to gender-affirming health care.

Such restrictions may be among the reasons half of transgender patients in the U.S. leave their home states for surgery.

Research in the journal JAMA Surgery by Oregon Health & Science University finds surgical expenses remained roughly the same in the destination states as at home.

But commercial insurance claims reveal patients paid nearly 50% more in out-of-pocket medical expenses such as coinsurance, copayments and deductible payments.

That doesn't include time off work, paying for travel and lodging, or the difficulties involved in receiving necessary follow-up care.

More research is needed to verify causes, but a lack of qualified surgeons is likely one of them: Most patients who left home for surgery did so in the South, which has only 11 such surgeons, according to a 2020 study.