Facial and voice gender-affirming surgery can alleviate gender dysphoria and may improve recognition of gender congruence. Previous research has demonstrated that facial and voice gender-affirming care improves patient-reported outcomes. The World Professional Association for Transgender Health, along with every major medical association in the United States, has called for health insurance coverage for all aspects of transgender care as medically necessary for the treatment of gender dysphoria. Despite policy statements and outcomes research demonstrating its efficacy for the treatment of those with gender dysphoria, insurers may specifically deny facial and voice gender-affirming surgery based upon the mistaken belief that the surgery is “cosmetic” and not medically necessary. As such, a recent national survey showed that 55% of transgender individuals were denied insurance coverage for transition-related surgeries; barriers specific to facial surgery were not assessed. Advocacy and further research providing confirmatory scientific evidence may be necessary to definitively designate facial and voice gender-affirming surgery as medically necessary across all insurers.