Summary
What do they do? Lyon-Martin provides hormone prescribing, monitoring and support within a broader clinical service. This proposed slice covers clinically eligible adults seeking masculinization whose treatment would otherwise start later. It excludes minors, estrogen therapy, surgery and other clinic programs. More
Why this approach interests us
- Extra clinical and navigation capacity could bring forward wanted, clinically appropriate treatment.
Our main reservations
- The small external trial’s utility interval includes no benefit and harm. Local waiting times and marginal costs are unknown.
What do you get for your dollar?
Our conditional best guess is $4.57M per better life (10 QALYs) for a proposed donor-funded acceleration of adult testosterone starts. This is not an estimate of all gender-affirming care, nor a judgment about whether an individual should receive treatment. Inspect the model →
- our best guess
- $4.57M — per 10 incremental QALYs; conditional analyst model
- positive scenarios
- $95K–$768M — Not confidence bounds; null and harm possible
- cost per supported start
- $1,000 — Assumed all-in access budget, not a clinic quote
- funding room
- Unverified — Capital expansion is not a hormone-access tranche
1. What do they do?
Lyon-Martin provides hormone prescribing, monitoring and support within a broader clinical service. This proposed slice covers clinically eligible adults seeking masculinization whose treatment would otherwise start later. It excludes minors, estrogen therapy, surgery and other clinic programs.
Identify an avoidable wait
Establish the real alternative start date, not simply whether an appointment was booked.
Add appropriate capacity
Finance clinical and navigation time with labs, medication access and reimbursement accounted for.
Count only the earlier health window
Credit health while care is brought forward; do not assign lifetime treatment benefit to a short delay.
Scope of this review. Clinical eligibility and treatment decisions belong to the patient and qualified clinicians. This is philanthropic program research, not medical advice.
2. Monitoring and information sharing
64 adults enrolled; 62 completed, 31 per arm
Randomized secondary analysis; Australia. Baseline-adjusted EQ-5D-5L difference 0.07 at three months; reported 95% CI −0.07 to 0.21, nonsignificant.
Our assessment. Open-label, short follow-up and UK utility tariff. EQ-VAS is not preference-based utility; symptom changes are not deaths prevented. Published interval and P value are retained without deriving a probability distribution.
3. Qualitative assessment
Extra clinical and navigation capacity could bring forward wanted, clinically appropriate treatment.
Key reservations
- Local wait duration and accelerated-start count are unknown.
- Cost and additionality are judgments, not observed Lyon-Martin economics.
- The utility interval includes harm; positive scenarios alone do not establish effectiveness.
- No long-term or mortality benefit is credited.
Benefits not included in our estimate
- Benefits beyond month three
- Mortality inferred from suicidality scores
- Additional depression/dysphoria credit already reflected in utility
- Minors, estrogen therapy, surgery, psychotherapy and other primary care
4. What do you get for your dollar?
Our best estimate: $4.57M per 10 QALYs.
The nominal $1,000 budget is an assumption: three $250 clinical/lab/medication encounter bundles plus $250 allocated coordination, including unsuccessful engagement. We assume half the supported starts are actually accelerated and retain half the external effect for transfer.
A better life is our comparison unit of 10 additional quality-adjusted life years (QALYs), potentially spread across people. These are uncertain estimates, not measured returns or verified donation offers.
How we calculate the estimate
DOLLARS PER BETTER LIFE: 10 × $1,000 ÷ (0.07 × 0.25 years × 50% × 50% × 50%)
≈ $4.57M per 10 QALYs
Model inputs and assumptions
- Cost per supported earlier start
- 1000 (range: 250 / 1000 / 2000). Assumed nominal USD $1,000: three all-in clinical/lab/medication encounter bundles at $250 plus $250 navigation/coordination allocation including unsuccessful engagement. Neither unit price nor utilization is measured locally; no assumed reimbursement savings. Trial utility anchor or explicit assumption.
- Three-month utility difference
- 0.07 (range: 0.14 / 0.07 / 0.01). Nolan 2024 randomized secondary analysis: baseline-adjusted EQ-5D-5L difference 0.07, reported 95% CI −0.07 to 0.21; nonsignificant. UK tariff, short open-label trial. Positive scenario values are not confidence bounds. Preserve reported interval rather than reconstructing one from the inconsistent reported P value. Trial utility anchor or explicit assumption.
- Wait avoided
- 0.25 (range: 0.25 / 0.25 / 0.08333333333333333). Central three months matches the external trial window; local wait and number of accelerated starts unknown. Credit no benefit beyond three months; not a lifetime treatment estimate. Trial utility anchor or explicit assumption.
- Within-window benefit onset
- 0.5 (range: 1 / 0.5 / 0.5). 50% assumes a linear ramp from zero to the measured month-three endpoint. Immediate full benefit in the favorable case is a stress assumption, not observed onset. Trial utility anchor or explicit assumption.
- Local transfer retention
- 0.5 (range: 1 / 0.5 / 0.25). 50% judgment for Australian-to-SF care setting and population differences; no local causal utility measurement. Trial utility anchor or explicit assumption.
- Genuinely accelerated share
- 0.5 (range: 0.75 / 0.5 / 0.25). 50% judgment for starts actually brought forward by the donor rather than existing insurance/funding or alternative access. Do not credit all scheduled appointments. Trial utility anchor or explicit assumption.
Illustrative $100,000: 100 supported starts and 0.219 additional QALYs
- Favorable positive: $95.24K per 10 QALYs. 10.5 QALYs per $100,000; not verified funding capacity
- Central analyst estimate: $4.57M per 10 QALYs. 0.219 QALYs per $100,000; not verified funding capacity
- Unfavorable positive: $768M per 10 QALYs. 0.00130 QALYs per $100,000; not verified funding capacity
Uncertainty. No shortened wait, no additional financing or no utility benefit means no finite positive-benefit price. The utility interval includes harm. Signed utility sensitivity is supported by the model; nonpositive health results are not presented as a positive cost-effectiveness price.
A three-month endpoint is not three months at full benefit.
The randomized study compares immediate initiation with a three-month wait. Our central onset factor assumes a linear ramp from zero to the utility difference at month three. There is no further duration multiplication or separate credit for symptom-score changes.
HEALTH PER SUPPORTED START: 0.07 × 0.25 × 0.5 × 0.5 × 0.5
0.0021875 incremental QALYs
QALY conversion assumptions
The favorable sub-$100K case jointly assumes $250 cost, 75% additionality, larger utility benefit and immediate full onset. It is a research possibility—not the expected price or an available opportunity.
5. Funding and previous grants
We have not identified a priced tranche that demonstrably shortens waits rather than replacing existing financing.
A February 2026 HRC approval schedule proposes $202,000 annually for mixed integrated care. An April DPH planning list separately shows $1,742,500 for core services. These are different funding lenses—not a current hormone budget or an unfunded balance. The capital campaign’s additional-patient goal covers multiple services.
This review does not establish a verified marginal funding offer or a complete history of grants.
We have not verified a suitable donation route for this reviewed activity. Confirm the legal recipient and intended allocation before donating.
6. Sources
- Healthcare services. Lyon-Martin. Local prescribing, monitoring and support identity; not marginal unit cost. Published: Undated; retrieved: 2026-09-07.
- Testosterone and Quality of Life in Transgender and Gender-Diverse Adults Seeking Masculinization. Nolan et al., JAMA Network Open. Primary randomized secondary analysis; preference-based utility endpoint, not local effect. Published: 2024-10-25; retrieved: 2026-09-07.
- RFP 100 grant agreements for commission approval, p.12. San Francisco Human Rights Commission. Proposed mixed integrated-care funding, not a hormone-access budget. Published: 2026-02-09; retrieved: 2026-09-07.
- Contracted programs planning list, rows 292–293. San Francisco DPH. Dated planning figures; not executed current cuts or private funding room. Published: 2026-04-17; retrieved: 2026-09-07.
- Save Lyon-Martin capital campaign. Lyon-Martin. Prospective multi-service capacity and permanent home; not incremental hormone starts. Published: Undated current campaign; retrieved: 2026-09-07.
Annual expenses: years and sources
Average annual expenses (three consecutive fiscal years): $5,874,325. Organization size is separate from the modeled cost-effectiveness of a donation.
Lyon-martin Community Health Services
Whole legal entity Form 990 Part IX total functional expenses; latest original reconstructed filings checked, fiscal-end year from printed reporting dates. Older fallback rows from IRS extracted API.
Latest original filings checked; ProPublica extracted API lags these original returns.