Becoming and Re-Becoming: Why I’m Pursuing Gender Affirming Surgery

Many of us have at least one aspect of our bodies we like a little less; a too-knobbly knee, upper arms that aren’t as toned or muscular as we’d like, a nose with a ridge that we find distracting. For many, these are simply quirks to be worked around, accounted for, or possibly even embraced in the end as evidence of our humanity. For others, it can become more complicated. Dysphoria steps in when we find ourselves at odds internally with a body we see reflected back at us and the body we expect ourselves to have — and gender dysphoria makes you feel as if you are locked in a battle that, in that moment, you feel you lose over and over again not only as you look in the mirror, but also as you’re in public and visible to others.

Dysphoria has ebbs and flows for me; I may go weeks without that horrible heart-pounding, nauseating feeling where I’m confronted with the reality of what I look like versus what I have tried to piece together in my mind. Otherwise, I may become aware of a body/mind mismatch several times a day. Some things are more reliable for setting it in motion; travel seems particularly difficult for me because I’m surrounded by strangers who are only vaguely paying attention to people around them and as such, they’re more likely to make a quick decision about a person. Because I already deal with significant travel anxiety, I dress for comfort first. Odds are good that a trip through airport security ends with me on a plane trying to meditate my way out of tears and spiraling anxiety, generally with limited success.

To put it even more simply: my body as it is right now, pre-surgery, causes a degree of daily stress that is consistently layered on top of everything else I have to juggle in my life. How I dress, sit in a chair, cross my arms, or even tilt my camera in work meetings or selfies requires a quick check of my body before anything else. Always, always that extra cognitive effort pulling me away from more important things, pulling focus in moments where I’d like to be putting my energy anywhere but towards repeated visual scans of my body.

When I first came out as a nonbinary trans person, there were three things I reinforced for everyone:

• My they/them pronouns were non-negotiable
• Medical transition is not necessary for trans people
• I would not be pursuing medical transition

From where I stand today, I consider two of these three bullet points to be true; my pronouns haven’t budged an inch and likely won’t in spite of myriad attempts to inform me that they’re cumbersome, not grammatically correct, or simply breaking too many traditional grammar rules to be considered (they’re wrong). I do not think that any person who is gender diverse should ever feel that they need to pursue medical transition (though I recognize it’s a more complicated situation for many, particularly for trans women); neither medical transition nor gender dysphoria itself are “requirements” for being transgender, and those who would require such things of a person could be accused of seeking only to resurrect arbitrary, nonsensical rules to gatekeep when our community has done so much to push away from such things.

But on the last point, well, clearly I have changed as I’m writing this for a reason.

I’ll continue by saying that the trans community’s general acceptance of flexibility in terms of an approach to medical transition (not universally granted, but I’d wager a majority are in alignment about the necessity, or lack thereof, of surgery or hormones) is something I have boundless appreciation for. By and large, I have been able to feel like I’m a part of a group where we are encouraged to put thought into what feels comfortable and who we are and adjust as we go along if we feel the need to do so, and only if we wish to adjust on our terms.

Like the vast majority of gender diverse people I know, early on after coming out I was incredibly concerned about the idea of not fully knowing who I was. What if I wasn’t quite what I thought and changed my definition after coming out? I knew I wasn’t going to decide I wasn’t nonbinary outright, but what if, after declaring myself to be agender (I don’t consider myself to be a man or a woman at all. I consider myself to be fully outside any binary), I changed my mind? Wouldn’t that reinforce anti-trans narratives about people changing their minds after undertaking a major life change? Wouldn’t it reinforce the idea that our identities as trans people must not be so very important (or, more significantly, that we weren’t “born” to be who we truly are if we changed)?

What I heard back from the community was an affirming, gentle, and kind answer: that we have every right and reason to continue to examine our identities and refine our ideas as we go, and that doing so in no way negates who we are. I’m friends with many trans men and women who have known who they are for a while and, as they continue to pursue treatments to feel comfortable in their bodies, have had unshakeable, deeply rooted beliefs about themselves. I’m also friends with trans people who have shifted over time; some coming out initially as a trans woman or man only to ultimately decide that they felt more comfortable under more of a broad, nonbinary definition. The trans “umbrella” is named as such for a reason; it covers myriad experiences.

None of this creates any sort of hierarchy in terms of who is “more” trans, or who “counts” more. It’s simply an indicator of our lived reality: that as human beings, we are handed a sheaf of smudged and often inscrutable papers with a purported guidebook for existence, often with lines crossed out and edited or removed outright. Language is the mechanism by which we communicate with the world and contextualize it; we require language to relay sophisticated and complex concepts and all of this is ever-changing. We went centuries without understanding concepts like conception, evolution, or germ theory…and often, we came up with ideas we now recognize as flawed or outright wrong.

This brings me back to my mental orbit when I first came out: insistent that there was no need to change my body. I truly felt that at the time and for a lengthy period worked hard to champion this idea for others (and will forever continue to do so regardless of my own decisions). What changed, then? The pandemic, actually. Given how horrible the past few years have been for those who have lost family members and friends or have had their lives completely rearranged, I’m aware that alluding to anything approaching a silver lining in the pandemic seems crass at best but all the same, isolating helped crystalize a few things for me.

When the pandemic began, there was a vague notion that we’d only be “locked down” for a few weeks; early on, I knew this wouldn’t actually be true (I had a friend who is a doctor who’d begun warning me months before that Covid-19 would be extremely serious, and I believed him). As such, I settled into a work-from-home routine quickly, as I was lucky enough to have a job in the game industry where that was an option. My previous routine had involved waking up at about 4:30am/5am most workdays in order to be on the earliest possible bus, then train, then shuttle to work. My commute was about 3 hours total each day; sometimes more. Just the commute itself drained a lot out of me and dropping it meant I found myself with more time to rest, sleep, and think. Beyond that, I realized I had the opportunity to do something I hadn’t before: radically change my presentation without much comment as my coworkers would only be seeing me on a blurry zoom call.

I had supportive friends and coworkers, so I wasn’t concerned about changing how I dressed and looked too much beforehand, but there was one constant undercurrent I didn’t often bring up with others: the idea that I needed to temper the amount of change I was undergoing to make it easier to be accepted. I was convinced that making too many rapid moves in terms of how I looked or even behaved would alienate people or make it difficult for those who were close to me to feel supportive of me or to even truly recognize me as nonbinary and not, well, ‘still kind of a woman, actually’ in spite of all I said. “They changed overnight! I don’t even know who they are anymore!” was a thing that I imagined people thinking about me — right or wrong — and it absolutely dictated a lot about how I looked. It took me at least a year to finally cut my hair short after keeping it rather long for years; just that felt like a daring move.

Once the reality of the pandemic began truly hitting home for our communities, I was faced with the idea that it would be months or more before I saw coworkers and friends in person again. I decided to take advantage of the opportunity to wear whatever I wanted; I hadn’t been able to wear a chest binder to the office before, as wearing one for an entire workday would be unthinkable to me (it’s not safe to wear a chest binder for more than about 8–10 hours; for me, anywhere near the range of 8 hours was never tenable). While I was working from home, I could wear one for meetings when I knew I’d be on camera for more than a few people, and I was more able to wear men’s button-up shirts if I chose, which was a professional look I preferred over more feminine clothing.

Faced with the prospect of having no one to cut my hair for me for a while, I also started buzzing all my hair off. I wasn’t sure exactly how I wanted to look moving forward on a long-term basis, but just these changes felt dramatic enough to allow me to set my own agenda for presentation moving forward. What I found more and more was that, surprisingly, my chest was an issue.

I began noticing that, when I went out in public, I wanted my chest to be de-emphasized as much as possible. Part of it was about how I wanted to look in general (I quickly realized that I liked how I looked in a button-down shirt much more when wearing a chest binder to flatten my chest, essentially), but I admit to a second thing: that while I would still be misgendered often, a less noticeable chest meant that strangers talking to me might go a few more revolutions in their mind before attempting to guess my gender or pronouns. Notably, I’d realized I would be referred to as “miss” and “ma’am” far less often when someone saw me from behind first when talking to me. I felt that my chest was a contributing factor to being perceived as a woman when I’m not. I feel like I can’t possibly make this any clearer for people, but I still want to do so one last time: I am not, and will never be, a woman. This has nothing to do with womanhood in general (as I think anyone should celebrate their gender) and everything to do with who I am as a human being.

I wanted to share the part of my rationale relating to being misgendered in public because it’s absolutely a part of my reasoning, and to leave that out would be disingenuous, but I want to emphasize that the main and most significant reason for pursuing gender-affirming surgery remains my own personal level of comfort and the desire to appear the way that I want to appear. I don’t expect top surgery to change much at all about how I’m perceived or (mis)gendered when I’m in public and that’s okay; feeling better in my own skin is the first step.

Even as I became more comfortable with the idea of how I wanted to look, however, I still felt completely unsure about surgery. Many of my fears about commentary about top surgery from those around me have some foundation, unfortunately; even now, some far-right pundits refer to those who perform top surgery as “nazi butchers,” and I’ve wondered how many people I knew might privately think similar things or even outright tell me that they feared I’d destroyed my body somehow. I also began wondering if part of the reason I was accepted more readily in some instances was because of a lack of interest in physical transition; i.e., I was palatable because ultimately, someone could internally decide that regardless of what I said about my gender, I was still secretly really a woman or would eventually return to womanhood.

But beyond that, even, I had the hives I was breaking out in over and over to contend with every time I put on a chest binder. It got to where just putting on a binder would cause me to break out in hives almost immediately. Your dilemma then involves pitting your desired physical appearance against the physical toll achieving that might take, and it wasn’t just about the hives. It was also about the fact that I couldn’t walk up a flight of steps in a binder without needing to stop to breathe carefully, or the fact that I’d sometimes get sharp pains in my chest that wouldn’t go away. I couldn’t be myself or even fully present at any point in time when I was binding.

Even with all the physical costs to weigh, I chose the binder time and time again. Before I finally began talking about it with my therapist, I had two final events push me to the brink. While at Newark International Airport, I was wearing a binder and stepped through their body scanner at security. A guard asked me to step aside so that she could run an additional scan, as something on my chest had flagged the machine. There’s nothing you can do in that situation but cooperate as meekly as possible; I didn’t even feel comfortable asking if we could go to another room for a screening. Instead, I stood there with my arms out in front of a giant line of passengers as she asked me why it was that my chest kept being flagged by the scanner. I said that I was wearing a chest binder, and then had to repeat myself when she didn’t hear me the first time. I’m sure no one around me cared or was paying attention at all, but within my own mind I felt like I’d screamed the words in an otherwise silent room and now everyone would “know”. I felt uncomfortable and humiliated; I wore a binder to do my best to stay under the radar in public and be left alone and here I was having to explain myself to airport security.

Then there was my work outing. I had switched jobs during the pandemic, and now worked with a new team of folks — all of them wonderful, accepting, and kind, but still people who hadn’t actually seen me in person before. The first time I met them, I realized they’d only seen me from the top half or so of my chest up, and only on blurrier Zoom videos. I’d have to wear a binder, of course, there was really no other option for me. When one coworker cheerfully grabbed a yard game from his car and explained how to play it, I started panicking. Even talking at length while wearing a binder is tough; for me, much by way of movement made things even worse. But I was already there and I wanted to make a good impression, so I played through a lengthy round of a yard game that required throwing wooden blocks.

After several throws, I had to step back and carefully regulate my breathing because I was in such pain that I could barely think straight. I’d try to take a deep breath and I just…couldn’t. When I got home, I removed the binder to find welts and rashes; the next day, I noticed light bruises. I shouldn’t have been wearing it that long; maybe I should have been wearing a different binder altogether. But that was what I’d felt I had to do in order to actually feel comfortable as a person at that event. What a paradox, eh? To achieve a level of comfort that’s emotionally more sustainable, you’re forced to endure waves of physical discomfort over and over.

So indeed, I’d gone through absolute misery to look the way I now fully knew I always wanted to look in public. Why, why, why was I so sure that actually moving ahead with the surgery I’d now wanted for nearly a year, but been afraid to say I wanted, would be so scary? I kept trying to figure it out. I knew I didn’t want to be seen as someone with breasts by anyone else at this point. I never wanted to wear another underwire bra again, and even sports bras didn’t offer enough compression to do the job. Yet sports bras were my only other bet if I didn’t want to wear a binder too often, so how was this supposed to, well, work?

I’d long been researching top surgery by then (about a year, as I said), first just under the guise of wanting to know more about my community, then to see what it actually entailed so I could feel educated about the ins and outs of any decisions in front of me. I felt I fully understood all the variations on the procedure, all the potential outcomes or pitfalls, what to expect as you heal and beyond.

What I needed was a push to do so, and I finally had that when I found myself talking with the leader of my Jewish nonbinary support group one night. I remembered telling them that I was afraid that going through with surgery now, after being so adamant that I didn’t need it before, would telegraph to people that I was fickle or that I did feel that people “needed” surgery to be accepted. What if telling my experiences fully and plainly, without twisting the truth to feel like a more polished story, would make people believe that I was being capricious? The person I was speaking with shook their head and asked me again why I wanted to make the decision for myself instead of allowing others to make it for me. They asked me how I felt in that moment at the airport security line. I became teary-eyed and admitted that it had led to the worst dysphoric episode I’d had in my life; that I spent the beginning of my flight just crying silently in my seat, wishing I didn’t look the way I did and wishing I could just make my body right without having to justify myself or explain it to anyone. Worse, I began wishing that I simply didn’t exist at all. I was at a point where that honestly seemed to be an easier option to me than a straightforward surgery so many of my peers had gone through themselves only to emerge happier than ever.

After sharing it all, they helped me realize something I’d completely missed: that my early desire to not force myself to make any medical decisions had actually made it so much easier to make this decision now. I’d allowed myself the time and space to feel out what would be best for my path as a nonbinary person; that I had made a decision that was carefully considered.

Trans people who do decide to undergo some degree of medical transition may choose to do so for any number of reasons which are their own; how “carefully considered” they are is no one’s business and they deserve the space and time and support to make the right decisions for themselves. While “detransitioning” takes place, it’s much rarer — and many of those who detransition are still completely supportive of the steps other people take.

I’m now 40 years old; I feel more comfortable with who I am than I ever have in my life. I can imagine that my definition of myself may change over the years, though, and why not? I look forward to what the future holds in terms of how we look at ourselves and how we present ourselves to the world. Yet, of one thing I’m pretty certain: I’m not cisgender, and I never will be. And I deserve to spend the rest of my days on this planet in a body that feels comfortable and right for me. Top surgery isn’t “butchery” and it isn’t a self-destructive act; for me, it is a freeing, constructive act that will allow me to feel comfortable with myself.

If one surgery can make me feel that much better about myself, what could possibly be so bad about it?