[Lengthy post for the keenly interested]
For new readers, I’m the parent of a young adult (24) who identifies as genderqueer and transgender. Link was assigned female at birth. I would say they were raised culturally female (although less gender-boxed than most), but by age 16, did not relate to being a girl or woman. Transgender people who lean to the male side can be anywhere on the spectrum of masculinity – born in the wrong body and wanting to become a man, staying in the same body and taking on a male identity, focusing on externals such as clothing or gestures, modifying the body with gender-related surgeries, taking various levels of testosterone to get the desired effects, or any combination. In Link’s case, they began with binding their chest to make it look flatter and to not be mistaken so often for a girl. Link explored their male side in terms of clothing and appearance, interests, friends, love and sexuality. Two years ago they started taking a low dose of testosterone which caused permanent masculinization, with changes to their voice, build, body hair, and emotional “timbre.” They decided the next step would be top surgery: mastectomy to gain a male appearance.
Why Link wanted top surgery
- Identifies as genderqueer or male (Link prefers they/them as pronouns but will answer to he/him for those who need the simplicity)
- Usually misgendered and seen as female. This causes serious distress because of their gender dysphoria (the diagnosis of being mismatched to their body)
- Wanted androgynous appearance. Link had a DD cup size which always drew attention and completely obliterated any chance of appearing male.
- Having breasts at all – unwanted appendages. Most trans men think of breasts as not belonging to their bodies (or to the bodies they want) and being extraneous.
- Binding, discomfort and medical issues. Link used compression tank-tops (binders) to cover and flatten the chest area. They have several layers of extreme compression fabric. For larger sizes, they are only partially effective. They can cause bruising, rashes, breathing difficulties and even broken ribs. They limit your movement and don’t allow for fitness activities. Over years, they can seriously impact health. Yet because of dysphoria, it is impossible to go out without one.
- Not just about what clothing they could wear, but romantic and sexual attractiveness and self-identity
- Knew the surgery wouldn’t “solve everything” but would solve some things
How a lot of people I know reacted to the idea of top surgery (even some “LGBTQ friendly” ones):
- We should love and accept our bodies as they are.
- This is an ideal, but not the norm for most people! If it’s hard for the average person, it’s that much harder for someone with a gender identity disorder.
- They must hate themselves.
- Transgender people want to live in a society that appreciates gender diversity and accepts them as they are or want to be. If that society existed, they wouldn’t hate themselves.
- They are mutilating themselves!
- Mutilate means to disfigure or permanently harm. When a trans person is able to go from a detested state to a desired state through surgery, they are not disfiguring but reconfiguring, and healing from harm.
- Trans men are anti-woman.
- No, they are just not women. We aren’t obliged to hate people and things we are not. I’m not a blonde; that doesn’t mean I’m anti-blonde. If I am a brunette and I colour my hair blonde, it doesn’t mean I hate brunettes.
- Or anti-feminist
- The majority of trans men were raised as female and learned see the world through the lenses of women, LGBTQ folks and other oppressed groups. Many trans men reject macho culture and are actively trying out a new model of manhood (or gender freedom) that bodes well for future equality!
I find attitudes toward appearance-related procedures contradictory. While most people I know have not had any such procedures, and some scorn them, they’re not uncommon either. And some have a medical component. For example, correcting an overbite changes one’s appearance, but will also help with jaw misalignment. Laser eye surgery means you don’t have to be seen with glasses, and of course, it corrects your vision. Women will often say they got breast augmentation or Botox not for their partners but “just for me.” It matters more if it’s forever (hair straightening might be seen as OK since it is temporary, while tattoos are not). But a lot of people draw a line between beautifying (for acceptance or approval) and changing one’s very identity – because isn’t the world easier to understand when one’s outward sex characteristics remain fixed?
What I thought of top surgery (as a parent):
- At 16, I did think Link was too young and they should make an informed decision as an adult. The surgery was much less available 8 years ago and there was less information out there. I also thought that Link’s being genderqueer might be a stop along the way to becoming a man, and they might want to wait and create a bigger medical plan later. If I knew someone with a trans teenager now, I would probably advise them to start transition earlier. It helps you get on with your life. My caveat is that the young person needs to be mature and stable enough to comply with medical instructions.
- Ideally Link would love or accept their own body as it is, and people would treat Link as they wish to be treated, but that is not even remotely a given.
- Initially, I wished Link didn’t care what others said or thought. But no one is that stoic, nor should they be. We’re not steel people; words and looks and gestures scratch and dent and rust us. We care about the opinions of everyone around us, even “the general public” or online personae. Even more so when you are 16 or 24.
- I became afraid of the health impact of Link binding their chest for years.
- Eventually I saw Link as a new person whose body didn’t match their real self – they needed to make it right.
- It was a logical step after two years of testosterone – another part of the transition.
My fears (as a parent):
- It is major surgery and all surgery has risks
- If the surgery was inept, corrections would be needed later
- I didn’t know if Link would be able to find a trans-friendly family doctor for follow-up care
- Maybe they would want to continue on and have bottom (genital) surgery – and that is really serious!
What top surgery is:
- Double mastectomy and chest reconstruction for a male chest appearance
- The mastectomy deals only with the removal of breast tissue and doesn’t follow up by creating an aesthetically pleasing, male-appearing chest. That part is known as reconstruction or contouring and may have a separate cost or approval process.
- There are 2 types of surgery depending on the amount of skin and tissue: peri-areolar (circum-areolar) and double incision. The former is for those with less tissue to remove. Those with more tissue will need the double incision technique.
- Nipples are retained in place or grafted back on (often resized)
- If the surgery occurs when the patient has been on testosterone for a while, they may have been dealing with new-male acne, sweat and chest hair under their binder
- It is unlike mastectomy after breast cancer – for that, nipples are often removed and there may be less attention to the final appearance of the flat chest (did you know that about 45% of women who have mastectomies after cancer choose not to have breast reconstruction, live with flat chests, and are just happy to be alive?)
- Top surgery is a day surgery and patients are released after a few hours!
OK, so that is my spiel. Next time I will detail Link’s specific surgery and what it was like for me as a parent, too.
What are your thoughts?
Note: all photos were taken from uncredited Internet sources. If you are the copyright holder of these images, please contact me regarding permissions or take-down requests.
Part 2 of this post is here.