I had top surgery when I was seventeen.
There’s a lot of fearmongering going on about gender-affirming care for minors and what it entails. Politicians and public figures have used this point of division to remove access to life-saving care for young trans people. What a lot of these discussions are missing are perspectives from young trans people accessing gender-affirming care and what it means to them.
My first year of college, I went on a backpacking trip in the Cascade mountains. This was the first time I had ever backpacked, and it was physically and emotionally grueling. There were a few wasp stings and injuries and a couple of minor falls, but I came out of it with a group of close friends for my first years of college. This was something I couldn’t have done without access to gender-affirming care.
I started binding when I was thirteen and had always felt a deep discomfort about my chest. When I first learned about what being trans meant, I knew that I wanted top surgery. If I knew nothing else, I knew that for sure. It would take away so much of the discomfort I had felt for years.
My parents supported me when I came out to them, which isn’t true for many trans youth. I also had access to high-quality binders. Still, I was binding for over eight hours a day, and occasionally overnight, although this can cause serious damage to your ribs and lungs. It was difficult for me to swim and exercise—I was constantly thinking about my binder and how constricting it was. I watched other people my age live more freely and I wanted that for myself.
Even with my parents’ support, having surgery was not an easy process. I was in therapy for several years, and eventually got a letter from my third therapist supporting my decision to have surgery, which was required by my surgeon to align with the World Professional Association for Transgender Health (WPATH) guidelines. (There is nothing inherently pathological about being trans or seeking gender-affirming surgery, and many surgeons and healthcare providers now use an informed consent approach that does not require a letter from a therapist.)
My parents and I waited several months for a virtual consult with an out-of-state surgeon I had researched extensively, and then several months after that to schedule surgery. It had to be over the summer, while I was out of school. My dad and I would have to drive to Cleveland, Ohio and stay for the week. My parents would pay out-of-pocket, since insurance didn’t cover the surgery. I am uniquely privileged to have parents who both supported my identity and were willing and able to financially support my transition.
I expected to feel ecstatic after surgery, especially with all the excitement that I’d built up for years! But after the initial week of recovery, what I remember most is feeling angry. Why did I have to go through this when other people didn’t? Why did I have to be in pain just to feel comfortable in my body? Why did I have to wait for so long to have something I knew I wanted and needed from the beginning? I was resentful of the cis boys I knew who had flat chests without surgery. I wished I could have avoided puberty and the need for top surgery altogether (which is a real possibility for trans youth who start puberty blockers at a young age).
Later, I learned that post-op depression is pretty common for all types of surgery. Surgery is traumatic, even the gender-affirming kinds, and it wasn’t just my body that needed to heal. With time, the anger dissipated.
I recently shared this experience with a parent whose trans kid is looking into having top surgery soon. I hadn’t seen post-op depression talked about much, and instead saw beaming photos of top-surgery reveals all over trans corners of social media. Those photos don’t tell the full story (for everyone), so I talk about it when I can so others can feel more prepared.
Talking with this parent also reminded me of why it mattered that I went through that experience. Not just for my own gender affirmation, but because there are other young trans people out there seeing others accessing care and realizing that it’s a possibility for them. Those one-on-one connections that help us find our surgeon, figure out how to prepare for surgery, and watch Naked and Afraid with us while we’re swollen and recovering.
There’s obviously more to gender-affirming care than top surgery. The process of starting testosterone was more difficult in some ways, and is a constant evolution, and also helped me to feel more at home in my body. Not everyone wants or needs these forms of healthcare, and transition looks different for every person.
Sometimes I feel the need to defend young peoples’ access to gender-affirming care by refuting common myths I see shared by conservative politicians: no, young kids (aside from intersex babies) are not having genital surgery; puberty blockers are safe and reversible; most trans people don’t regret having gender-affirming surgery; it’s not a quick or easy process that someone decides to take on in a day.
But I also want to reject those talking points because they make our experiences small. They delegitimize joy as a reason for young people to access gender-affirming care.
Having top surgery drastically improved my quality of life. There are things I take for granted now—swimming at the pool without a shirt, wearing a t-shirt with nothing underneath, getting out of the shower and being able to look at myself in the mirror—that felt inconceivable before. It gave me ease and freedom to move my body. It affirmed who I was and who I am.
Trans youth should have access to gender-affirming care, and be empowered to make decisions about their own bodies. Parents play a role in this, and their support is often required for any type of gender-affirming medical care for minors. But trans youth know their identities better than anyone, and often have to fight for years to be seen for who they are. Taking away gender-affirming care is removing life-affirming and sometimes life-saving care. Access to gender-affirming care is access to joy.