I'm sitting in a cafe near North Miami Beach, awaiting a celebratory meal. I just came from my “reveal” appointment with Dr. Garramone. I had what’s commonly called top-surgery last week, and today, I got to see the results.
I’m extremely happy with the results and for the first time, I feel I can see my actual chest. Before today, it was hidden under “other tissue.”
It still amazes me how difficult it can be to be well informed. I'm a mental health professional. I have been a member of the LGBT community my entire adult life. I have close friends who are transgender and have had gender affirming surgeries. I have access to the vast stores on knowledge on the internet. And yet, until recently, I didn't know that a person didn't have to identify as transgender to access hormones and/or surgery.
Believe me, the question, “am I transgender?” Is one I have asked myself many times over, for many years. But I was still assuming a gender binary. And though these thoughts and questions and the desire to “make changes” would hit me in waves, repeatedly over many years, when I imagined what I thought the transition experience would be like, or what I assumed it required… I didn't feel any more “male” than I felt “female.” And so, I would assume that meant “I’m not transgender,” And I would table the thoughts until the next time they presented themselves.
Another factor was that I had great coping skills and feel very "at peace" with myself, so the degree of distress I experienced was very low. As a result, non-action was easy for me to live with.
Then, after an abnormal mammogram set off a new round of “if I don’t want to have breasts, am I transgender?” I happened across a video or an article about non-binary people getting top surgery, and a whole new world opened up to me!
Once I realized I could pick and choose what I wanted to change and shape my identity and appearance without feeling constrained to the binary extremes … I got excited!
And I know I was excited because for the first time in a year, I was able to stick to diet and exercise goals and lost 15 pounds in 4 months. I had a image in my mind of how I wanted to shape my appearance and it was all achievable! I also scheduled, and followed through with my surgery during that 4 months with only very minimal nervousness or doubt.
I’m now recovering and thinking about how I can use my experience to help other gender expansive (gender non-conforming, non-binary, genderqueer, gender fluid, bigender, …) people and transgender people to shape their appearance and their lives the way they want.
It can be confusing to figure out what one wants. I believe if I had a clear male identity, I would have taken the step of surgery, decades ago. And even though my identity is genderqueer, had I known I could access surgery, I might have done it a little sooner. Or maybe now was the perfect time? I certainly have no regrets!
So, how do you know if you are non-binary (or genderqueer, or two-spirit, or gender expansive, or gender fluid) so you can make decisions about what actions you might want to take? Essentially, you don’t have to! There are many guides on the internet to all the terms and what they mean, here’s one: Ashley Jay Brockwell Another place to look is on genderqueer.me, and this page has more links to more articles at the bottom of the page.
But, what might be more accessible is to decide what gender traits feel most authentically like you, from clothes, to hair, to names, to pronouns, to behaviors, to social expectations, to body parts and body appearances. Once you’ve worked that out, if *you* fits pretty close to one of the binary extremes, then you might be most comfortable identifying as male or female. (But you don't have to!)
If that aligns with the gender assigned to you at birth, then you might choose to identify as a cis-gendered male or female. If it aligns with what is typically considered the “opposite” gender to the one assigned to you at birth, then you might choose to identify as transgendered male or female.
And if the combination of gender traits that feels the most authentically *you*, doesn’t fit well into either of the male or female binaries, or changes from day to day or month to month, or just because you want to, then you might choose one of the many word options available to describe the gender expansive experience!
I still haven’t made a final decision about what words I want to use to describe me. I’m currently using genderqueer partly because I identified as a “soft-butch-lesbian” most of my life and I am part of the LGBTQ generation that took back the word “queer” as part of our cultural empowerment (Think: Queer Nation in the late 80s and early 90s.)
As for the traits that feel authentically *me,* I wear very “male” clothes and a very “male” hairstyle and no make-up. I use a female name and pronouns and feel I am a form of “female” that transgresses just about everything considered traditionally female… so am "female" and “not-female.” I did not want to have breasts, but I like the softness that estrogen provides, and I like my voice the way it is. Yet, I like muscles, and want sideburns. I decided to keep my estrogen, and commit to exercise and experiment with ways to get sideburns. If I can get them, great. If not, I can live with that.
I know that one of my fears as I began working with a therapist to get a letter that would allow me access to top surgery, was that I would not be seen as “trans enough” to get approval. I was also concerned that my strong coping skills would mean I wasn’t “distressed enough” to qualify me for surgical intervention. What I’ve learned is that according the the World Professional Association for Transgender Health (WPATH) standards of care (SOC), adults don’t have to “prove” anything to “qualify” for surgical interventions or hormones other than that they are mentally and emotionally prepared for these interventions, have realistic expectations about the results, understand the changes are permanent, and (if of childbearing age) have considered their reproductive options.
The role of the therapist is not to be a gatekeeper and deny people access to medical interventions. The WPATH SOC 7 encourages clients to individualize the possible interventions to whatever combination is right for them. According to the WPATH SOC 7, psychotherapy is best used for "exploring those combinations, reducing internalized transphobia, processing social/familial adjustment, and increasing individual resilience."
It’s important to recognize that most therapists are not familiar with the WPATH SOC 7. So, if you are seeking a therapist… ask them. Reading and understanding the WPATH SOC 7 document is just the first step. The second step would be professional membership in WPATH. Additional steps would be the training classes offered by the WPATH Global Education Initiative: the 2 day Foundations in Transgender Health, the 1 day Advanced Mental Health course, the ½ day Child & Adolescent Treatment Workshop, participation in a mentorship program and after 2 years of work, some community involvement, and the passing of a certification exam, the therapist can become WPATH Certified.
Clearly, few therapists are going to invest the time, energy and funds to become certified. But you will want to ask how much time, energy and funds they have been willing to commit to learning about the best information and methods for treating you! After all, your treatment is what is most important to you, right?
I have become a member of WPATH and plan to begin their educational program next month. My goal is to become certified so that in 2 years I can begin teaching these classes locally to other psychotherapists in the Southeast. It is critically important that members of the mental health profession become educated in this area to advocate for the lives and mental health of our community and to help combat the transphobia so common here in the Deep South. Many people’s lives (of all ages) depend on this!