Weird conflict about top surgery.

[ratherslowseal]

It seems maybe a little superfluous on this site, where discussion about sexual topics, especially uncomfortable ones, is a given, but I'll warn anyone reading that my post contains discussion about my sexuality and the sexualization of my pre-op chest. Please take care of yourself and click away if it is too discomforting or triggers dysphoria, and it is something you'd like to avoid.

I have been thinking about the current state and likely trajectory of the quality and legality of trans healthcare recently, and how to prepare myself for changes to my formal access to hormone therapy (I'll leave it at that, I'd rather not skirt the boundaries of what could get me or the site in trouble, as long as it's in my control). As I have thought about it, I've come back to thinking about the possibility of top surgery in the next six years, so long as I continue to have insurance coverage and that my insurance will cover a gender-affirming subtotal double mastectomy ("top surgery"). At present, there is no material barrier that would keep me from initiating the process to get top surgery.

I do not really remember if I have brought this up before on this site, but the one thing holding me back now is that I do receive sexual gratification and pleasure from my chest and the sensation it provides, which I would all but lose with standard top surgery, unfortunately no insurance will cover nerve preservation/reinnervation and you have to instead fork out the money (about 10k USD, IIRC) and later struggle for reimbursement. I am not sure if that is desirable or if I am in the position to realistically pursue that, even if I had the money or a loan.

Also, a "little" side tangent, I think that trans male and transmasculine communities put too much emphasis on getting your ideal surgery or transition. A relevant example would be encouraging people to travel, or consider traveling, to the "best" surgeon (at least for individuals in the US), usually on either coast. I am not denying the amazing care and innovations in trans healthcare these surgeons or their teams provide and take part in (especially Dr. Scott Mosser and the GCC in California), but this is simply not a realistic option or expectation for most people. It is a financial privilege. This is even worse in discussions about bottom surgery, especially phalloplasty, but I don't read or engage in those so much as it isn't something I personally desire but rather a topic of interest and curiosity (and to support other trans people, there is no shortage of fearmongering about phalloplasty).

I enjoy touching my nipples, even through fabric or my K-tape (how I usually bind), and it is difficult to make a decision where I know I would never experience the same sensation again afterwards. The part of this that complicates my feelings more, though, is that sometimes (far less often now, it is somewhat related to how confident I am, I've noticed) I am aroused and masturbate to the fantasy of my chest being sexualized and myself being feminized/misgendered due to it. I have tried to limit my engagement with this interest of mine (I personally understand it as a kink, I know others would reject that language/its basis but I think it describes my relationship to it and its presence most succinctly), since I have noticed it does have negative effects on my self-perception and confidence if not kept in check. I'd guess that I developed this interest due to internalizing (to some extent) transphobia, specifically the idea that my masculinized, transsexual body is without value and undesirable, measuring myself to the standards of heterosexual men. This is also closely connected with the objectification of women's bodies and the beauty standards they are subjected to. I think a big reason I gravitated towards this interest is because I know that, to such standards, I am a relatively attractive person, and that all I'd need to do is to excise my transness to be superficially acceptable and desirable.

I think that the barrier to top surgery, then, is that going through with it means I would undeniably go against the grain of what is socially acceptable and desirable, instead of excising my transness I would be ridding myself of the ability to put on a costume of cis womanhood for temporary gratification (which usually ends with me feeling dysphoric, shocker). It is a stand against sexist and cisnormative standards, against transphobic rhetoric that am mutilating my "natural" female body, or whatever Abigail Shrier says.

Also, the list of negatives, sans the unlikely medical complication (which are usually minor and resolved with outpatient care, IIRC), is incredibly short compared to the massively positive impact that passively existing with a flat, masculinized chest would have on my well-being. There are three things on there, and really only one of them is meaningful to me (loss of nipple sensation), the second being that I would not be able to breastfeed if I could ever afford having a child (which isn't guaranteed to be viable anyways, and also carries mental health risks for me, so it isn't at all worth it to forgo top surgery just to have that option when I know the alternative is better), and the third being the previously discussed topic.

Thanks to anyone for reading my too-long rambling. I don't really have any other trans friends or community that I can really talk to about this that I think would get it. I know my boyfriend (who is cis) would be supportive and listen to me, but I think I would benefit a lot from connecting with other trans people, especially trans men, about this topic.

[Heather]

Hey there, ratherslowseal.

I picked this one up in part because you're feeling, thinking and saying some things that have gone through my own head about top surgery, too, so I hope maybe it's helpful to hear from someone who has had some similar feelings and conflicts. I don't think any of this is weird, by the way. Doing permanent things to change our bodies is often complex and far-reaching in its complexity, because, of course, our experience of our bodies is so far-reaching and complex, not to mention super personal.

To give you a little background about me and my body before I say more, I have large breasts I don't bind, and I have long experienced people looking at them then immediately misgendering me because in their minds, big breasts they can see must = a woman. My own body, by itself, and in the presence of people who don't gender it, doesn't usually cause me any kind of dysphoria, I only experience that when people use it to gender, and misgender, me. I'm agender, and I also don't feel or believe there is actually a "masculine" or "feminine" way bodies can look. I feel like those just happen to be two arbitrary categories people have divided people and personality traits and appearances and bodies into, and as someone who is nonbinary and agender, for whom those categories feel as bonafide as say, calling the same things "red" or "blue" there just isn't such a thing as my having a body that doesn't "match" my gender both because I don't really have a gender and my body, in my mind, obviously is the right body for my gender because it's the body I am in. It probably stands to mention that I have had to have a bunch of non-elective surgeries since I was a kid, so I'm never going to be someone racing to get a surgery I don't have to, and that's before we even get to how I'd raise money for yet another.

Like you, I also experience a great deal of pleasure with my chest as it is. I also am right there with you when it comes to everything you've said about the costs and cultural expectations, though. At the same time, even though I personally resent that it's even something for me to think about given that I don't myself experience dysphoria with my chest, I have thought a lot about what it might be like not to be misgendered quite as often or as easily (I still would have a very hourglass body, and there's nothing that can be done about the rest of it as far as legible gender and people's assumptions are concerned, thus the "often"), and there are times when it sounds really, really lovely. But for me, it's still pretty clear it just isn't the right thing. It probably won't ever be, but who knows. I say that about bangs, and yet, every decade or so I find myself growing the dang things out again.

I've had a really long time to think about this, though, decades now, since top surgery became something that is within more people's reach. That time has also allowed me a lot of time and experience to explore how all of this feels, emotionally and physically, and do things like really put my mind through what top surgery could or couldn't do for me, or how I'd even feel about going through another surgery and all that entails. Having also gone through a bunch of new body changes with menopause, that's something else that provided a bunch of food for thought.

I say all of that because you are so young, and I can't help but wonder if time alone won't go a long way for you here. In other words, it does sound to me like a big part of where you're at is that you just need more time to really land on a decision with this that feels very right to you. Right now, you've obviously got a lot of conflict around it, and it sounds to me like making a decision either way at this stage of the game would leave you without feeling like you were deciding on something that really felt solid to you, instead of still being surrounded by questions and what ifs.

I wonder if you have had any conversations with any surgeons yet? I ask that, because consultations are usually free, and could both answer a lot of your questions and give you a different context to feel out this choice in. Just sitting in the office having a conversation about this with an actual surgeon is pretty likely to add at least some clarity to your feelings, I think.