Experiences of trans and gender diverse young people

So you go for your first appointment and they weigh you and take you into see him and then usually like with a nurse and then the surgeon comes in and then he tells me, he asks me some questions about my lifestyle and my health. He only takes like non-smokers and people with a specific BMI, but I’m over that BMI now so he’s gonna delay my surgery but it’ll be fine and then he asks me to go behind a curtain and take off my, everything from the top up and he looks at my chest and he prods and pokes and measures and stuff because and then he’ll then I put my stuff back on and he’ll explain the surgery and he’ll like drew me diagrams about the procedure he’s gonna do because he doesn’t decide on the procedure he’s going to do until he’s like seen my chest and he explains like recovery times and like drains and stuff like that.

So why didn’t you like this one of the professionals?

Oh [laughter] he was just, I just didn’t like his attitude he was, he said something weird like I felt like he said something weird about like my race and I was just like yeah you’re, you’re not the one I can’t remember exactly what it was that he said but it was something about like whether I’m gonna keloid scar or not but like the way he said it was like hella unnecessary and like other practitioners spoke to me about like keloid scarring in like black communities and like in like Irish communities or whatever but the way that this one said it I just felt really uncomfortable and was like you didn’t need to, that was like quite uncalled for. And then like when I took off my top and like for him to do his examination like the first thing he was like, honestly like a professional, he was like ‘Oh those are big aren’t they?’ I was like you’re fucking kidding me [laughter] I can’t believe I still paid the man, but yeah it was, it was horrific, it was horrific, I was like this guy is something else.

And then also like pregnancy is something that I consider like within my transition and like something that I might do like later on in my life innit and so I wanted to know about a procedure called like button hole where they like keep whatever the duct that in, that you can chest feed and so I asked him about it and like fair enough if like whatever you’re like because of like the size that they can’t do it like cool just tell me that, be professional about it, cool, but he said that in like quite a uncomfortable way and then he went on to be like ‘Well I think you really need to consider this because I do think like breast feeding is very important for a child and so whether you want to do this now or whether you want to do this later is something I think you really need to consider’. I was like [laughter] you’re actually wild [laughter] I was like this is not okay like how are like how are you telling me like, I was just, I was shocked honestly.

So I was on the waiting list for chest surgery, for a double mastectomy, I was on that waiting list for about a year and a half, I was waiting for surgery with the clinic in [city], for a surgeon called Mr [name], again that was, that was a clinician that I’d researched into, I did a lot of research and I went to the gender clinic knowing they are going to do a referral for me, I need to know who I want to be referred to.

So I was on that waiting list but I, so for whatever reason I did my pre-op, and I did my initial assessment with them, but it, I was, I was told at the start it would be about a year, so that was the time frame I had in my head. And unfortunately it just, my surgery, well I wasn’t even given a date, the prospective time zone that I was to expect to have my surgery just kept get pushing, kept being pushed back sort of further and further, to the point where I think I think it was about now, when I should have been having it, and given what’s happened with Covid 19, it wouldn’t have been now.

So I think it was around October last year, I had a very serious conversation with my parents about private surgery, cos I think throughout my transition like I said before, I’ve always been a big advocate for kind of utilising the NHS, but I think at that point I was, so I, you know I’ve been binding non-stop for, is it five years? Five or six years, pretty much every day, and I was starting to notice that it was changing my, acutely aware of it now, my posture, breathing difficulties, you know taking it off every day, it was getting more and more painful. And I, mentally as well, you know, it, yeah that, my chest is always something that I’d struggled with, and wearing a binder every day was non-negotiable.

So essentially I got to a point where I started to explore private options for my surgery, and pretty much as, well as I think to be expected with some private health, private health services, it happened quite quickly, so I spoke to somebody, I had a consultation, I went for my initial assessment a couple of months after that and I had my surgery in March this year. And all of that was fairly seamless, and actually you know I had quite a good experience. I think, I chose a surgeon that was geographically close to where I lived, and to where my parents lived, so that was helpful, I didn’t have to go backwards and forwards to, I had done already for when I was on the old waiting list, but that was quite easy, and yeah, there were just a number of things that, you know I’m glad I did that, even though I’d, I had quite a moral conflict about it at the time, and I’m glad I did that.

Well even before this I was like okay I need to, £10 grand that’s a lot of money like which is the ball park figure that it was gonna cost the surgery itself costs £7000 the consultations cost about over a £1000, I think all together and like the transport and whatnot and then with the surgeon that I was going with he wanted me to stay in [town] for like a week and so I had to book like what’s it a hotel and like air B&B and my whole family, well not my whole family like my mum and some friends came down. So all together it ended up costing about like £10 grand and I was like where do I get this money from? And so I started a Gofund me and thankfully a lot of people supported me through that and I was able to raise the money that I needed to raise and I was able to go and get my top surgery and that was, that was a blessing.

From what I remember, you need to bring slippers to hospital. They tell you this in a little letter like please bring these things. What I wasn’t sure of was whether or not I was supposed to give them my phone or leave my phone with my friends. And I think the best, for me it was more convenient to leave kind of like my more valuable things with friends or family because they can get those things to you faster than if you leave them with hospital staff. The hospital staff will get them when they have time. They are very busy people. So, that’s a good thing to know I guess. You are not supposed to eat I think, at least 12 hours before the surgery, the night before the surgery I think I could stop. I have to stop eating at 6pm and the surgery was at 9 or 10 in the morning. With most surgeries, that’s the same case as well. So your friends and family can follow you up until a certain point, but it’s pretty much just up until the waiting room and then after the waiting room you get taken to get your clothes changed and put all your belongings in a bag that you then give to the nurse that is walking you to the operation theatre.

And then you can say bye to your friends and family and you walk through to the operation theatres and you wait some more and you are sitting there, half naked with a dressing gown without really knowing what’s happening. And then they ask you to well, they asked me to lie on the table and so it was also kind of strange, because I kind of always imagined that I would be on this bed and I would be wheeled into the operation room, but you put yourself on it and you are talking away with people that are then putting the mask on you while they are asking you questions and then yeah, you become unconscious and when you wake up you are kind of like very confused. I didn’t ever feel very unclear like I woke up, I was aware where I was and what was happening. I was being told to move from one bed to another. I was awake, no, wait, sorry I am mixing up my tonsil surgery. I remember kind of being aware what’s happening when I did wake up and being wheeled down and talked to, having conversations with people and feeling like I was clear headed enough to be in the moment. I was expecting to be more hazy on like medication and painkillers but I also was very exhausted. And then I stayed for a night in hospital and that was a terrible night because you could not move very well because my chest was, not even in that much pain. I thought I was gonna be in way more pain than I actually was in. It was quite manageable, I guess I was also on heavy painkillers, but it felt more numb than pain because that is the thing, they also cut all the nerves and so it’s not like it’s super sore. It feels more weird and numb and like not really part of your body more than actual painful.

I think something that’s important is that there’s a lot of associated costs with top surgery that people don’t think about. So whether or not you’re getting the surgery on public or private healthcare, and all the associated costs with that, there’s like you have to buy a lot of stuff, like there’s specific things you need to wash with the night before. Because you can’t move your arms there are aids that like that cushion, or a lap stand that particularly if you’ve got like any kind of back issue or anything, like become obviously even more essential. But like for anybody when you’re sitting that much or trying to sleep upright, have a profound difference. But also like surgical cleaning stuff after the operation, to clean your own wounds and scar ointments, or…Trying to think of all the different things that cost money, there was just like, like if you don’t have access to people who can come and make you food then you’re going to end up having to buy more takeaway, like. There’s just lots of… there’s lots of costs that people don’t think about with it, I think is what I’m just trying to say, is a big thing. And so not to underestimate that because basically if you’re not meeting those needs and those costs then you’re paying for it with your body, and so being aware of like how expensive it is, not in a way that scares people off doing it but in a way that helps inform people.

I went by myself. I did it all by myself really. I mean I’ve got, like I said I’ve got an amazing family and they would have all been there in a shot, but it was a long way to go, and you know I’ve had other surgeries before, it’s easier to do it by yourself, you’re not thinking about somebody else, you’re not thinking, you know it’s best to just get there and get done. The night before I stayed in a hotel, by myself, and that was daunting I guess, I didn’t have the best sleep and then the next day you wait around a lot before you get to, well I did, I had to wait around a lot before you got taken down to surgery so that was very daunting, and I was like ringing my Mum crying, like “Mum, oh what if something happens?” Like what if I’m like a zombie apocalypse and I wake up on the chopping board and that’s it. Everybody’s gone. Do you know what I mean? It could be anything but its, I think it’s going to be daunting whether you’ve got fifty people there or one person there, or nobody there. So, for me it was more comfortable just to get in and get done.

I mean there’s a lot of things that are difficult, you’re not unbandaged for five days, so you’ve got catheters and stuff that you, you have to use, and it’s fine until you know, you’re having to start to try and get back to normality, you know. I didn’t take any painkillers at all; I was only on paracetamol. So, I know, yeah. And the issue with me being in surgery before, I know that it clogs you up, and this sounds gross but the hardest thing to do, after surgery, is go to the toilet. So I didn’t want to have lots of morphine that even though it would kind of stop the pain, it would then later on become more of an issue. So I didn’t, I did it all on paracetamol. And it was still you know you’re packed up; you’re packed. So, they put like this huge pack up you, to stop it from closing. Your body will always treat it as a wound, that’s why you have to dilate and that’s why they have to pack it for five days after surgery. So once they started to unwrap me and everything like that, they wanted to encourage me to go to the toilet, number two, because I still had the catheter in, and everything like that, I still had the pack in, but I had, I was eating like normal, so I was eating all these high fibre foods, and prune juice and coffees and it, the hardest part I’ve got to say is trying to go to the toilet. Because I couldn’t push otherwise you’d prolapse, and I thought I’ve got this far and I can’t destroy it already, you know. It were really difficult. Really difficult. I was dancing around, I was walking around the hospital, I was trying to shift something, but it was really, really hard.

The process was like with the actual surgeon was fine like he’d done it a lot of times, it was all pretty quick because obviously you’ve been waiting for this thing for however long and like this, this momentous occasion in your life and then it’s just like, you’re just one of however many are getting done on that day and like they’re just trying to get through it all but it was okay. However I did end up making a complaint to the hospital because as soon as I came out of my surgery one of the nurses well not as soon as, in the evening one of the nurses came in and misgendered me and I was just like [laughter] I was like did you not see what I done, did you just see what I went through and I was still in pain I’m on morphine, I was like oh my God. And so that was horrible, really horrible and sometime, and it just felt like that particular nurse was just trying to, so the opening hours were like open so my family and my friends could have stayed for as ever long as they wanted to but it seemed like they was trying to get them out and I was like ‘Why are you treating us like this, what is going on here?’ And so yeah I had to make a complaint to the hospital because I was like they just didn’t show care they didn’t show like respect for my friends and my family and that just wasn’t cool and I was like I’m in this unfamiliar place, [town] probably like one of the only black people in this hospital right now like and this is not okay. They also gave me like a really crap like lunch and dinner and they didn’t show me the full menu so just gave me a jacket potato [laughter] and then later on I found a full menu and I was like what! And so yeah I made a complaint and yeah it was, it was received [laughter].

I think people have different priorities. My priority was definitely the flattest option over what’s it called, aesthetics. Except I didn’t want, I think it’s called, the anchor cut when there is a line that goes from your nipples down and then it meets the line that is under your chest. That one always seemed a bit weird to me and unnecessary and so I didn’t, didn’t want that. That was kind of the only starting point I had. I didn’t want that surgery. And then some of them are also specific according to the size of your breasts there is some of them that you just can’t do if you’re larger or smaller chested. So that also limited my options. It kind of like, it’s obvious to what you have and what you want out of the surgery what option you should go for. And obviously, if you consult with the surgeon who will tell you the pros and cons of the different ones. My surgeon specifically agreed that she didn’t do the anchor ones either, the ones that have line down and across. They can also relate to what which ones your surgeons are comfortable doing and confident doing and you might want to go with their confidence level as well because you also don’t really want to do a surgery that your surgeon is maybe doing for the first, second or a seventh time. Maybe something that they are more confident in, will give you better results. There is a lot of things to factor in.

For me the main result was always about just being flat chested and it’s just all the small things that you just appreciate now like you can run downstairs without having to hold your chest and you can lie on your stomach without feeling that you are being suffocated. You can get dressed so much faster in the mornings you literally throw on a t-shirt, you don’t have to wrestle with a bra or a binder or a sports bra and again, you don’t have to wrestle with binders, ever. You don’t have to try to get one on when you are wet from a shower. Don’t have to remember to take one off when you are like drunk and passing out. So many small things. It’s just so freeing. I think my nipples, don’t look identical. I don’t really mind. I thought I would, before surgery I was more worried that I would be devastated if I had a weird physical result. I was worried that that would maybe take away from the happiness of finally like having the surgery because obviously you have so much time to kind of hype yourself up for the surgery and how it’s gonna change your life and how everything is gonna be better from after that point. And I don’t think anything drastically changed in my life other than just like that convenience and happiness of finally being flat chested. It wasn’t like I was being misgendered any less or, I wasn’t being misgendered that often in the first place sort of thing. It wasn’t like a confirmation of now I am a man or something like that. It was just what I needed. I wasn’t after that it was just, it wasn’t really important what the actual chest looked like, it becomes a normal part. I think maybe it’s different for some people though maybe they start fixating more on how they’re unhappy with their result or but I think for most people they will just realise how unimportant it actually is, what exactly it looks like and how perfectly it looks like a chest. It looks like a chest.

So I had double incision top surgery, so two incisions were made like under my chest tissue to remove it and then my, I had nipples grafted on as well so my nipples were removed and then re-grafted onto my chest after they sort of finished removing my chest tissue. So the initial stage of healing is just sort of the incisions healing so they like sort of scab and then like heal as you imagine. And then after that it’s more to do with sort of like nerve reconnecting and so some people never get full sensation back in their chest, some people get some sensation, I have like some sensation with like weird bits of like mixed like nerve sensations. There’s also stuff like if you have your nipples grafted how well they take, there’s a chance of like rejection and stuff but a lot of it is just sort of like incisions healing post-surgery they usually use dissolvable stiches so they just like dissolve so you’ve not got to have any stitches or anything removed. And yeah I think the most painful part for me was actually having the dressings removed rather than actually anything to do with the surgery it was just like having the plasters taken off but yeah.

I’m a lot more comfortable with my body now and I think something I’d decided that my goal was with top surgery even if my actual surgical results weren’t great, so even if I had like really bad scaring or whatever I wasn’t super bothered because I would be able to wear a T-Shirt without having to wear a binder underneath it so although like physically it might not look great I’d be able to wear clothes and have a flat chest and that was all I wanted. So the fact that yeah I ended up with really good results was just an like added bonus but being able to like get up in the morning and just throw a T-Shirt on rather than having to sort of wrestle myself into a binder and then put a T-Shirt on has been incredible and then being able to go swimming like shirtless was also such an incredible experience like the first time doing that was just ridiculous it was so cool. But yeah it’s made me a lot more confident in myself as well even when I’m like just wearing clothes like no-one else knows this change that’s happened but it’s, yeah really clear to me how much my confidence has grown.

So in terms of aftercare you have dressings on your like incision and surgical site for, so you have full dressings on for like a week and then depending on how well you’re healing and how quickly you’re healing they slowly reduce the number of dressings you’ve got on. So after like two weeks you just have dressings on, or at least for me just after two weeks I had dressings just on my nipples that I was able to change myself. I had drains in for the first three days which removes excess fluid form your chest and then they were removed like before I left the hospital. Different surgeons have different procedures and different like ways of reducing swelling and stuff so sometimes you’re given a post op binder, I wasn’t given one of those they then once your like incisions are fully healed so there’s no scabs on them or anything it’s just the scar line they recommend using stuff like silicone scar strips or bio oil massaging your scars and making sure you wear sun cream if you’re wearing anything that’s too thin or not wearing anything at all. I didn’t follow much of that advice I would occasionally massage them using stuff like coconut oil because it’s anything that sort of for lack of a better word a lubricant to make sure you’re not sort of damaging the skin and I’d wear sun cream if I was going out without my shirt on. And everything all healed perfectly fine but there are, there are like scar treatments you can do to reduce the redness or whatever of scars and some people find those really useful and some people don’t and some people like use a lot of them and some people just don’t use any and I’m, I didn’t use any and I’ve had like really good results and my scars are super pale and flat which is great.

I was just really listening to what my body said and trying really hard to not push myself any further than I could comfortably do. So it was stuff like not moving my arms too much and not lifting my arms too high because it sort of stretches like the incisions and scar sites. I slept a lot for the first like week or so just making sure that I could like really rest and like let my body heal but I think I was so happy with the fact that I’d had surgery done that a lot of it was really easy because I was just so relieved to have had it finally done that like my mental health improved massively just by having like surgery and so looking after myself was so much easier because I was just, although I was a little bit uncomfortable because obviously I’d just had fairly major surgery I was also so much more comfortable in my body that everything all just, it just made up for everything else.

So some of the most helpful stuff that I found out about top surgery, as opposed to hormones, like aside from I think for people who’ve never had surgery some of the stuff that’s true like lots of surgeries, like how it can affect your digestive system, or your mood, and like that sort of stuff. I think there’s, like a lot of really helpful to me was what to prepare for the recovery. And so like people saying to me like if you can afford it then things that you, that will really help, that you could buy or try and find are like a lap table, because you can’t move your arms, like, get a lap table. A husband pillow, which is hilariously named, but honestly is one of the top tips. If I’d have bought one thing after surgery, I think it would have been that, if I could only have afforded one thing. It’s basically like, do you know what it is? It’s like a pillow, it’s like a back rest pillow that then has arms that come either side of you, and so because you have to sleep upwards, or like just because of sitting all day, and like holding your posture it was actually like profoundly helpful. I think information about what you can and can’t do with your arms, like the doctors kind of give it to you, but in a very, like it is very like you’re not going to be able to move your arms away from your chest, but they don’t really tell you why, or they don’t tell you why, they don’t tell you what you can do to help you prevent it, and they don’t tell you things like, well some of your nerve endings are going to be cut, so you are going to be able to do it, but you shouldn’t do it anyway. And so people then think like well it doesn’t hurt, so I’m just going to do it, but they’ll end up pulling their scars apart or something. So I think like a more humane explanation, or not humane but like accessible I guess explanation of like the what and the why, and like one of the most common questions I get from people, and I think I had it at the time is like can you, can you wipe your own butt? Like what level of care is needed here? And I’ve not, I’m sure that for some people they haven’t been able to, I’ve not met somebody who’s had top surgery yet and who hasn’t been able to wipe their own butt, but I feel like just knowing that is significantly less terrifying than not knowing that.

You have other things. I had I had bleeding still for a while, but then that stopped but so then you have discharge and I had this thing called granulation tissue, so until I kind of researched it and spoke to my consultant, and who’s been incredible. My consultant has gave me her email address and she’s message, like I message her with any pictures or any complications that I feel like I’m having, and she’s incredible. You know she looks at it, identifies it and knows exactly what to do. So I, what I found out was that I was getting granulation tissue which is when your body starts to heal in that certain area you just get extra tissue, but that does bleed and that does weep, so I was having to treat that for a while, and you know it’s a bit of a messy job for the first few months.

Pads are really essential. They’re going to really identify if there’s something, you know, something up down there, you know up, down, because it is going to see things that if you’re not wearing a pad you wouldn’t necessarily see you know. So I saw these spots of blood, which I was, you know horrified with. And I started to just feel around, like I said I was very comfortable with having a look around personally anyway, and I had like lumps down the scars, and I thought, “Oh my God, no way could I get an infection, like I’ve been so clean, I’ve been washing it, I’ve, you know every morning I do this, that and the other, like you know, it’s not even been that long, and I was squeezing it and this, you know, this liquid was coming out, so that was really scary, that was really daunting, and I thought, “Oh God, like what if my stitching’s gone wrong, or what if something’s, you know something’s wrong with it. And again [name] was incredible, my consultant she messaged me straightaway and she just said, “Look, again this is just very normal, they’re like because of dissolvable stitches as you’re heal, as you heal over it it’s just a collection of fluid and stuff. So they can bleed and they can weep, just to massage them, you know five, ten minutes a day, and just keep an eye on them, make sure they don’t worsen and stuff like that, so it is scary. It’s scary to, you know they don’t give you any information like that really. They probably did, they’ve probably given me leaflets of it, but I just went in guns blazing, you know. So yeah research stuff like that or listen to what I’m saying because that shit does happen.

You know obviously you can contact them, like, I’ve literally contacted her probably every week, every couple of weeks, just to make sure, taking pictures, you know. “Is this normal?” “Is this normal?” I sent one last week, and I was like, “It’s very red down there, like is that normal?” And she’s like, “It’s going to go through many, many colours, so don’t worry about it.” So they are very supportive and I am a fretter anyway, I think as soon as one thing feels abnormal, I kind of know my body very well, so I think, “Oh this doesn’t feel right, I need to check that out.” So, they are very good with it, but you are left to your own device quite quickly, so.

Aftercare, I know a little bit about things like post op binders to keep the chest compressed to prevent fluid build-up and the drains to drain fluid if you want them. Not that a surgeon will give you a lot of choices generally down to the surgeon’s preference whether they want to use drains or not. So and things like scar care as well. It’s important to think about. And if you’re yeah, scar care and like general wound care is something I’m familiar with in general. There are horror stories of very, very rare situations where people have been pretty bad in taking care of their chest after surgery. They’ve had a nipple graft and their nipple’s like grown black and died and fallen off, but that’s very rare, thankfully. And if you go in knowing what you need to do and you listen to all of the surgeon’s instructions, that won’t happen.

With the surgery specifically I got my drains taken out two days after the surgery, I think. I had the surgery on Monday morning and then I think I had my drains taken out Wednesday or Tuesday. But I think about I want to say three weeks after that. You still have dressings on at that point to, that basically like cover the scars, the nipples and then the two patches that your tubes came out of. So, about three weeks after that, the dressings came off. I had to go back to [city] to get those off. They did another check they didn’t need to reapply any. So, it was fine to like let the scarring and healing begin at that point. And then, about six months after you get called back in to do a follow-up on the actual healing process and if you need any like follow-up procedures if you have some swelling or folds or anything that needs to be corrected or that you find that you feel like you need to be corrected. In my case, I was quite happy with the result. I didn’t need any follow-up procedures. The surgeon felt the same. So it was pretty much the end of the line for me there. But I think if you do have some issues the process takes a bit longer, but that’s basically the end of surgery care. You get officially discharged at that point and then that’s your top surgery journey over.

So you have to dilate four times a day at the beginning. Three really, but if you struggle doing it three times a day because you’re losing depth, or losing, or it’s too tight, then you have to do it four times a day. Now I just did it four times a day anyway because I was worried to lose depth or tightness. That is a nightmare. You try and sit for twenty minutes, four times a day, and spread that evenly through the day. I was getting up at six o’clock in the morning, and then going, doing it, you know at 12 o’clock at night, just to make sure I was doing it every sort of six hours, and that really took a toll on me, I was so tired, I was exhausted.

Believe me for dilation you’re going to need a lot of lube, okay, because it’s bigger than what you think. The dilation is huge, it’s huge and you’ve got to use the whole length of it, so yeah you need, you’re gonna need lube, it makes it a lot easier.

She, obviously through video call I have to speak to her because of the pandemic, but she was really good with me, she was asking me how my dilation’s going on, because you have to do that way regularly than what you think, you know, it is, there’s a lot more that comes with this surgery, you should not consider it light heartedness. But it, if it makes you feel empowered do it you know. So, I was doing everything right. I had everything that I felt like was going right, but you worry constantly, like you’re constantly worried about your new parts because it’s foreign to you. And she messaged me, and this is about six weeks after surgery, seven weeks after surgery, and she goes, and “Have you managed to orgasm yet?” And I’m like, “What should I be playing with it already? You’ve only, you’ve only just done it, like what you want me to start fiddling around with it, what if I break it?” And she was like, “No you definitely need to, you need to you know experience your body. You know don’t be afraid to touch it.” As soon as they unbandaged me, they said, “Look, jump in the shower and don’t be afraid to touch it, find your body because the less you’re scared of, the better it is.”