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Non-Gender Euphoria

The Necessity of Top Surgery for [Some] Non-Binary People

By Mika KauffmanPublished 5 years ago 6 min read
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2 weeks post-op

My insurance denied me coverage for my top surgery, twice. That didn’t stop me from having it.

Top surgery [for some] is a medical necessity. Doctors, therapists, psychiatrists, LGBT resource and community centers, the Diagnostic Statistical Manual (DSM), and most insurance companies agree. There’s plenty of scientific studies on the effectiveness of undergoing a gender-affirmation treatment, including hormone replacement therapy and surgery. An analysis conducted by researchers at the What We Know Project (WWKP), and initiative of Cornell University’s Center for the Study of Inequality (CSI), reviewed more than 25 years of scholarship on transgender health: “Among researchers who have studied gender transition, there is little doubt that it improves the well-being of transgender people, often markedly,” said Nathaniel Frank, director of WWKP and co-lead of the study. “A consensus like this is rare in social science.” The positive outcomes of transitioning and related medical treatments improves the quality of life of trans people, producing higher self-esteem and confidence, and reducing anxiety, depression, and suicidal tendencies.

Western Society’s expectation of gender is that all people, including trans people, conform to identifying as either a man or a woman. But what if you don’t exist on the binary, like me?

I am non-binary, trans masc. My pronouns are they/them/theirs/themself. Navigating my gender identity, or as I like to call it, my “non-gender identity,” has been, and continues to be difficult in a society that exists with such rigid binary terms. I grew up in a little town in Baltimore County, Maryland near the Maryland/Pennsylvania line, an extremely white, conservative cishet community. I hated my breasts growing up, but I could never pinpoint why. I didn’t have the language or vocabulary to understand that I was suffering from gender dysphoria, so I became bulimic in an attempt to flatten my chest. Flash forward to 2017: I’m living in New York, I graduated from Tisch with a Master’s degree in musical theatre writing, and I’m living with my partner of four years. I wake up every morning and take at least an hour to get ready, trying on anywhere between 10-20 outfits. I always settle with the tightest sports bra, an over-sized boxy shirt and leggings. I sob when I see myself in the mirror.

My friend Scottie comes into my life. They’re non-binary and use they/them pronouns. They introduce me to a world of acceptance, love and transcending the binary. I recognize so much of myself in them. I want to be them. My partner refuses to use their pronouns, and we fight about it endlessly. It scares me. What if I wanted to change my pronouns? Would he love me anymore?

After doing a ton of research, I order a gc2b binder. It arrives after what feels like an eternity, and I try it on for the very first time.

First time trying on a binder

This was the first time I ever looked in a mirror and loved what I saw. This is non-gender euphoria. I quickly captured it. I never wanted the feeling to end. My partner found my binder the next day, and asked what it was; I lied and said it was a “sports bra.” I eventually left my partner for many reasons, the biggest being that he was transphobic, and I felt like I could never reveal who I truly was to him. I needed to discover that for myself.

2018: my hair perpetually continues to shorten, my closet is FILLED with plaid, button-down shirts, I’m living in Astoria, and loving my independence as I discover who I am. I am not a woman. I’m not a trans man. I wear make up and boxy clothes. I have five binders I wear interchangeably every day. I become immersed in the trans community through a round table at the Musical Theatre Factory in NY. I meet someone (also trans), and we fall in love and make plans to move in together with our two black cats. I am happy, except for one thing: my breasts.

When I was aware of my breasts, I felt nauseous and wanted to cry (and did, many, many times). If I could rip them off my body, I would have—binding was the only solution, a temporary solution, to hide my breasts and minimize their appearance. But it caused chronic back pain, and on top of that, the material covered the majority of my chest and shoulders and that made me super self-conscious with my clothes, so I would wear more clothing to cover it up, making the summer even more brutal with the heat. In the fall, I got bronchitis, and landed myself in the hospital because the constriction of my binder made it ten times worse. It wasn’t sustainable, and it was hurting my health, but I needed it.

Once I made the conscious decision that my breasts needed to go, my dysphoria got significantly worse, so I acted quickly. I set a date with my partner’s surgeon for FTM surgery, double incision with nipple grafting. Hearing “female-to-male surgery” made my skin crawl, but that’s what they called it, and that's what I needed, so I pushed forward. I had to pay $7,500 upfront, out of pocket. My health insurance refused to cover my surgery and hospital fees, because my surgeon has his own plastic surgery practice and didn’t normally work out of a hospital. I explained that we were doing the procedure in a hospital because of the length of time I had to be under anesthesia. It wasn’t enough. I had to pay over $3,500 for the hospital fees two weeks before the procedure, out of pocket. Next, I needed a letter from my psychiatrist stating that the surgery was necessary. She didn’t correlate having top surgery with the ease of my depression, and was suspicious of me identifying as non-binary and not as a trans man. She used my dysphoria as the ultimate reason for allowing me to have top surgery, but stated a caveat that she was concerned with my mental health. My surgeon gave me the benefit of the doubt. I had to pay my psychiatrist $400 for that letter upfront, and with no guarantee of her actually writing it. My step mom and dad covered that fee. On a particularly low day when I felt overwhelmed by the amount of debt I was accumulating without any steady income, I tried calling my health insurance again after my surgery to see if they’d cover any of the fees, proving that the procedure was done in a hospital. They said: “we can’t prove post-surgery that the surgery was necessary.”

My insurance denied me coverage for my top surgery, twice. That didn’t stop me from having it. This surgery saved my life. I can look in the mirror and love what I see. I can swim without anxiety. I can enjoy sex with fewer triggers. I can try on clothes without dreading how something will fit and look around my chest. I tried on a dress for the first time in years and didn’t have a panic attack. The quality of my life and my mental health has improved significantly. Some non-binary people use HRT. Others get surgery. Someone don’t have to change a thing about their bodies to be happy and valid. If the health care system truly understood the necessity of trans health for all trans people, binary and non-binary, gender non-conforming people, perhaps it wouldn’t take thousands and thousands of dollars to find happiness for those who need surgery. Perhaps our anxiety wouldn’t triple from having to pay a healthcare system that hates us, and we can live normal, healthy lives without asking people for money on social media. Perhaps we wouldn’t have to convince people that we needed this, at all.

I will never forget when my sister asked how much I was paying for my surgery. I told her around $12,000.

“So you’re serious about this?”

“Yes. $12,000 serious.”

I am much happier.

lgbtq
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