Not letting my ideal self hold me back: Top surgery

I’ve written before about how now that I’m on testosterone (8 months now), my dysphoria about my chest has gotten worse. Finally recognising my more angular, muscular self in the mirror, the incongruence between whom I recognise and the breasts covering my chest has become increasingly more painful. My deal with myself was that I would wait until I’d reached my body weight goal before I sought top surgery (a double mastectomy), but this week something shifted, and I’ve decided to begin the process towards getting my surgery date. This decision had more to do with the realisation that I withhold things from myself, punish myself, because I’m not at my ideal bodyweight than any other factor.

I’ve written about my relationship with my breasts, the Roommate Agreement I’ve drawn up with them numerous times since my breast reduction in 2010. And nothing has changed, except the certainty that I can no longer share my body with the breasts that are not mine. And what has also changed this week, perhaps because freshly out of a 3-year relationship, I’m tired of compromising with myself and others when it comes to what I know I want, and need.

The compromise in terms of body weight has been a lifelong struggle. I’ll buy that outfit when I’m at my goal weight. I’ll dress my body now and start experimenting with my fashion sense when I have a body that I want to dress fashionably. I’ll remove my breasts in order to be more happy and at peace with myself when I weigh what I should weigh. And I’ve had enough of that compromising, that delaying, that punishment – the idea that the me right now is not good enough to have those things and only the me at my agreed upon BMI is worthy of all of those things that present me just has to live without, work for, sweat for, struggle for.

Part of that compromise, that denial!!! comes in the form of telling myself that it’s ok to wait. That it’s necessary for the best results. That it will motivate me. That the dysphoria isn’t that bad. That I’m not as dysphoric about my breasts as other trans people. But that’s all a lie. The reason my dysphoria isn’t as bad as others is that I work from home and hardly go out, so the only reflection of my dysphoria is most often me, which I block out. But the truth is it’s getting harder and harder to placate myself with my bound form in public. It’s getting less easy to tell myself that people can’t see that I have breasts beneath my binder. It’s getting more difficult being misgendered for the sole reason of my breasts. I can no longer be ok with being called ‘sir’ at the windowless point one of the drive-thru and then being called ‘ma’am’ as soon as I pull up to a window. It’s no longer liveable with when I’m ‘sirred’ on the days I wear a binder and ‘ma’amed’ on the days I don’t.

And all of that ‘the results will be better if you’re at your goal weight’ is bullshit. There are hundreds and thousands of people who have had top surgery while being 20-30kgs heavier than I am right now, and not only do they have great results, but they speak of the incredible freedom, the incredible gift, top surgery was – how it freed them from the oppressive, motivation-sapping listlessness that stopped them from pursuing their best physical form. And those who wanted to become leaner and more muscular have found it easier doing it post-surgery than any incentive to do so pre-surgery ever did. And I want to thank my brothers and siblings on Instagram who shared their journeys with body issues and top surgery with me – you’ve made it easier to accept that I deserve to feel that freedom, that joy, that sense of self, and the courage to realised that delaying these things due to berating myself and punishing myself with the endless and tortuous battle of losing enough weight to be deserving.

I am deserving. Just as I am. I am enough. And this week sees the beginning of my journey to top surgery day.

I am going the government hospital route here in South Africa, instead of the private route. The reasoning is two-fold. 1. I cannot afford the R35-R70 000 that private doctors charge. 2. I have had a breast reduction at a government hospital and I know how brilliant the surgeons there are. (Government hospitals are used as training hospitals for medical students, and thus see the best surgeons in the country working and teaching there). The surgeries are costed on a sliding scale, from free (if unemployed), to R15 000 (hospital stay, etc. included). I also want the position in South Africa where privileged people use private options and the bulk of the transgender community is seen as being ‘stuck’ with the government alternative*. I am choosing the government alternative. Because I am a trans person and an activist, so for me to use an inaccessible option is not something I can do. I want to be able to make a difference to the accessibility of government top surgery in terms of conscientising the medical community to our specific needs, enabling more trans people to seek healthcare without fear of stigma.

* I am here speaking about Johannesburg, where we have more than one govt hospital and not Cape Town, where the one hospital has a waiting list years long.

I could save up the R70 000, but I don’t see why I should, as the government Doctors are just as good, if not better than most of the private Doctors. I suppose the anarchist in me also has an issue with Doctors getting away with charging such an obscene amount of money because these life-altering, non-cosmetic surgeries are not yet government funded. I have seen firsthand the passion that government doctors have at the possibility of making someone’s life better, and firmly believe that this should be their first motivation, and so often isn’t in the private medical community. And if that’s not true, point me in the direction of a private doctor who does even a handful of pro-bono cases a year because they don’t need the money and because they care…

Anyway. So I’ll be getting my letter from my hormone-prescribing doctor to state that I am transitioning, and I will get the financial and other logistical documents together needed to determine how much my surgery and hospital stay would cost. And then I will open a file at the clinic and without complaint spend my morning or day waiting in the queue.

I’m excited. In the meantime I will build up these pecs.

Because I am enough. Because I deserve this.