You’ve known that you’re transgender (or fall somewhere under the trans* umbrella) for some time now, and maybe you’ve started a social transition—making decisions about things like your name, your pronouns, your clothing and possibly even taking hormones. But how do you decide if you should also get any surgeries (often known as top surgery and bottom surgery, but there are additional options)?
It’s a tough choice, like any medical decision, and it’s definitely not a short or easy process. Before you choose for yourself, we talked with trans activist, comedian and playwright Ashley Lauren Rogers, about what transgender individuals should think about as they’re gathering research and weighing options. Here are some things to consider before making decisions about your medical transition and surgeries.
Even if you don’t medically transition or get surgery, your identity is valid.
It’s not, “You either go on hormones, get surgeries, or you’re not transgender.” However you identify is who you are—full stop.
Besides the fact that gender and sex aren’t binary to begin with, because transgender and intersex people exist, you have the right to define your own gender, regardless of what transition choices you make.
“Whether you have internal or external genitalia doesn't define you as a woman or a man,” says Rogers. “You do.”
If you’re feeling any sort of pressure to medically transition, get surgery, or even just to make the decision sooner than you feel ready because you’re worried you “aren’t really trans,” and if you don’t make up your mind, stop. Take time to breathe, and realize you don’t need all the answers to be who you are.
The process is long and difficult.
Rogers calls the process “very long,” and says that you’ll be asked each step of the way whether you’re sure. She also stresses that “you should consider everything a medical professional tells you.” If your doctor wants you to start a small dose of hormones before moving up to a higher dosage, or is worried that a part of medical transition might be difficult because of a pre-existing condition, make sure to take all their advice into consideration as you make decisions.
Getting any kind of surgery, no matter what type, is a drawn-out process. Because of the risk factors involved, especially if you have any additional health problems or a history of complications with surgery or anesthesia, you can expect to discuss it in detail with medical professionals. The first step is usually consulting with a therapist who is trained in gender transition, so if you don't already have one you see for this, you should start searching for one. The Trans Healthcare website lists out SRS surgeons in the United States. Trans Care Site is also a great place for transgender healthcare listings.
You don’t need to make a decision quickly.
This may go without saying, given how long the process takes, but you don’t need to make a decision quickly or feel locked in to a particular decision. If you have doubts, take your time to consult these doubts on your own, as well as with physical and mental health professionals.
You should also ask yourself why you want to medically transition or have surgery, says Rogers. She suggests people ask themselves the following: “Why am I angry? I had to figure out what was actually the source of these negative feelings. Was it just the fact that I couldn't wear women's clothing? Was it that people considered me a man and I disagreed? Was it the genitalia I was born with? It took me a very long time and I did see some mental health professionals to help unpack this.”
Many transgender and non-binary people feel gender dysphoria, while others may not—so it’s perfectly normal to sort through these feelings and figure out why you’re seeking a surgical transition and what you’re hoping to get out of the process. You want to set realistic expectations for yourself and be prepared for the emotions the process may bring out!
It’s not an “all or nothing” process.
Because there are so many medical and surgical options not, you may feel like you really want or need some surgeries, but not all. Rogers says, “I realized there are some things I actively physically want to/have changed and there are some I don't see any need to change. That doesn't make me any less a woman because of that.”
Explore your options with your doctors and find out what makes the most sense for you. It’s not a one-size-fits-all process, and you can elect to surgically and medically transition in some ways but not others. You can go on hormones and have facial surgeries, but not have top or bottom surgery. You can have top surgery without having bottom surgery right away, or at all. It’s all up to what makes you feel most comfortable!
You’re the only person who knows what you need.
You should definitely consult professionals in this process, but you’re entitled to get second, third or even more opinions if you feel like the first doctor or therapist doesn’t understand you and your needs.
You also can take friends' and family members' opinions and advice into account, but just remember: they’re not you! They don’t know what you need or what will make you happy.
“There are many people who won't believe you and try to tell you that you're too young to know and when you become old enough they'll tell you that if you truly knew you would've done it by now,” says Rogers. “When you know, you know, but you should still seek help from mental health professionals to help unpack everything.” Doctors usually prefer that you're over eighteen to begin the process of medically transitioning, but it's becoming more and more common for trans teens to start the process with their parents' or guardians' consent.
In other words, trust yourself, but don’t be afraid to consult professionals who you feel really understand your current needs, too.
You need to take this process safely.
Above all else, remember to be safe. Like with many other medical procedures, there are unsafe options out there.
It may feel, right now, like you need to take action right away and you can’t wait. But there are serious risks involved with taking medications from anyone but a medical professional, and with changing your dosage on your own.
“Remember that the physical process is going to take some time. Do not rush it!” says Rogers. “By that I am referring to HRT (hormone replacement therapy). Do not get your hormones from anyone who is not a medical professional and do not take any more than the prescribed dosage.”
Rogers also stresses that transitioning is a lifelong process, and surgery is not the “final step” or an end point.
Remember: you define who you are. Whether or not you medically or surgically transition in any way is up to you. “And above all else you are not defined by your genitalia,” says Rogers. “The second you take hold of your identity it is true.”
If medically or surgically transitioning in some way feels right for you, take your time. Consult medical professionals, and feel free to consult more than one for extra opinions. Talk to other transgender people about their thought process if you know any who are open to these questions and feel comfortable sharing. Read blogs and writing by others in your situation and see how it makes you feel. And above all, remember that your decision of how and when to transition does not define your gender. Only you define that!