I'm Glad I Didn't Get Gender-Affirming Surgery As A Minor
On life-changing operations.
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With transgender children at the center of a fiery debate about what types of surgery we should allow, and with even more gender-affirming care bans for trans people of all ages on the horizon, I’d like to talk about my experience with gynecomastia.
Gynecomastia is a condition in biological males where they have a larger-than-usual amount of breast tissue. It affects about 10% of males at some point in their life—including me.
While this condition goes away with age for most biological males, for me, it never went away away. I distinctly remember being bullied all throughout my life for having “man boobs”, (and for being fat in general) and I always thought that something was wrong with me. I only learned recently that the condition had a term at all, and in fact was pretty prevalent. I also learned that a lot of men actually get corrective surgery to make their chests look “normal”. Essentially, this is a socially-acceptable form of gender-affirming care: men getting surgery to make their bodies look more like what society expects male bodies to look like. (Good for them!)
In fact, according to a study published earlier this year in the Journal of the American Medical Association (JAMA), 80% of all breast reductions performed on adults in 2019 were performed on cisgender men; that’s 507 out of 636 surgeries, far exceeding breast reductions for transgender and gender diverse (TGD) adults. (It’s worth noting that this paper was specifically looking at breast reductions that were NOT for medical purposes, like removing cancer or resolving an injury.)
The study also found that only 151 breast reductions were performed on minors in 2019, and of those, 146 (97%) were performed on cisgender males (to treat their gynecomastia), and only 5 were performed on minors. To put it another way, the rate of gender-affirming surgery for transgender and gender-diverse ADULTS was 5.3 surgeries for every 100,000 adults, 2.1 for every 100,000 minors ages 15 to 17, 0.1 for every 100,000 minors ages 13-14, and zero procedures were done on minors 12 or younger. What the data shows us is that gender-affirming surgery is exceptionally rare for minors, and when it does happen, 96.4% of the time it’s a simple chest procedure, nothing to do with their genitalia.
This all got me thinking about my own gender journey. As a teenager I used to hate my chest, but now, as a trans woman, I specifically take hormones specifically to try and grow my chest out (among other effects). Most of the hullabaloo about gender-affirming surgeries for minors is about “regret”. What if a child gets surgery because they think they’re transgender, only to later realize they’re actually not, and then they’re stuck with this permanent change??? What we never hear about is the reverse: what if a minor gets surgery to make them look more like their biological sex, only for them to later realize that they’re trans?
For me, this is barely a hypothetical: if a doctor offered an anxious, teenage me a breast reduction surgery, I absolutely would have said yes, only to realize at age 22 that actually I wanted to transition into a woman, a mission for which having breasts is somewhat useful. I could have gotten gender-affirming surgery and regretted it, not because I was “actually cisgender”, but because I was “actually transgender”.
This is to say nothing of the “corrective” surgeries routinely performed on intersex babies, perhaps the most disgusting manifestation of cissexism imaginable. Transphobes will literally force bottom surgery surgery on a newborn baby, who can’t possibly consent to such a thing, just to make them look more normatively cisgender, then tell a 17-year-old trans boy who’s been consistent in his gender identity since being a child that he can’t possibly consent to a “life-altering”, “irreversible” breast reduction, then let a cisgender boy of the same age get the same top surgery.
I already know what the ’phobes will have to say about this; merely my framing of gynecomastia correction as “gender-affirming surgery” is sure to get me fighting for my life in the comments section. But for my aspiring cisgender allies, I want you to consider the backwards logic of all of this. One of the core anxieties of the anti-trans movement is that men and women aren’t as different as we think they are. Cisgender women can grow facial hair; they have all the same androgen receptors in their bodies as men do, it’s just that they usually lack the testosterone to activate them. Cisgender men have all the body parts they need to make healthy breast milk, they just usually lack the hormonal reagents. As men age, their hormone levels drop and they grow breast tissue. As women age, their hormone levels drop and they lose breast tissue. Over the course of their lives, males and females essentially go from looking pretty much the same as babies, to diverging in appearance once their hormones hit, to converging again once those hormones go away.
We are all just sacks of chemicals, ultimately more similar than we are different. That’s pretty scary when you’ve been told your whole life that men and women are fundamentally, irreconcilably different beings with specific social roles to uphold. In that world, trans people are pretty radical. All we’re really saying is, how about we imagine a better gender system? How about we allow people to self-determine? How about we follow the science and recognize what we have in common, instead of obsessing over our differences?
Here’s hoping that in 2025, we can embrace the real data on gender-affirming care.
Currently Reading
An expert’s perspective on the massive new gender-affirming care ban in the UK.
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The EPA has banned two new chemicals, trichloroethylene (TCE) and perchloroethylene (PCE or Perc). These follow in the steps of the unique regulations on methylene chloride (DCM) from last year, which I wrote about at the time. Time will tell if the chemical industry will revolt at these new rulings, but for now, it seems like another win for green chemistry!
A haunting look at the future of the film industry. I predict that 2025 will bring the first fully AI-generated feature film to be played in real theaters, along with it a discourse we are currently unprepared for.
Watch History
This new “liberal deprogramming” playlist is full of hits, including the newly released video on Joe Biden’s legacy from Elliot Sang!
This fun video showing the true scale of Pokémon.
A how-to on data visualization from Dr. Fatima, a creator I deeply respect!
Two takes on consumerism: one on how product returns (don’t) work, one on why Etsy sucks now.
The incredible Kat Blaque on the ineffectiveness of “hearing out the other side”.
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Bops, Vibes, & Jams
As I prepare my annual “Favorite Things” list (see lists from 2023 and 2022), I’ve been returning to my favorite albums of the year. Doechii, Clairo, and Tyler, The Creator have all been coming up in the rotation!
Speaking of Doechii, her Tiny Desk Concert was insane!
I’ve also been revisiting the classic “MM… FOOD” for its 20-year anniversary!
And now, your weekly Koko.
That’s all for now! See you next week with more sweet, sweet content.
In solidarity,
-Anna
cis folks have endless access to gender-affirming care. GAC is only deemed “controversial” as soon as the person seeking it is trans, and i really appreciate you writing from this perspective. valid af, and so happy your note found its way to my feed.
This post was so insightful, thank you for sharing! As a cisgender woman I'm still trying to undo my assumptions about gender, thanks for reminding me that men and women are more similar than they are different! I think the existence of trans and intersex people shows how we all exist along a beautiful spectrum, each of us is unique and nothing is truly 100% black and white in how we exist as the gender we identify with 🌈💖