Gender-affirming chest reconstruction surgery is highly effective for nonbinary patients

Zinnia JonesEven in the context of transgender identities and gender-affirming care and medical treatments, gender norms and stereotypes received from a cissexist society can still be uncomfortably prevalent, and this is particularly visible in the hostility with which nonbinary people trans people are often met. From within trans communities, “transmedicalist” factions often argue that the authenticity of one’s transness is defined by one’s desire and willingness to undergo certain gender-affirming medical interventions; from outside, “gender-critical” trolls characterize being nonbinary as merely adopting a superficial identity for the sake of distinguishing oneself as “special” or “different”, while wider society often has little awareness of the possibility and reality of genders outside the female/male binary at all.

None of these notions reflect the reality of nonbinary trans people’s lives – and one instance in which this becomes particularly clear is in nonbinary trans people’s pursuit of gender-affirming surgeries.

The binarist perspective often misuses the effects of transition treatment within the context of physical sex – the addition or removal of bodily features considered typically female or typically male – to reinforce the notion of a strict gender binary. Those who endorse this perspective may ask of nonbinary people, “then what are you transitioning to?” – already implicitly excluding the possibility that nonbinary genders, and nonbinary people, exist and are valid. This is just a particular manifestation of a more general position in broader society that fundamentally excludes the possibility of all transness, binary or nonbinary: the notion that the sexed features of the body are what defines and authoritatively determines one’s gender and identity. Partial or selective implementations of this view are seen in the stubbornness of individuals who may refuse to gender a trans woman correctly until they believe she’s had vaginoplasty. Those who seek masculinizing chest reconstructive surgery (top surgery) are generally assumed to be trans men who identify as men; this masculine-stereotyped feature is treated as synonymous with manhood.

Nonbinary trans people demonstrate that this is not in fact the case. Esmonde et al. (2019) report on a series of 458 trans patients who received a gender-affirming chest surgery (either breast augmentation or mastectomy/chest reconstruction) from 2012 to 2017; of these patients, 58 identified as nonbinary, all of whom were assigned female at birth. The authors note that trans people with a nonbinary identity comprised 13% of all transgender patients receiving surgery at their practice over this period. 33 of these patients completed a questionnaire at a mean followup time of about six months, and overall, these respondents agreed or strongly agreed that their surgery improved their quality of life, improved their sexual health, increased their ability to exercise regularly, and increased their comfort with the appearance of their upper body while both clothed and unclothed.

The authors further noted that nonbinary patients were subject to the same requirements for surgery as binary trans people in that they had to obtain a referral letter from a mental health professional affirming their suitability for surgery, and observed that the referral latters “often noted how the patient endorsed a non-binary gender identity and had chosen not to pursue masculinizing hormones, as those masculine features were not compatible with how they experienced their nonbinary gender identity”. They emphasize that, given the prevalence of nonbinary trans people presenting for medical care, clinic staff should be aware of gender identities and pronouns beyond the binary and be trained to handle these with respect and sensitivity. Moreover:

“… surgeons and medical office personnel should take care not to assume how a non-binary identity translates to a patient’s goals for surgery, expression of masculine versus feminine characteristics, or sexual orientation.”

Trans people’s genders are as real as cis people’s, and nonbinary trans people’s genders are as real as binary trans people’s. Just as some binary trans people experience and are diagnosed with gender dysphoria, some nonbinary trans people likewise experience and are diagnosed with gender dysphoria. Just as some binary trans people pursue gender-affirming medical treatments, some nonbinary trans people pursue these treatments as well. Nonbinary trans people similarly benefit from appropriate gender-affirming treatments. And, crucially, nonbinary people have just as unique an individual conception of the particular nature and form of their gender as any binary trans person does. Lay perspectives spuriously questioning the inclusion of nonbinary people in trans communities should be considered irrelevant in light of the facts at hand: that even by the strictest definitions and standards, nonbinary trans people are “real” in every sense that binary trans people are.

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About Zinnia Jones

My work focuses on insights to be found across transgender sociology, public health, psychiatry, history of medicine, cognitive science, the social processes of science, transgender feminism, and human rights, taking an analytic approach that intersects these many perspectives and is guided by the lived experiences of transgender people. I live in Orlando with my family, and work mainly in technical writing.
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