You're the Top
4 min read

You're the Top

On seriousness, humor, and what everybody will tell you about top surgery.

I had top surgery a year ago today. I was going to do a joke post about “things people don’t tell you about top surgery,” but the only honest punchline would be to leave it blank. People tell you everything, both true and not, both good medical advice and nonsense, both personal experiences and rumors. In the lead-up to my surgery, I stopped going to my support group, and it wasn’t because of immune concerns (though I did have a really upsetting allergy and/or virus for a solid month beforehand, with no symptoms except a constant headache and tinnitus and a subtly congested affect without any clogging of the actual pipes, and I did stay home to coddle it). No, I avoided the group because people were telling me constant horror stories, and I didn’t want to hear them! “No matter what,” I told myself, “I won’t have all the complications these people had; at worst, I will have some of them.” Later, I had one, and it was fine.

Trans people exchange horror stories for two primary reasons, I think. One, we don’t trust doctors to understand our problems, or tell us everything we need to know.  Many of us have had bad experiences with doctors, and the rest take the cue. Two, ailments are fun to talk about, especially when they’re over. The ailment becomes a badge of distinction, a military medal, a signature cocktail, a special coffee order, or a favorite trouser cut that minimizes your hips. The problem is that not everybody looks as good in those trousers as you do, or finds the cocktail as piquant. Sometimes it really is best to let them order a Long Island Iced Tea, even if you’re sure they’ll suffer for it.

(I should mention here that when I write about alcohol — or alcoholism, a significant theme of the MS I currently have in draft — I’m doing it with the blesséd ignorance of Richard E. Grant before they made him get hammered for the first and only time to prepare for the part of Withnail. I find alcohol disgusting, always have, and the only drink I’ve ever finished was a nip of Bailey’s in a hot chocolate. There are other things I have in common with Old Gregg, but this is a post about top surgery.)

Another thing everyone tells you about top surgery is that their old chest was nice to look at, and they really felt a pang about it. They express the apologetic wish that they could have “donated” the material, or even just explained to the girls that they deserved a better father. (I do know exactly one trans man who doesn’t say this — “Mine were dogshit” are his usual words — Calvin, hi.) This is a sentiment I understand, and have felt. I think it’s a real indicator that we take this seriously, despite the relentless, almost alarming number of top surgery jokes that we make. I knew I was choosing between two different kinds of pain. It’s just that, when Kaiser opened the door to show me the massive system of conveyor belts that is their gender clinic, I also gave a little scream of delight and threw myself onto one.

I had a very easy medical transition, for reasons that come down to luck and privilege. The hard part was accepting that I wanted to make the intake appointment. Once I did, though, things just happened. I had a top surgery consult the same day. And once I was talking to the surgeon, I realized I was absolutely ecstatic at the thought of doing this, that from “take a deep breath and say I’m pretty sure” I had gone over to “there is simply no question.”

I look back now, and I’m astonished by how readily I knew it. It’s an argument for the informed consent model of transition, from which I’ve benefitted greatly. I knew what I wanted; I learned what I wanted partly because someone took the time to inform me, in detail, of what was possible, and did not decide for me. The thing about earlier and more restrictive models of trans care is that they involved, to some extent or another, someone deciding for you: whether you seemed serious enough, whether you had thought about it enough, whether you’d displayed enough early evidence of transness, whether they thought people would want to date you afterwards. I’m sure that most of these doctors were wrong sometimes. Perhaps some of them were even wrong in the other direction — declaring people “trans enough” who in fact had other things going on — although it is difficult to imagine someone asking for top surgery without meaning it.

I mean, it’s a major surgery. And we know it’s major. We know the scarring will be significant, that nerves will have to regrow, that some people won’t find the results attractive, that we might not. That’s why we run so little risk of regret. Nobody demands this thing, this rebuild of a body that had already been factory-sealed and purchased and used, without full awareness that it will hurt.

It is not only the concern about doctors, and the joy of triumphing over a seroma, that makes us tell jokes and horror stories. It’s also anxiety about the seriousness of our feelings. Most people aren’t used to being that serious about anything. We are also used to being mocked when we are, and so we mock ourselves: “I didn’t lift my arms for three months, and, boy, are my arms tired.”

I get it, but I would urge my people to resist the safety of humor, and to take desire seriously, both when considering top surgery and when advising people who are planning it. The process is rather funny, and it is also very difficult — hence why it is funny — but it’s not hilarious and it’s not impossible. Trans people have historically been kept in ignorance of transition’s possibilities by those who tell us we’re hilarious or impossible, and so we owe it to our community to be serious sometimes. And if we can’t do that, we can at least retire the “dinosaur arms” line, for the love of God.