While gender-affirming surgery is always a personal decision, many transgender people are expediting the process in hopes of completing desired procedures before President-elect Donald Trump takes office in January. Not all trans individuals opt for gender-affirming surgeries, but for those considering it, the Trump administration's hazy stance on transgender rights and protections is creating an urgency to act now, before it may be too late.
“I’m frustrated,” admits Bryce Niska, a 38-year-old based in Portland, Oregon. “I was getting mentally prepared to have top surgery, and now I am adding all the anxiety of having my female reproductive organs removed. I don’t want to run into problems getting it covered after Trump goes into office because I rely on Medicare and OHP.”
Prior to the election, Niska, who identifies as genderqueer and uses male pronouns, was not in a rush to have a hysterectomy. But now, he feels pressured to make a personal medical decision based on politics and, he noted, personal safety. “I want to be seen by society as the person that I see inside myself,” Niska tells Complex. “I had a few close calls with people questioning my gender that almost got violent. I had a problem with agoraphobia before that, and now I can’t leave my house much at all.”
I want to be seen by society as the person that I see inside myself. I had a few close calls with people questioning my gender that almost got violent.
Many Americans are fearful about violence against marginalized communities post-election, but for trans people, hate-based attacks are a constant worry. According to the National Coalition of Anti-Violence Programs, violence occurs with disproportionate frequency to the transgender community in comparison to other groups. For instance, NCAVP reports that trans women are 1.8 times more likely to experience sexual violence compared to other victims, and trans people of color are six times more likely to experience police violence than their white cis counterparts. According to the National Transgender Discrimination Survey report, 78 percent of transgender youth are harassed at school due to their gender identity.
While gender-affirming surgeries are not a guarantee to prevent harassment or violence, many individuals seek them as a means of feeling safer in their own identity. Many people, too, choose to have gender-affirming surgeries for their own mental health, self-esteem, and body image.
For Lore Graham, a 27-year-old writer who identifies as nonbinary transgender and uses gender neutral pronouns, having gender-affirming surgeries significantly improved their relationship with their body. “My body feels like it should feel,” they tell Complex in an interview, “and matches who I am as a person.”
Graham, who lives in Boston, Massachusetts, had a peri-aerolar mastectomy in June 2015 and a full hysterectomy in July 2015.
“I no longer have to bind my breasts,” they explain. “Instead, I have an androgynous chest that I am comfortable with, both when I’m clothed and when I’m topless. Now that they’re gone, I have much less anxiety and far fewer issues with negative body image.”
For trans people, opting to have gender-affirming surgeries is an intimate decision best made between a patient and trusted doctor. But with the current political climate, many trans people feel pressure to get what they can done now, rather than risk the opportunity expiring entirely in the next year.
“Just four days ago I had my hysterectomy,” says Sebastian Flowers, a 28-year-old trans man based in Oakland, California. “It was only planned a week in advance and was the first stage of bottom surgery for me. I felt heavily swayed to go for it as soon as possible and forgo having my eggs frozen, to quickly complete my transition before Trump is able to access power to either approve or deny basic human rights—including healthcare—for people of trans experience.”
For Flowers, changes will happen rapidly in the coming year, expedited by the uncertainty of what trans rights may look like under Trump’s Presidency. “In February 2017, I intend on getting ALT phalloplasty, also known as bottom surgery. It would include the creation of the neo-phallus, clitoral transposition, glansplasty, and scrotoplasty with testicular implants. Then, an erection rod and any revisions will be surgically done in April or early May.”
Flowers, who began medically transitioning at the age of 22 via testosterone treatments, admits he feels rushed in this process, but feels confident he is making the right decisions at the right times. “I am taking steps to prepare my body and my mind through exercising, meditating, and surrounding myself with loving and affirming energy,” he explains. “These two last surgeries will mark an end to 13 years of dysphoria, and I will be in the body I was born to be in.”
In the Trump Era, we must work to protect trans people, Muslims, Jewish people, POC, LGBTQ people, scientists, repro health workers, etc.— Broderick Greer (@BroderickGreer) November 17, 2016
For members of the trans community seeking gender-affirming surgeries, cost can be a prohibitive factor. “Though some states are initiating progressive laws that mandate coverage for various LGBTQI+ health needs, most individuals in this community still face significant barriers with insurance companies paying for needed services,” Signey Olson, a certified midwife and nurse practitioner who specializes in LGBTQ care, tells Complex. “Many companies claim that gender-affirming medications and surgeries are cosmetic or elective and therefore do not require coverage. This is a large-scale affront to trans individuals because gender-affirming care is as essential to one’s physical and mental well-being as any other form of healthcare.”
Many companies claim that gender-affirming medications and surgeries are cosmetic or elective and therefore do not require coverage. This is a large-scale affront to trans individuals because gender-affirming care is as essential to one’s physical and mental well-being as any other form of healthcare.
Parker, a 23-year-old trans man living in Washington, D.C., knows all too well how frustrating it is to seek financial support from insurance companies when it comes to queer-inclusive medical care. “By far the biggest obstacle I faced was insurance coverage,” he tells Complex. Parker, who had a double mastectomy at age 21 and a hysterectomy at age 22, had to switch insurance companies in order to find the coverage he needed.
“Three days before my hysterectomy, I received a call from the doctor’s office stating I would have to put a hefty deposit down to reserve the surgery date because my insurance came back saying they would not cover the surgery. I was devastated,” he explains. “My parents were kind enough to pay to have me on a separate insurance just so that I could have the surgery done, though I was paying for everything myself.”
As Olson notes, obstacles from insurance companies range from frustrating to debilitating for trans patients who seek care in order to alleviate gender dysphoria, anxiety, and other health issues. “It needs to be clearly written in our legislature that transgender related therapies are in no way optional for individuals pursuing them,” she explains. “If this could be accomplished, it would send a clear message to our trans communities that they are accepted and welcomed.”