Body Week is Them’s annual look at what it means to live in a queer body today. Read more from the series here.
As gender-affirming care has become more normalized over the past several decades, top surgery has become increasingly accessible to broader segments of the population. But thanks to both the right-wing obsession with the so-called “irreversible damage” being done to young “girls,” and a general overrepresentation of young people in online spaces, the vast majority of depictions we see of people who have had top surgery are of young people. This leaves out an important part of the community, who may not have had access to top surgery when they were younger — whether due to a lack of insurance coverage, or simply not knowing that trans people existed.
This relative rarity of representation of trans people who medically transition as older adults is evident in online communities and support groups dedicated to gender-affirming care and even in healthcare settings; just take a look at the bodies represented on surgeons’ before-and-after pages and you’re likely to see mostly young, thin, white bodies. This doesn’t leave a lot of space for the experiences of older trans people, who are often grappling with different emotional and medical challenges, and whose timelines might look a little different. It can also create an implicit sense that it’s harder, or even impossible, to transition when you’re older. That time “runs out.”
Yet many trans people who transitioned when they were older will confirm that nothing could be further from the truth. “I think if you had asked me this last year, I would have felt a little bit of sadness about, you know, showing up late to the party,” says Theo, who got top surgery at 50. “But at the same time, it took the time it took, and I’m happy to be here, and I get to have an awareness and appreciation of the experience, because it’s something that I’ve held in my mind and in my heart for so long.”
Whether it’s a social transition, taking hormones, getting surgery, or anything else, the only “right time” to transition is whenever you want to. Below, we spoke to six trans people whose stories of getting top surgery after the age of 45 are proof.
Note: Some subjects in this story requested pseudonyms for anonymity. Their names are marked with asterisks.
“I don’t know that I would have thought about my relationship with my body as being dysphoric,” says Kit Wang. “It just wasn’t right. It sort of felt like it was one note in a chord that was out of tune. And as long as I didn’t pay too much attention to the chord, everything was fine.”
Kit describes himself with a chuckle as being “late to the party” when it comes to medical transition. The idea, of course, had been floating around for many years before he actually took steps to move forward with it. “I was spending a fair amount of time in the decades before that with trans folks, mostly trans men. And it was just like, I don’t know if this is the right time, I don’t know if this is the right place. What are all the ramifications?” For various reasons, he kept putting off transitioning — whether it was because he was busy getting ordained as an Episcopal priest, or raising his son. Plus, Kit notes that before the Affordable Care Act, the process of getting insurance to cover your surgery was a huge pain. He also hoped the medical science behind gender-affirming care might get better with time (“I’d watched people’s nipples fall off, you know?”) “Life is multi-faceted and complex, and all kinds of things just get in the way,” he says.
Kit finally got surgery when he was 57, a couple years after he started testosterone. He vividly remembers the first time he went swimming after healing. He had always loved swimming, but found it hard — and a little depressing — to do it in a binder and rash guard. Shortly after getting surgery, they found themself at a clergy retreat in Maine. At a swimming pool with a friend, they dove into the water, and were able to feel it on their skin for the first time in years. As they emerged from the pool, their friend said to them, “I wish I’d had a picture of your face. It was just beatific.”
“It was amazing just to be able to do that, and not feel self-conscious,” Kit says. “To be able to do something that I’d always loved to do, and had kind of given up because it was just too complicated.”
At the time we’re speaking, Theo is just one month out from top surgery, and the euphoria is fresh. They’ve been healing much faster than they thought they would. They’re already back to working in the garden, both at home and at the school where they are a teacher. “It feels like many, many layers of myself have been lifted from me, metaphorically as well as literally,” they say. “It’s been a process of rediscovery to really get to know my body in this new way.”
Several years ago, when they began to experience menopause, they were taking low-dose estrogen, which they eventually realized was worsening their dysphoria. “My therapist said [that] a lot of times when people are experiencing gender dysphoria, if they’re not taking hormones that are in alignment with what they feel in their body, that can sometimes feel almost poisonous. For whatever reason, that really struck me,” Theo says. Soon after that conversation, they stopped taking the low-dose estrogen, and started on low-dose testosterone. “When that started, the pieces started to come together.”
Theo has been pestering their doctor about when they’ll be allowed to go swimming again. “There’s a river spot that a lot of queer and trans people go to. I went there with my partner [last summer] and saw all of these beautiful trans bodies swimming and floating, and chatting with each other. There were fat bodies, and skinny bodies, and transfemmes, and transmasc people, and seeing that let me know that not only was [top surgery] something I wanted, but that it was okay for me to want that.”
This sense of giving yourself permission is powerful, especially when the world expects you to have everything about your identity figured out by the time you exit your twenties. Theo remembers discussing this with a new friend, who had been in queer community for a long time: “I said, ‘I feel a sense of shame and a sense of guilt around coming into my queerness this fully, this late in life.’ And she said, ‘What a joyful and amazing thing to be able to experience new things, or first times, as we age!’ To be 50 years old, and to be able to experience things for the first time… it took the time it took, and I’m happy to be here.”
Before he got top surgery three years ago, getting dressed was an ordeal for Charley. “For 10 years of my transition, I put a tank top on in the morning, and then a binder. And then I put a T-shirt on, and then a binder, and I put another T-shirt on, and another binder, and then another T-shirt, and then a dress shirt.”
Even with these layers, he says, he faced difficulties moving through the world in a gender nonconforming body. For many years, even after he knew he wanted surgery, it was out of the question financially. “No one would hire me before I transitioned, because I’m, you know, this big, Black, butch-looking lesbian, and nobody in Charlottesville, Virginia is going to hire somebody who looks like me,” he says. “But once I started fully passing, I started getting the jobs that enabled me to be able to start considering top surgery.”
Getting top surgery comes with another set of hurdles, though, if your body doesn’t mirror the thin, white, “normative” body that is often considered the default in many medical settings. This can make finding a surgeon hard, particularly if you’re darker-skinned, bigger-bodied, or if you’re older: You just won’t find a ton of bodies that look like yours on the results pages of surgeon’s websites. This was true of Charley’s surgeon, too. “I just had to trust this guy that he was going to sculpt my chest to fit my body,” he says.
Fortunately, his trust was merited — and thanks to word of mouth, Charley opened the door for the surgeon to work with many other Black trans men in the area.
“I definitely love my body more, and I take care of my body better,” he says of life post-surgery. “I am more confident in who I am. It had gotten to a point [pre-surgery] where I didn’t care what I wore, and now I'm like this clothes whore! …It’s just giving me a confidence that I didn’t know that I had.”
This confidence has opened up new doors for him. In 2022, Charley released a memoir about his experience as a Black trans man living in the South, and he’s currently working on two new writing projects, both of which are cookbooks — one that features his mother’s recipes alongside stories about being a “girl” and then a man in the kitchen; and another in collaboration with a group of nine other Black trans men, sharing recipes and stories about their relationship with cooking.
When I ask about post-surgery moments that stood out to him, he remembers one of the first times he pulled a shirt over his head post-surgery. “I took this clean, fresh cotton, white T-shirt, and I remember feeling it come over my head and touch my skin. That was the best feeling I’ve ever had to feel — that cotton against my skin. I don’t have to put all these things on anymore to be able to go out into the world.”
Syd first began to think about getting top surgery when they were in their twenties. But at the time, many surgeons required patients to be on testosterone for at least a year before they would perform surgery. So, as someone who didn’t want to go on T, surgery just wasn’t an option for them. But years later, when they were in their early forties, a friend informed them that this requirement had largely been dropped — and possibilities opened up.
“I think I must have been around 45 or 46, maybe, when I had this moment where I’m like, ‘Oh, I love this chest. It's not who I want to be, it’s not the chest I want, but it’s mine,’” they say. “I had this moment of, like, accepting my body as mine. And then I started the process of getting top surgery.”
Syd notes that something often left out of top surgery stories is the grief that can come after; there’s a pressure, particularly in a time when gender-affirming care is under attack from the Right, to construct a narrative that’s all smiles and gender euphoria. “There was so much that came up in the weeks after surgery, when I was in recovery: grief and sadness, and anger, and depression,” they say. “Not that I was questioning the surgery, it’s just all of this old, old body stuff, and old stuff around like not trusting myself, not caring for myself, not feeling loved, not feeling cared for, and not feeling worthy of care or love. It just was so alive. It was something that I ended up sharing with a number of my friends who have also had top surgery, and they were like, ‘Oh, yeah, shit. This totally happens. That’s totally real.’ And I was like, ‘Okay, well, why don't we talk about it?’”
Syd believes it’s important to make space for these conversations, because, if we don’t, how else can we truly care for one another? “It's surgery, it is the cutting open of our literal chests, which is our heart, right?” they ask. “How do we hold each other in that space, without shame and without it being wrong?”
“I was there getting my breasts removed — and the woman in the waiting room with me, she was there to get them made bigger. The irony of it all!”
For Greyson, getting top surgery at 54 was a game-changer. “I’ve always dressed masculine, in men’s clothes, since I was like a teenager, when I could tell my mother, ‘No, this is how I'm comfortable, and this is what I’m going to wear,’” he recalls. “And, you know, my shirts, trying to button them where the breasts were…” Greyson remembers being relieved when they came out with sports bras: “Thank God! At least something where you could kind of bind.”
“I just never felt like I looked like how I felt,” he says, but top surgery changed all that. “I became much more comfortable. My relationship with my body, I felt more accepting of it.” He also notes that it made physical intimacy with partners much easier, opening up space for connection in ways that weren’t possible before. Before surgery, he says, “they were these appendages. I didn’t let my intimate partners touch them. That's changed since I’ve had top surgery.”
Greyson currently works as a chaplain. He says he loves getting to work with fellow queer folks: “When I get to serve other queers, they light up!” When I remark that I’ve encountered a surprising number of older queers working as priests or in similarly spiritual lines of work, he’s not surprised. “There’s a lot of queers in chaplaincy,” he says. “You know, Jesus hung out with the people that were considered the outcast, and that's us!”
When Jake woke up from his top and bottom surgery — he got both on the same day! — he says he felt a sense of euphoria.
Jake is a physician and gender-affirming care advocate. Pre-surgery, he says, his relationship with his body involved “pretty much ignoring it.”
“I knew my breasts were there, but when you look in the mirror, you just sort of don't look there,” he recalls. “You ignore it.”
Surgery transformed this relationship. “It was just much more comfortable. It was more comfortable physically, it’s more comfortable emotionally, intellectually, the clothes fit differently… I was able to present the way I wanted to.”
Jake sees the emotional and physical aspects as being intertwined, when it comes to how we all move through the world in our bodies. “It’s not only the transgender population that has body parts that they don’t like, right? Everybody seems to have something they don’t like about themselves, and they tend to ignore it, or they think negatively about it. And my hindsight is, even if they’re parts that we’re not really thrilled about, if we treat our bodies with respect and love, they’re going to respond more healthily than if we don’t.”
He sees this lesson applied in his work as a medical practitioner: “I really try to emphasize taking care of their body in a loving and nurturing manner. If you’re constantly sending negative messages to your body from your brain, it makes it really difficult for it to do its job and be healthy.”
When it comes to other people who are past their forties considering top surgery, Jake hopes that they won’t disqualify themselves on the basis of age. “If you really, really want it, don’t let your age be an impediment. Embrace it, and do the things that you need to optimize your recovery,” he says. “Some people say, ‘Well, it’s been this long, I don’t need to do that.’ If you don’t need to, that’s fine — but if you’re feeling you really want to, it’s possible.”
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