JJ’s top surgery: Part 1

Six a.m. JJ is already in a hospital gown and lying on a gurney, ready to be prepped for their surgery. The last time I was in a hospital with JJ, I gave birth to them. JJ arrived unexpectedly seven weeks early and spent the first month of their life in the NICU.

The memory of JJ being taken away to NICU before I even held them—would they survive?—comes flooding back to me as a rush of nurses, an anesthesiologist, and the surgeon himself, Dr. Hammada, arrive to wheel teenage JJ off.

Cat turds

JJ and I chose Dr. Hammada for his passion and attention to detail but also his sense of humor. “January 6th?” he asked during the consult, noting  JJ’s birthdate on their chart. “An auspicious date.” Was that a chuckle?

I shared with him that while insurrectionists stormed the Capitol, I had been making the “Litter Box Cake” JJ requested for their thirteenth birthday—an assemblage of cake mix, crushed Oreos, green food dye, vanilla pudding, tootsie rolls, and a plastic litter pan and scoop. You melt the tootsie rolls in the microwave and scatter them artistically in the “litter box” so they resemble cat turds.

“If you like the results of the surgery,” he joked, “you must bring me one of these cakes.”

Which top surgery scars did JJ prefer? Dr Hammada explained how scar tissue forms, noting that some scars, as they heal, can be angry, not unlike the Capitol insurrectionists. It was an unforgivable joke. I loved him for it.

Then he examined JJ’s chest behind a curtain, fully anticipating that my thirteen-year-old would not be comfortable with me present. I had not seen JJ naked for a long time, I realized as I sat in the chair with my purse on my lap. How funny that when they were a baby, I cared for their body 24/7. 

Now JJ’s body was their own.

“If there’s anything you don’t like,” Dr. Hammada told JJ, looking into their eyes, “you come back to me, and I'll fix it.”

T-Rex

During Covid, on one of our walks, JJ had asked out of the blue, “When I turn 18, can I get top surgery for my birthday?” They were 11 years old.

Before I had time to register my shock, my mouth answered JJ in the affirmative, leaving my mind behind like a discarded spouse. “Of course you can,” I heard myself say with that odd mother-cheer that becomes a permanent tonal register as your kid throws out more and more questions. The same way any parent says of course when their kid expounds on Allosaurus versus T-Rex.

Turns out, I was the dinosaur. I maintained that I was an ally to trans people, but I gave trans issues very little thought at that time.

And yet I had said yes to JJ. Why? I think it must have been out of instinct—a sense they needed me to confirm that I would support them in this eventual step of their transition. But I wasn’t ready.

I hated the thought of my kid’s body being cut. Their body felt sacred. I still thought of it as mine. When JJ was an infant, we would nap side-by-side in the afternoons. My eyes blinked open to their eyes blinking open. We were of the same body. Perfectly in sync. 

Too late

JJ’s discomfort in their body grew acute when they turned 11 and started their period. They didn’t just want to hide their breasts—they wanted to do away with them. Disappear them.

Had I known of JJ’s dysphoria prior to their puberty, we could have tried puberty blockers. Once your period starts, it’s too late. Cue the binder.

A binder flattens a wearer’s chest with pressure. Like a sports bra, but extreme. Lots of people use them, but you can’t get them just anywhere. (Target sold chest binders as recently as 2022 but withdrew their righteous Pride merch at a whiff of disapproval from some consumers.) You have to buy them online, and it’s hard to find a design and size that work. You’re lucky if you find one.

We found one. A single one. The only one JJ would wear. I tried to buy more, but the maker had disappeared. 

Binders make it hard to breathe. You cannot, for example, do phys ed with a binder. JJ was exempted from PE in middle school because of this, which was positive and accommodating, but if you think about it, it also meant JJ was excluded from being athletic. 

It was becoming clear that top surgery would free JJ from dysphoria and let them live freely in their body. But I was still having a hard time.

Lamentations

By this point, JJ was 12 and seeing Dr. Chanoz, the gender specialist who had first prescribed them testosterone. Dr. Chanoz asked if JJ wanted top surgery. JJ said yes. The doctor shared a list of surgeons and advised me to book consultations ASAP, as some doctors schedule months out. She recommended I discuss payment, insurance, and many other important details of this undertaking.

I wasn’t sure what to do.

At my monthly PFLAG support meeting, I let loose my lamentations about JJ’s potential surgery. I couldn’t stand the thought of their body being cut into. I was scared.

Other folks in the meeting were offering soothing words when a woman named Melody stepped in with her opinion. She said she didn’t think the surgery was a big deal at all. Cis boys routinely get it for gynecomastia. It’s not terribly invasive.

I’d always found Melody confrontational. But just then I realized she was the one telling it like it is. She was frank. She was right. 

The goods

I considered my own breasts. They were brought into being, strangely, by the gaze of my adolescent male cohort. From the minute they appeared, they were regarded as separate from me—objects, playthings—and yet entirely representative of my sexuality and attractiveness.

One boyfriend told me that if he could spend a day as a girl he would simply play with his breasts.  It was as if my boobs existed to titillate cis het men.

As I look back, my experience with breasts has been maybe 20% erotic, 20% functional, and 60% tedious to repulsive.

JJ, born premature, could not breastfeed. But my boobs worked overtime. The pump churned every two hours, pulling the goods out of me to feed to my child through a bottle. I’m on good terms with my boobs. They did right by me. But JJ is a separate person.

It was clear that they did not want their breasts. But also that they did not need them.

Terrifying

I realize people may find it surprising that JJ had top surgery at 13, not 18. Was this upsetting for me? Terrifying? Yes. 

But what was more terrifying to me was the way JJ held their body. The constant presence of The Binder. Perceiving that their breasts were an obstacle to them feeling comfortable and safe in their body.

JJ began their transition during Covid. That was when they changed their name, knowing it would appear changed in front of their classmates on the Zoom screen when they attended school.

The thing you have to understand about JJ is that they have never liked attracting attention. They refused to go on stage for the preschool holiday performance. They have always dreaded breaking rules. Not so much because they refuse to question authority but because they do not want to cause a scene by getting in trouble. So when JJ considered the matter of coming out and its social ramifications, they wanted do it in the least conspicuous way. Being trans was not an attempt to gain attention. Nor was it a “phase.”

The plan

Over two years, my worry shifted from the idea of top surgery to the problem of getting it scheduled. Getting gender care was never straightforward—and keep in mind this was years before the 2024 election. Before gender care and top surgeries started to be canceled as hospitals caved to the right wing trans panic.

Dr. Hammada’s office gave us an appointment the same week I called. His admin diligently worked with our insurance and was clear regarding out-of-pocket costs. Dr. Hammada was accessible. He understood.

At our consultation, he proposed JJ have their surgery a few weeks before school started, allowing them time to heal. This was the fall of 2022, when everyone finally went back to school in person after lockdown.

If all went well, JJ would return to their community transformed.

We scheduled the surgery.

Stay tuned for Part II next week! — T.C.