Coming out as non-binary can involve intense social transitioning — taking the huge leap of telling folks about possible pronoun and name changes, for example — and it's common to also seek gender-affirming medical care. And while gender dysphoria — an sense of discomfort with physical characteristics that your body has or lacks — isn’t a universal trans experience, transmasculine people with varying levels of dysphoria may consider pursuing testosterone treatments or top surgery in order to help.
Top surgery — a gender-affirmation surgery with diverse options that can give people a gender-neutral or masculinely-contoured chest — isn’t something all transmasculine people need or even want. (Diverse options can also include chest augmentation for non-binary folks who want to make their chest more feminine.) Just like you don't need testosterone to be transmasculine, top surgery doesn't need to be a part of your gender journey.
But for non-binary people who do want top surgery, especially those who aren't on testosterone, resources can be infuriatingly hard to find. YouTube communities and anecdotal research — which often depends on your friend knowing a friend who got surgery last year — can all be huge lifelines for transmasculine folks who want top surgery.
Three non-binary people, two of whom are not on testosterone, spoke to Bustle about their decisions to get top surgery. And they all agree on one thing: hearing other from other non-binary people about their experiences with top surgery helped validate their own feelings and needs.
Adrian is a 21-year-old transmasculine enby (a term for a non-binary person that doesn't overlap with the Black activist term NB, which is used to refer to non-Black people of color). When they first came out in their late teens, Adrian didn’t think top surgery was an option for them. They tell Bustle that before seeing another enby talk about top surgery on Tumblr, they thought it was “exclusive to trans guys only.” But after breaking a rib made it impossible for them to bind their chest safely, top surgery became a goal for Adrian, who has since gotten their surgery. (Chest binding is another way that many transmasculine people seek gender euphoria, and safer ways of binding are currently being developed.)
Another 27-year-old non-binary person, who asked to remain anonymous for privacy reasons, also hesitated before getting top surgery because of lack of readily-available information about non-binary top surgery without testosterone. "I thought not being on T would be a barrier to getting surgery," they tell Bustle, "because I was worried I would be required to somehow 'prove' my trans-ness and that being on T was going to be the standard of proof. Turns out, being on T was not a necessary prerequisite at all." According to the World Professional Association for Transgender Health, being on testosterone is no longer a requirement to be a candidate for top surgery.
A 30-year-old anonymous transmasculine person who is not on testosterone tells Bustle that they're at once nervous and excited about getting top surgery without testosterone. "Since I'm pretty curvy and don't want to be on testosterone, once I have top surgery, I'll retain my lower body curves stereotypically associated with femininity, but I will be able to take off my top (or wear a low-cut dress) to reveal a 'male-contoured' chest. It's terrifying but it's genderqueer AF and it's something my body wants every day."
There are many types of top surgery you can get depending on your preferences and your current chest size. But before you even get there, finding a gender therapist — a licensed mental health professional who specializes in working with individuals and families during gender transitions — can be a big help. A gender therapist will be able to write a letter explaining that your surgery is medically necessary so that you can potentially get at least part of your top surgery covered by insurance. Even if you don't have insurance, some surgeons still require a gender therapist's letter before they'll see you for a consultation.
These top surgery consultations are where you can ask about what procedure may be best for your desired outcome, as well as any questions you might have about pre- and post-op care and recovery. When you're figuring out how to approach these conversations with medical professionals, it can be especially helpful to form a community, whether IRL or online, that understands what you need and what you're going through.
That community of understanding should ideally include your surgeon, too. The anonymous 27-year-old tells Bustle that "As a person of color, it was really important to me to find a surgeon that was also a person of color" because they needed to be able to trust that their surgeon understood their skin care, their potential scarring patterns, and their experiences as a non-binary person of color.
It's also important to do intensive research into insurance and other financial options for your top surgery. While a 2019 report by Transcend Legal found that more employers are reducing transgender exclusions in the health care plans they offer, trans-affirming health care is still difficult to access.
Throughout the process, "try to make sure you have good people around you," the anonymous 30-year-old says. "And if you're scared about possible post-surgery depression and panic, you might want to write a letter to yourself to read after your surgery. Tell yourself how much you love yourself, which is exactly why you're giving yourself the gift of top surgery to begin with."
Top surgery, with or without testosterone, really can be a tremendous gift for folks who want or need it. Adrian says that after their surgery, they "feel more comfortable in my body. It makes me more neutral because I’ve finally gotten some stuff off my chest. I feel like my more authentic self, you know?” Which is exactly what top surgery is for.