Medical services

[Doc]

I want ftm top surgery, but I don't want to go on hormones. I identify as male, but don't generally mind appearing as androgynous. I want this for my own personal satisfaction, not to change my outward appearance. It won't, I bind.

The only people I have heard of who have recieved this surgery without T are FtMs who pass well as male without T. I have heard of female-bodied people who identify as neutrois being denied this surgery repeatedly.

I've just started asking around about this, and the reaction I'm getting is 'you are not sure what you want,' though I feel quite sure. I suspect it's some kind of displacement -- 'what you want would still leave me unsure of your gender, so you must not be sure what you want.'

Any thoughts, stories or personal experiences regarding the possibilities and difficulties or impossibility of getting medical services that are 'For GID' when your outward social gender-presentation whatfoos are ambiguous and you are not trying to 'correct' that ambiguity?

[seldom]

If you identify as male, and are TS, you can get top surgery without hormones.  I know one transman who got top surgery long before they were ever on T.  In fact if you read the standards of care the treatment for transmen can be Therapy -> Top Surgery-> HRT  or Therapy  > HRT > Top Surgery.  The standards recognize that not every transman wants Top Surgery and not Every transman wants T.  Most want do want both though.

This is very similiar to TS women who are just okay with HRT. 

I would highly suggest you read through the Standards of Care.  You can do what you are talking about (Top Surgery only), especially since you do identify as male.  The standards recognize how one becomes happy as a TS varies from person to person.  If you are transman who does not want T, and wants to be identified as an androgynous male, the standards allow for that.

[Doc]

Thanks. I've really been getting the impression that this will be really hard. 'Cause what I want will just make me happy, not make me pass as unambiguously male. People will probably still read me as female. That's just not the important thing to me. I actually did read the standard, which I understood to want me to be on HRT for two years before I could get my chest done, and then little addendums from various shrinks and doctors allowing for exceptions (guys who pass without T and thus don't need it, guys with damaged livers who can't take T, guys with big unbindable breasts who would look odd on T) that didn't really seem to include anybody like me.  Maybe I read an old version?

[seldom]

Well it really depends on the place.  The real key is the real life test for FtM and the letter from your therapist that you have been living full time.

From the SoC sixth edition (hopefully this clarifies things for you):
Natural History of Gender Identity Disorders. Ideally, prospective data about the natural
history of gender identity struggles would inform all treatment decisions. These are lacking,
except for the demonstration that, without therapy, most boys and girls with gender identity
disorders outgrow their wish to change sex and gender. After the diagnosis of GID is made the
therapeutic approach usually includes three elements or phases (sometimes labeled triadic
therapy): a real-life experience in the desired role, hormones of the desired gender, and surgery
to change the genitalia and other sex characteristics. Five less firmly scientifically established
observations prevent clinicians from prescribing the triadic therapy based on diagnosis alone: 1)
some carefully diagnosed persons spontaneously change their aspirations; 2) others make more
comfortable accommodations to their gender identities without medical interventions; 3) others
give up their wish to follow the triadic sequence during psychotherapy; 4) some gender identity
clinics have an unexplained high drop out rate; and 5) the percentage of persons who are not
benefited from the triadic therapy varies significantly from study to study. Many persons with
GID will desire all three elements of triadic therapy. Typically, triadic therapy takes place in the
order of hormones = = > real-life experience = = > surgery, or sometimes: real-life experience =
= > hormones = = > surgery. For some biologic females, the preferred sequence may be
hormones = = > breast surgery = = > real-life experience. However, the diagnosis of GID invites
the consideration of a variety of therapeutic options, only one of which is the complete
therapeutic triad. Clinicians have increasingly become aware that not all persons with gender
identity disorders need or want all three elements of triadic therapy.

and

. Breast Surgery
Breast augmentation and removal are common operations, easily obtainable by the general
public for a variety of indications. Reasons for these operations range from cosmetic indications
to cancer. Although breast appearance is definitely important as a secondary sex characteristic,
breast size or presence are not involved in the legal definitions of sex and gender and are not
important for reproduction. The performance of breast operations should be considered with the

same reservations as beginning hormonal therapy. Both produce relatively irreversible changes
to the body.
The approach for male-to-female patients is different than for female-to-male patients. For
female-to-male patients, a mastectomy procedure is usually the first surgery performed for
success in gender presentation as a man; and for some patients it is the only surgery undertaken.
When the amount of breast tissue removed requires skin removal, a scar will result and the
patient should be so informed. Female-to-male patients may have surgery at the same time they
begin hormones. For male-to-female patients, augmentation mammoplasty may be performed if
the physician prescribing hormones and the surgeon have documented that breast enlargement
after undergoing hormone treatment for 18 months is not sufficient for comfort in the social
gender role.



Basically...you don't need hormones, and under the current rules there has been plenty of FtM who had top surgery before anything else happened.  Top surgery does not have the same requirements of GRS.  The SoC recognize people have different levels of congruity and ways to achieve it.  You will need a therapist letter though for top surgery explaining your situation.  The requirements for top surgery are the same as HRT, not the same as SRS.  So it is pretty easy to get compared to SRS.  You identify as MALE, that is what is important.  How you go about transitioning and where you want to stop is up to you.  Who knows you may change your mind about T.  I say the most important thing is to start therapy. 

[Doc]

Well it really depends on the place.  The real key is the real life test for FtM and the letter from your therapist that you have been living full time.

Thanks. You've been more helpful than others I've asked. Alas, I remain puzzled. The whole thing is so subjective. Either I have been 'living full-time' for over a decade or I have never lived full-time at all, depending on your point of view. I live as me, I feel male, I do what I want to do and the only consessions I make to my femaleness is buying menstrual supplies and using whichever bathroom seems to me the one less likely to get me yelled at, kicked out of the restaurant, or beat up. But I still look like a 'funny little guy, oh wait it's a woman in men's clothes,' or simply a 'woman in men's clothes,' or an 'I can't figure it out', and I get called 'she.'

Basically...you don't need hormones, and under the current rules there has been plenty of FtM who had top surgery before anything else happened.  Top surgery does not have the same requirements of GRS. 

Before anything else seems to happen all the time. In the absence of anything else being done seems to be an option only taken by FtMs who pass as unambiguously male without HRT anyway. I've never heard of any female-born man with an, "I don't really care if I pass, and I don't really care what sex strangers think I am, but having breasts bugged me so I got them removed" story.

The SoC recognize people have different levels of congruity and ways to achieve it.  You will need a therapist letter though for top surgery explaining your situation.  The requirements for top surgery are the same as HRT, not the same as SRS.  So it is pretty easy to get compared to SRS. 

Well, I am sure I could get HRT. Quite easily if the experiences of other FtMs is any indicator. But that'd be me taking the 'typical' FtM route, a track towards a 'complete' transition to an unambiguous male appearance and social status. I don't think this'd be necessary for me to achieve a satisfying level of congruity, and as such it wouldn't be worth it. But what I want, while it would increase my feeling of congruity, would (I imagine) decrease everybody else's, or make no difference. So I don't know what to expect in seeking it. I know that androgyne people who ask for similar get refused and I don't understand why the system would make a distinction between wanting physical androgyny (how naughty!) and finding a form of physical androgyny to be a pleasing and acceptable minimalist treatment.

You identify as MALE, that is what is important.  How you go about transitioning and where you want to stop is up to you.  Who knows you may change your mind about T.  I say the most important thing is to start therapy. 

Another person told me that since I am FtM, I am simply entitled to chest surgery regardless. Strikes me as hideously unfair to those who identify as androgyne, that.

Indeed, I may change my mind about T. I think that'll have a lot to do with how my body changes or doesn't change as I age. Right now, aside from the breasts, it's okay.

Yeah, I will need to start therapy before I can seriously seek surgery. What I don't want to do is blow a bundle on therapy if there's no real hope that it'll lead to what I want done. I don't feel like I'm needing help dealing with or recognizing my own identity and I don't really like therapy.