Susan's Place Transgender Resources

I think I've hit a (literal) tipping point. I'm experiencing daily pain in my upper back, along with a burning sensation in my shoulders. On some days, I have to stop what I'm doing and lay down.

I did a little research and learned that this might be due to my breasts. I'm tall and thin and I'm overflowing a 36C bra, having started with a totally flat chest. My breasts are very dense - mostly glands instead of fat, so they're heavy. I wear bras most days but tend to prefer less supportive spandex "sleep" bras and a few others that don't have any wire and that are unobtrusive, with the goal being to minimize my breasts. I'm not out publicly, except for the occasional outing as this point, so my daily goal is to hide them.

I usually hunch my shoulders and/or torso when outside or around others in order to prevent them from showing. I don't really do in consciously but I can't help it.

I worked outside all day yesterday and chose not to wear a bra beneath my sweatshirt and the pain was quite severe by the end of the day. I'm ready to work again today and will need Advil in order to manage this.

I feel that the foregone conclusion is that the loss of upper body muscle has combined with a lack of breast support and bad posture to create this issue. I'm going to try to stick with more substantial bras, make an effort to stand up straight, and do some stretching and yoga to stretch and strengthen these muscles, but I wanted to take an informal survey and see if others have experienced this.

Thanks.

@Courtney G

Dear Courtney:
My "non-medical" thoughts are perhaps what you mentioned .... "bad posture"
    I would think that hunching your shoulders and/or torso would put extra-strain
    on the muscles in your back and shoulders.

Perhaps as a trial, you might want start wearing a very supportive, maximum support sports bra, which
also will help you to minimize and be stealth, just as long as you are wearing larger size heavy fabric loose tops
such as a sweater or sweatshirt.  Winter is arriving so that might be a good option.

I likewise have fairly large breasts 38C+ and have not had those issues.

Wishing you well...
HUGS, Danielle

Quote from: Northern Star Girl on November 23, 2025, 09:26:59 AMPerhaps as a trial, you might want start wearing a very supportive, maximum support sports bra, which
also will help you to minimize and be stealth, just as long as you are wearing larger size heavy fabric loose tops
such as a sweater or sweatshirt.

I agree with you Danielle. It's hoodie season now, so this is easier. The only problem is that I have a bunch of nice bras that my wife donated to me and I've outgrown almost all of them! Lol.

Maybe this will all change if my facial feminization surgery takes place soon and goes well. 😉

Dear Courtney,

Everything you described — the burning in the shoulders, the upper-back fatigue, and the way it spikes on days without support — lines up very closely with something a lot of women (cis and trans alike) deal with when their breast size, posture, and support aren't in balance.

When breasts develop quickly, especially dense ones, the pull on the upper-back and shoulder muscles can cause what's often called *postural strain*. The muscles between your shoulder blades and the ones that anchor the shoulders forward can become overworked, inflamed, and irritated. That kind of strain can absolutely produce the burning sensation you mentioned, and it often worsens if someone is trying to hold themselves smaller or hunched to be less noticeable.

That doesn't mean anything dangerous is happening — just that your body is sending a very clear message that the way it's being loaded right now isn't sustainable.

But there's one piece that I want to gently highlight:

Daily pain bad enough that you sometimes need to lie down, combined with dense, heavy breast tissue and significant posture compensation, really is something your doctor should be aware of.

They can check for things like:

• Muscle strain
• Nerve irritation
• Whether your spine or shoulders are being pulled out of alignment
• Whether a physical therapist could help you correct the underlying pattern

None of those checks require you to be "out," and you can frame it exactly the way you did here: *"My chest development has changed my posture, and now I'm having daily upper-back and shoulder pain."* It's a very normal conversation, and doctors see this in women all the time.

Everything you're planning — better support, winter layers to stay stealthy, posture awareness, stretching, and gentle strengthening — is exactly what most providers would start with anyway. But given that the pain is daily and occasionally severe, having a professional evaluate it means you won't miss something important or let it become chronic.

And your point about feeling more able to stand naturally after facial surgery makes sense. Many of us unconsciously fold ourselves inward until we feel safe enough to expand. If FFS helps you feel freer to stand upright, that alone may reduce a lot of the strain.

You deserve to *feel good* in your body, not just endure it. Talking with your doctor can help make sure this gets addressed early, before it becomes something that follows you for years.

Quote from: Susan on November 23, 2025, 10:50:52 AMEverything you described — the burning in the shoulders, the upper-back fatigue, and the way it spikes on days without support — lines up very closely with something a lot of women (cis and trans alike) deal with when their breast size, posture, and support aren't in balance.

Thanks, Susan, for the info and thoughts. I have a full wellness check coming early next year, so I've decided to work on my posture and wear supportive bras until then and to mention this to my practitioner if it persists.

The struggle with the one-two punch of gender dysphoria and body dysmorphia I continue to find it very difficult to move forward. I had a list of "must do" items (HRT, hair replacement surgery, rhinoplastic, body hair removal, facial hair removal and FFS) and I've gotten through all but the last two. One would think that completing each of these steps would move my transition forward, but it's as thought *all* of the items are on the critical path.

If I didn't have to show my face, I feel that my body would allow me to present just fine.

(https://i.imgur.com/fh807ST.jpg)

Quote from: Courtney G on Yesterday at 10:07:18 AMThe struggle with the one-two punch of gender dysphoria and body dysmorphia I continue to find it very difficult to move forward. I had a list of "must do" items (HRT, hair replacement surgery, rhinoplastic, body hair removal, facial hair removal and FFS) and I've gotten through all but the last two. One would think that completing each of these steps would move my transition forward, but it's as thought *all* of the items are on the critical path.

If I didn't have to show my face, I feel that my body would allow me to present just fine.

I did the same thing. I made a "To Do" list and arranged it so that the order of steps made sense to me. That went right out the window. There were too many things on the list that I couldn't complete because those services were not available. I felt stuck because one thing on the list was holding me back from everything else.

In discussing this in therapy, my psychologist had me rearrange the list so that everything that I could do now was at the top of the list. Suddenly, I was moving forward again and getting things done. Finally, I was down to the last two items, electrolysis and surgery. Neither of these is available in South Dakota.

My list changed. I added new steps to the top of that list to make those two things available. I moved to Colorado, and I am now getting electrolysis done while saving money for surgery.

I feel the same way about my face, but I also realize that I am not going to look like a 25-year-old woman... ever. I am 68, so if I look like a 58-year-old woman, I can be happy. Make sure your goals are realistic. Good skin care and makeup go a long way.

Remember that we are our own worst critics. We are aware of every flaw, whether anyone else sees them or not. In most cases, people do not see them.

The human mind decides within seconds what it is looking at. If the body is showing female, it looks for confirmation of that: hair, jewelry, makeup, clothing. If it sees that confirmation, that is enough, and the image registers as female. It doesn't care if you are a gorgeous female or an average to ugly female. Just practice the things that point in the direction you are headed. If you want FFS, go for it when you can. Body hair removal, yes, but look at the photo. You can't see any body hair. Facial hair is a big dysphoria trigger for many of us, so it was important to me to attack as soon as I could.

Go easy on yourself. Review your list and work on what you can now. Then look at it again and see if you need to add steps to make the rest of the list possible. Then start again.

Personally, I think you look great. But I also understand how you feel. Just keep doing things that help you move forward.

I hope this helps.

Hugs!