Several months ago I wrote a letter for a client who was seeking top surgery. I characterized this surgery as medically necessary and its rejection would cause psychological distress. My client’s surgery was cancelled last month as it was characterized as “non-essential.” All non-essential surgeries were postponed for the sake of coronavirus mitigation. I struggle now with my own perception of how I characterize “essential” in terms of medical necessity and where and how that overlaps with our psychological health. And the implications of that evolving perception for my own personal and professional role and identity.
Hi there my friend,
Such a great topic and something that is close to my heart. I knew of people who had their surgeries cancelled because of Covid-19 policies and was holding a lot of questions about how this policy would impact them. If you do need/want to pursue hormones or surgery and it’s been deemed non-essential what does that mean in a broader picture for trans rights, and it the short term for mental health? We’ve been fighting for surgeries and hormones to be recognized as an important part of trans and non-binary people’s rights for a healthy and happy life, so what does that look like in the era of Covid-19?
Before I say any more about this topic I what to name my positionality in that I am a non-binary trans person who, at this time, is not pursuing gender-affirming surgeries. So what I say is from a place of understanding my trans experiences, not the experience of all trans people. And to help flesh out this response I have asked for contributions from two non-binary trans folks, one who has had gender-affirming surgery and hormones, and one who had their surgery cancelled because of Covid-19 policies.
As I looked into what the reasoning is behind postponing elective surgeries I found that the main reason is to make sure there is enough PPE (Personal Protective Equipment) available. And that only surgery for immediately life threatening problems should be permitted. That totally makes sense to me. And I can see the pain of waiting for months, or years, saving up money and getting the necessary support and courage to go through these life changing surgeries. Not to mention the psychological pain of having to wait even longer in these liminal spaces of being ready to get the surgery then being told you have to wait indefinitely. When does psychological pain become as important as physical pain and needing immediate care?
I asked a friend who has had top surgery what they though about all this and this was what they had to say: “I think top surgery is absolutely essential, and I think that it is really important that therapists/psychologists understand that it is essential. I think there may also be a difference between essential and emergency and it may not be an emergency in the same way Covid-19 is. I’m saying this from a privileged place, having already gotten surgery and not having to spend one more day in a binder. So, when I think back to right before the surgery, I felt like I desperately needed it in that time. If my surgery had been canceled I would have been DEVASTATED. But, I don’t think I would have died. I don’t think I would have killed myself, and if I would have, it would be the result of other mental health stuff that absolutely is influenced by and intersects with my trans identity. But that choice wouldn’t be an isolated result of not getting top surgery. I also think it is 100% true that someone’s life is on the line and getting top surgery will save their life. I believe the question needs to be handled individually and what is most life saving for the person involved.”
It seems to me that if we lived in a culture where gender-affirming surgeries were acknowledged as life saving and the barriers to these surgeries were removed then the pain of having to postpone would be more manageable. I imagine all the barriers to getting these surgeries, and the prejudice from the medical community towards trans folks, makes these reasonable delays feel like another rejection and create more desperation.
I also asked another person, who had their surgery canceled because of Covid-19, to share their experience and thoughts: “I am a non-binary person who was scheduled to have surgery in March. My surgery got cancelled hours before it was supposed to happen. It was by far one of the more devastating things to happen, to be so close to a dream come true and then for it to go away and to be in a pandemic. I can understand the need for all equipment to go to front line workers. I am considered a front line worker, and understand the importance not just physically but emotionally to be protected properly during these times. On the other hand as things start to open and surgeries are being scheduled, mine is not. I know someone who is having surgery on their ankle and that seems to be more essential than a non-binary body seeking relief. I have been in contact with my surgical team with very little communication and very little answers. I have been told that I might have to wait 6 months, or that I might have to reapply. It took me years to make the decision to have top surgery, to give myself that permission. For me this doesn't feel like an elective surgery. I have been spending most of my therapy sessions for the last two months processing all of this. Can I live in this body for a while? Sure. Will I continue to experience dysphoria and extreme hatred for my body? You bet. Who gets to decide what is essential and what is elective? I do find that the non-binary body is overlooked probably more than the trans body. We still live in a culture that doesn't recognize the essentialness of these surgeries. I would love our front line workers to be protected, to be paid what they deserve, for the demand to be met of proper PPE. I would also love for the non-binary/trans body to be seen and protected.”
From hearing these folks share, and my own sense of what its like to live in a trans body, it seems clear that the need for PPE is reasonable for postponing elective surgeries. But the deeper issue is that gender-affirming surgeries are often seen as elective, and not necessary for the emotional and physical health of the trans/non-binary individual. When the seriousness of the need for these procedures is fully comprehended by the medical community then there will be less distress and more understanding from both sides if surgeries need to be delayed for extraordinary circumstances.
I hope these perspectives offer some more food for thought and keep allowing for more understanding of trans and non-binary people’s experiences. And hopefully move us as a society towards less barriers and more freedom in accessing necessary health care from an understanding and compassionate place.
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Asking for a Friend is for informational purposes only, does not constitute as medical advice, and is not a substitute for professional psychotherapy advice. By submitting a letter, you are agreeing to let Karolina Walsh use it—in part or in full—and they may edit it for length and/or clarity.
Karolina Walsh Psychotherapy
Providing psychotherapy, counseling, and support for grief, addictions, trauma, PTSD, relationship issues, and GLBTQIA.
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