Getting This Off My Chest: Why Top Surgery Is Not Elective

Stories, Female-To-Male, Confirmation Procedures, In TransitionJameson O'Hanlon
Picture of Jameson O'Hanlon

Picture of Jameson O'Hanlon

By Jameson O'Hanlon

Today, I need to get something off my chest.

Looking back, I can still remember what life was like before this problem started—before I had a chest. Let me explain.  

I was an 8-year-old in Louisville, Kentucky. The grass was blue-green, the trees were fun to climb, and my skateboard provided many hours of steep-hill riding. I was the quarterback when we boys played football, the pitcher  on our baseball squad. I was forbidden to touch my dad’s golf clubs, but one day I pulled one out of the bag, brandishing it like I saw the pro golfers do.On my backswing, I hit the neighbor kid Lisa in the lip—and thankfully, she forgave me pretty quickly. Mostly, I tromped around the neighborhood shirtless, like the other boys during hot summer days.

Then one night, sitting in front of the television alone when I was 11 years- old, I noticed them. My chest was growing, and it hurt. But the distress, sorrow and grief I felt almost immediately was much worse than any physical pain I had ever endured. My breasts did not belong on me—but I was powerless to stop what was happening. And worst of all, I could tell no one.

For decades, I dealt with my bits. I tried to embrace them. I took Women’s Studies classes in college, and understanding the plight of women in a man’s world prolonged my suppression of who I really was. and am: a man.


One day a few years ago, they found something questionable in my right breast during a mammogram.

The doctors decided they wanted to do an ultrasound. After the ultrasound, they scheduled a biopsy. As the days passed by, my anticipation grew. I felt ashamed: there was something appealing to me about the idea of removing my breasts.

My inner dialogue was tormented. Wasn’t this supposed to be a woman’s biggest nightmare? Breasts are an important marker of femininity. My own mother had breast cancer and survived—and I remember her suffering. I read about women who got breast cancer and had double mastectomies and covered their scars with tattoos. It fascinated me. I learned that Angelina Jolie, whose mother died at age 56 from breast cancer, took a test and discovered she had the faulty BRCA1 gene, which meant she could and likely would develop breast cancer. She wrote a letter that was published in The New York Times explaining that she had already had a double mastectomy. Breast removal became all I could think about.

Do you actually WANT to have breast cancer, so you can rid yourself of these twin anvils once and for all?

Of course, I couldn’t help but also ask myself the obvious: Do you actually WANT to have breast cancer, so you can rid yourself of these twin anvils once and for all?

And yet I also had to admit the truth to myself: yes, this was the reality I was desperately hoping for. I dared not tell my wife.

I didn’t have to. The biopsy ended up just revealing dense breast tissue. And so I went back into hiding.


Last November, I lay in bed alone one night. I found myself typing the word transgender into Google. I ended up clicking on the name of a person whose last name sounded somewhat familiar. I recognized his face, too…and then it dawned on me. I had known this guy years earlier—when he was a woman, before he transitioned. At that moment, I finally knew who I was.

The first time I saw my therapist, I told her I had always been a guy inside. At that point, one thing was certain for me: I needed to get these things off my chest. She recommended two surgeons that had good top-surgery reputations, one in Florida and one in Charlotte, North Carolina. These surgeons only accepted payment up front, either out-of-pocket or through financing. I didn’t know what I would do.

This past April, Governor McCrory signed House Bill 2 (or the Bathroom Bill) into law, which requires all citizens to use the restroom that corresponds with the gender that is displayed on their birth certificate. This was in retaliation to Charlotte’s anti-discrimination ordinance, which added sexual orientation and gender identity to the list of banned discrimination areas that already included race, age, religion, and gender.

In response to this discriminatory bill, the Obama Administration published new regulations protecting trans people. Under the new regulations, transgender people are guaranteed equal treatment by insurers and medical providers, and will have the right to make civil rights claims against those that deny them coverage or necessary care because they are transgender. That includes forbidding health insurers from excluding treatments related to gender transitions. However, it doesn’t mandate those procedures be covered.

When I called my insurance company in June to find out if I would be covered for top surgery, they said no. But since my company was flipping into a new fiscal year in July, changes would probably be made to the policy. They told me I should check back after July.

I made an appointment with two different surgeons and chose one that I thought fit my needs better. I had no idea how I would come up with the $8,000 the surgery was going to cost, especially because the doctor requires up-front payment. I was planning an all-out crowd-funding blitz, plus I was approved to borrow a few thousand for an exorbitant fee and interest rate. It didn’t feel right, so I called the insurance company and gave them the codes. I found out just a couple of weeks ago that my surgery was going to be covered!

Only one problem remains, which I found out this week. The surgeon won’t accept the payment for the surgery through my insurance directly. They still want it up front.

Today, I feel sorrow and grief all over again. I thought I was going to have to fight the insurance company, and  was actually ready for that.  But I never expected my surgeon to say no.

I know that I’m kind of new to this level of realization about myself. But I do know, and have always known, one thing. This surgery is not elective. It’s necessary. The rest of society needs to catch up with trans folks. We don’t choose this. We don’t go changing our bodies on a lark. This is medically necessary. And most of us don’t have the money for it. We need to be able to use our insurance if we are approved for it.

I guess I will be taking the fight to my surgeon.



Jameson O'Hanlon is an Asheville, North Carolina-based writer who has spent the majority of his career in the hospitality industry. His obsessions include pizza, local breweries everywhere, baseball, and writing about the trans experience. Follow him on Twitter @brewkitchen86, or his blog on Tumblr,