Gender Affirmation

It's important to feel like your most authentic self with the physical form reflective of who you are deep down.

Here are just some of the recommendations we've compiled from our experiences and recommendations working with the nonbinary and transgender community.

Top Surgery

Feminizing Top Surgery

For individuals assigned male at birth who wish to create a more feminine chest, feminizing top surgery may involve:

Breast Implants: Silicone or saline implants are placed under the chest muscle or breast tissue to create a natural, feminine shape. Implant shapes and sizes are chosen to suit your body and goals.
Fat Transfer: A natural alternative to implants, where fat from other areas of the body is transferred to the chest to achieve the desired breast volume and shape.

Breast can be achieved through hormonal therapies as well without any trips to the operating room. Talk with your endocrinologist if you think avoiding the surgeon's blade might be a better option for you.

Masculinizing Top Surgery

For those assigned female at birth who seek a flatter, more masculine chest, masculinizing top surgery may involve:

Double Incision Mastectomy: In this common procedure, breast tissue is removed through incisions below the pectoral muscle, creating a flat, masculine chest. Nipple grafting is often performed to reposition the nipples.
Keyhole Surgery: Suitable for individuals with smaller chests, this technique uses a small incision around the areola to remove tissue, preserving nipple sensation and reducing visible scarring.
Periareolar or Minimal-Scar Technique: Involves removing breast tissue through a periareolar incision (around the nipple area) and is suitable for those with smaller breasts.

Nonbinary Top Surgeries

For nonbinary individuals, top surgery can be customized based on desired outcomes, blending elements of masculinizing and feminizing surgery:

Reduction and Reshaping: Involves reducing breast tissue and reshaping the chest to appear androgynous or neutral.
Partial Removal Techniques: Some patients opt for partial mastectomies that maintain a more subtle, less prominent chest structure.
Combination of Implants and Fat Transfer: For nonbinary individuals seeking a fuller but less traditionally feminine chest, implants or fat transfer can be considered in smaller amounts.

Make sure you have a conversation with your surgeon about your goals.

Finding the Right Surgeon

Choosing the right surgeon for gender-affirming top surgery is crucial for achieving the results you want while ensuring safety and comfort. Here are steps to guide your search:

Seek a Specialist in Gender-Affirming Care: Look for surgeons with specific experience in gender-affirming top surgery, as they will have expertise in the nuanced techniques required.
Review Before and After Photos: Many surgeons provide galleries of their previous work, which can help you visualize potential outcomes and assess a surgeon’s skill.
Consider Consultations and Comfort: Schedule consultations with potential surgeons and prioritize those who make you feel respected, safe, and informed.
Look for LGBTQ+ Affirming Practices: Seek clinics that explicitly affirm LGBTQ+ identities and have positive reviews from trans and nonbinary clients.

Helpful directories for locating gender-affirming surgeons include:

GLMA: Health Professionals Advancing LGBTQ+ Equality
World Professional Association for Transgender Health (WPATH)
TransHealthCare

Non-Surgical Options

Breast forms!

1. Silicone Breast Forms

Description: High-quality silicone breast forms are realistic in weight, texture, and appearance, offering a natural look and feel.
Where to Find:
- Specialty Stores: Websites like The Breast Form Store and Glamour Boutique specialize in products for transgender individuals.
- Online Marketplaces: Amazon, Etsy, and eBay offer a range of options, but check reviews to ensure quality.

2. Foam or Fabric Breast Forms

Description: Lightweight and budget-friendly, foam or fabric forms are less realistic but more affordable and comfortable for casual wear.
Where to Find:
- Brands like Nearly Me or general medical supply stores.
- Transgender support-focused retailers online.

3. Adhesive Breast Plates

Description: Full silicone chest plates with built-in breasts that cover the entire chest for a seamless look. Ideal for realistic aesthetics but can be warm and heavy.
Where to Find:
- Roanyer or AliExpress for a wide selection.
- Specialty cosplay or gender-affirming product retailers.

4. DIY Options

Description: Budget-friendly solutions, such as creating breast forms using rice-filled stockings, water balloons, or padding.
Where to Find: Tutorials are widely available on YouTube or transgender support forums.

5. Custom Prosthetics

Description: Tailored breast forms crafted to your specifications for size, shape, and skin tone. Best for those seeking a perfect fit.
Where to Find:
- Prosthetic Specialists: Companies like ContourMed or Pink Perfect.
- Medical-grade options from mastectomy product providers.

6. Retailers and Support Resources

Specialized LGBTQ+ Retailers:
- Point of Pride: Offers free breast forms for transgender individuals who qualify.
- GenderGear.ca (Canada-based) and TransShop (UK-based) for gender-affirming items.

Considerations for Choosing Artificial Breasts:

Comfort: Choose materials that suit your skin sensitivity and activity level.
Size: Select a size proportionate to your frame for comfort and aesthetics.
Attachment Method: Look for forms with adhesives, straps, or pocket bras, depending on your needs.
Purpose: Decide whether they're for everyday wear, special occasions, or photoshoots.

Understanding Chest Binding:
A Guide to Safety and Best Practices

What Is Chest Binding?
Chest binding involves using specially designed garments to reduce the appearance of breasts. It's commonly practiced by transgender men, nonbinary individuals, and others seeking a flatter chest for comfort or gender expression.

Types of Chest Binders:

Compression Binders: Made from stretchy materials for consistent compression.
Sports Bras: Double-layered or high-compression options offer mild binding.
DIY Options: Ace bandages or duct tape are not safe for binding.

Safety Tips for Chest Binding:

Limit wear to 8 hours daily.
Choose the correct size to avoid restricted breathing or pain.
Avoid binding during exercise—use a supportive sports bra instead.
Never sleep in your binder.
Clean your binder regularly to prevent skin issues.

When to Stop or Seek Help:
If you experience pain, breathing difficulty, or skin damage, take a break from binding and consult a healthcare provider if symptoms persist.

Binding is a personal choice. Prioritize your health and comfort, and explore safe, high-quality binders from trusted brands.

WHAT IS GENDER AFFIRMING CARE ANYWAY? Gender-affirming care, or transition-related care, is essential, life-saving healthcare for transgender people of all ages. Rather than a single treatment, it includes a range of services, like mental health support, medical care, and social services, each with well-established, evidence-based standards guiding access and timing. For many transgender and non-binary individuals, gender dysphoria—the distress of having a gender identity that doesn’t align with one’s sex assigned at birth—can be alleviated through gender-affirming care, helping people live openly and safely as their true selves. Gender-affirming care involves a range of medical, psychological, and supportive services to help individuals live in alignment with their gender identity. Components of gender-affirming care can include: Hormone Therapy: Using estrogen or testosterone to promote physical changes that align with one’s gender identity. Mental Health Support: Therapists trained in transgender and nonbinary issues can provide affirming, supportive care for mental well-being. Legal and Social Support: Assistance with navigating gender markers on legal documents, workplace support, and name changes. Gender-affirming care is backed by major health organizations like the American Medical Association and the World Health Organization, which recognize its importance in supporting mental and physical health. This care is delivered in age-appropriate, evidence-based ways, with decisions made alongside doctors and, when appropriate, parents. Leading health organizations, including the AMA, AAP, and APA, support it as medically necessary to affirm a person’s gender identity.

SOCIAL TRANSITIONING AND BEING A GOOD ALLY The most important way to support transgender and non-binary people is by affirming them in their journey. This can start simply—use their chosen name and pronouns, and if you make a mistake, just apologize, correct it, and move on. For transgender youth, support from parents, caregivers, and teachers is especially impactful. When adults encourage young people in transitioning, they’re helping them live as their true selves, just like other kids learning about themselves. Supportive actions like respecting their opinions, taking an interest in their activities, and providing a loving, trusting home environment contribute greatly to their happiness, health, and development into well-adjusted adolescents and adults. Research shows that parental support can save lives. Transgender youth who are affirmed in their identity, name, and pronouns report higher resilience and well-being, along with lower rates of depression, anxiety, and suicidality, compared to those who are not affirmed. For many, social transition is the first step. Social transition includes non-medical steps like using a new name, changing pronouns, adopting a new hairstyle or clothing, and disclosing gender identity. Social transitioning is entirely reversible, and it provides a way for transgender people of any age to start living authentically before any medical intervention. For those beginning transition before puberty, social transition alone allows them to fully express their identity.

HORMONES AND BLOCKERS Gender-affirming hormones are prescription medications that help transgender and non-binary people’s bodies develop in alignment with their gender identity, reducing negative psychological effects like gender dysphoria, depression, anxiety, and suicidality. These hormones are synthetic versions of testosterone or estrogen—hormones used safely by millions of cisgender people daily. Generally, gender-affirming hormones are not prescribed until age 18. Adolescents may access them in later teen years, but only with physician oversight, parental consent, and informed consent from the adolescent. Effects from these hormones are either partially or fully reversible, with informed consent covering potential side effects and benefits, including fertility discussions. Gender-affirming hormones are life-saving for transgender youth and adults. Research from The Trevor Project, Stanford University, and others highlights lower rates of depression and suicide risk among transgender youth with access to hormones, with benefits like higher life satisfaction and reduced dysphoria. Puberty blockers, another gender-affirming medication, can temporarily pause puberty, preventing unwanted physical changes and offering time to explore gender identity. They are FDA-approved, safe, and fully reversible—allowing normal puberty to resume when discontinued. Blockers are often prescribed early in puberty, with consent from the youth, parents, and therapists, and are closely monitored for any side effects. Puberty blockers can be life-saving as well. Studies show they greatly improve well-being, reduce depression, and lower suicidality risk by as much as 70% in transgender youth who access them.

SO MANY SURGERIES Gender-affirming surgery includes a range of procedures, but no specific surgery is required to be transgender, nor must anyone undergo surgery at all. These surgeries can include facial feminization or masculinization, “top surgery” to modify the chest or torso, and “bottom surgery” to change genitalia. Typically, gender-affirming surgeries are not performed on people under 18. In rare cases, 16- or 17-year-olds may receive surgery if it’s deemed clinically necessary to address severe gender dysphoria symptoms like anxiety, depression, or suicidality. This occurs only after extensive consultations with parents, doctors, and mental health professionals, as well as adherence to standards of care, including consistent gender identity and informed consent. For any age, gender-affirming surgeries are carefully considered through multiple discussions with mental health and medical providers to confirm appropriateness. Importantly, these procedures are not exclusive to transgender people—they are the same surgeries used safely for cisgender and intersex people for decades. Research shows that complication rates are low for transgender patients, comparable to or lower than those for cisgender patients undergoing similar surgeries.

AND LASTLY, FIRST STEPS: Clear, evidence-based standards have long guided who can access gender-affirming care and when. For example, in 2022, the World Professional Association for Transgender Health (WPATH) released its 8th Standards of Care, with additional guidelines from the Endocrine Society and the American Academy of Pediatrics. Access to gender-affirming care varies by state and hospital due to differing laws, but generally, transgender patients—along with their families if they’re under 18—begin by visiting a provider or gender-affirming clinic. Some start by discussing their needs with a primary care provider or therapist before being referred to a specialized clinic. For those seeking gender-affirming medical care, the process often involves extended counseling. If medications or surgeries are part of their care, they are only prescribed following thorough assessments, including necessary documentation, referral letters, parental consent (for minors), and mental health support. In every step, gender-affirming care is provided only after counseling and informed consent from the patient and their family.

Safe States for Gender Affirming Care

The current legal landscape varies significantly between states, affecting access to gender-affirming care. As of the latest information, the following states offer protections and affirm the right to gender-affirming care:

California, New York, Massachusetts, Oregon, Washington, Illinois, Colorado, New Jersey, Vermont, Connecticut, Maryland

These states provide protections for healthcare access, anti-discrimination laws, and support for transgender and nonbinary individuals.