What To Say: Gender Affirmation
How to talk about gender affirming surgery with your loved one
How to talk about gender affirming surgery with your loved one
Nathaniel Glanzman
Reviewer URLHow to talk about gender affirming surgery with your loved one
What we'll cover
People decide to have gender affirmation surgery for many reasons, and while some people who receive this kind of treatment are trans, it’s important to remember anyone can opt for gender affirming healthcare.
In this "What to Say" guide, we'll talk about what gender affirmation surgery means, why people choose to have it and what you might expect from this kind of care. We'll also let you know what to say to someone who’s preparing to have this surgery and what to avoid when trying to support them.
What it is
Gender affirmation surgery is an umbrella term that encompasses a surgery or procedure that helps affirm someone’s gender identity. If someone is getting this type of surgery, it’s important not to assume what that surgery entails.
For example, some people may choose facial reconstructive surgery (which the Cleveland Clinic notes may include cheekbone enhancements, softening or defining the chin or jaw, or a rhinoplasty). Others will choose to have chest surgery—often referred to as “top surgery”—to remove breast tissue and flatten the chest for a more masculine appearance. Some may enhance breast size for a more feminine appearance.
Gender affirmation surgery may also refer to genital or “bottom” surgery, where the existing genitalia is reconstructed. Sometimes, bottom surgery is referred to as “sex reassignment,” however this term is outdated and many find it offensive.
Mental wellbeing
While most people who receive gender affirmation surgery are trans and/or non-binary, many people opt for a surgery or cosmetic procedure that helps them find joy in their physical appearance and gender. For example, many cis gender women decide to get breast augmentation or reduction to feel more aligned with their bodies, or after medical procedures like a mastectomy. Whatever surgery your loved one is opting for, it’s important to know that people receive this type of care because they deem it necessary for their wellbeing.
It’s important to remember that for many people, this type of surgery drastically improves their quality of life. A study published in the Journal of Sex & Marital Therapy found that 94 to 100% of patients reported satisfaction post-operation depending on the surgery performed. A separate study of nearly 8,000 patients found only 1 percent of patients felt regret post-operation. Receiving approval for gender affirmation surgery is a very lengthy and thorough process. The most common outcomes of gender affirmation surgery are higher levels of life satisfaction and happiness, as well as reduced rates of suicide attempts, depression, anxiety and gender dysphoria.
However, like with all surgery, your loved one will need time to physically recover. Recovery time varies based on the type or surgery and the individual, but it is an opportunity for you to show up for your loved one and help them with errands, food prep and chores.
What not to say
The following are examples of things to avoid saying when speaking with your loved one about gender affirmation surgery.
“Does this mean you’re a [man/woman] now?”
Why it doesn’t work: This sort of questioning is invasive. While your loved one has decided to share their plans for gender affirmation surgery, it’s not an invitation to quiz someone on their gender, genitalia or identity. It’s okay to have questions, but avoid jumping to conclusions or putting people on the defensive.
"What about fertility?"
Why it doesn't work: It’s possible your loved one’s surgery will impact their fertility, but this is a decision they can make with their doctors, a qualified surgeon or fertility specialists. Avoid bringing up any argument against surgery or voicing your concerns about side effects. Simply put, your loved one is in charge of their reproductive health and decisions, regardless of how you feel about it.
"I just don’t see how it’s necessary."
Why it doesn't work: It doesn’t matter if you feel surgery is necessary — your loved one does. You may not see the value in this sort of care, but for many people, the process can drastically improve their self-confidence and quality of life. In fact, a study conducted by the Harvard T.H. Chan School of Public Health found gender affirming surgeries were associated with a reduction in psychological distress and suicidal ideation.
"This is too drastic."
Why it doesn't work: Avoid judgment-based statements that might put your loved one on the defense. You may feel it’s a drastic measure or want to “negotiate” for a different sort of treatment, but for your loved one, this decision is likely coming after a long time of deliberation, medical consultations and research. Trust your loved one, and remember it’s not drastic to want to live a happy, full life.
What to say
Now that you have a better understanding of gender affirmation surgery, here are some helpful phrases you might use when speaking to your loved one.
Note: These conversation starters are just suggestions. Each individual’s experience will vary and users should measure their words based on what they know and do not know about their loved one.
"I’m so glad you’ve found something that will make you happy."
Why it works: This phrase is great because it centers your loved one’s agency over their body. You may have a lot of questions or feel anxious and confused, but those feelings can be dealt with in a private setting. Instead, acknowledge that gender affirmation surgery is something your loved one wants, and give them a moment for the both of you to celebrate together.
"How can I help support you?"
Why it works: Your loved one is probably dealing with a lot emotionally and physically as they prepare for their surgery. If you’re able, offer to lessen their load and ask what they need. If your loved one isn’t sure, try offering tangible services, like a ride to the doctor’s office or bringing food during recovery. As always, you can offer help, but if the answer is no, accept their decision with grace.
"What should I know about your privacy?"
Why it works: Not everyone may know if your loved one is getting gender affirmation surgery. For example, they may take time off work or tell mutual friends or family they are seeking medical care, but not in what capacity. They may also decline to share exactly what kind of surgery they are getting. Checking in about this shows respect and consideration to your loved one’s privacy.
How to recover
If you’ve said the wrong thing or offended your loved one, you can still recover the conversation. First, you should apologize for the offending comment and reaffirm your support. Then, try something like, “This is new to me, but I really want to be supportive. Can we try again?”
It’s possible your loved one may need a break from the conversation, and you should honor their needs for space. Ask when you can check back in with them, and use the break to reflect on what you said or educate yourself more on the topic. Later, follow up with your loved one to continue the conversation.
Other suggestions
Showing support for your loved one doesn’t just happen in verbal conversations. People receive love in a variety of ways, often via physical touch, acts of service or quiet companionship. Depending on what you know about your loved one, it may be appropriate to hold their hand during a difficult conversation, write a kind note or text in the days or hours following a disclosure, or make them a nice dinner after a doctor’s appointment.
For gender affirmation surgery, you may consider marking reminders on your calendar or within Thoughtful when you know your loved one has a doctor’s appointment or consultation booked. A simple text, an invitation to see a movie, doing them a favor without being asked, or even giving a small gift shows your continuing care and concern for your loved one outside of just one conversation.
In the meantime, it may also be helpful for you to educate yourself on gender and gender-related healthcare. Reading first-hand accounts from trans people in particular may help you understand why this kind of treatment may be so important and necessary for your loved one.