I went to great lengths to avoid getting top surgery. First, I didn’t want to be trans. I didn’t want to go through the painful, often humiliating ritual of transition. I was also partnered with a cishet man who loved my body as-is, and who made it clear that any changes would be a dealbreaker in our relationship. 

Second, there was the issue of painkillers. 

I was raised in a house where pain was not acknowledged, physical or otherwise

“There’s a billion-dollar industry devoted to making you feel better,” my mother said. 

She pushed an ibuprofen bottle toward me if I complained about cramps or growing pains. We didn’t keep ice packs in the freezer when I was young. Our medicine cabinet was stocked with quart jars of painkillers. For any discomfort, from cramps to a headache, there was a pill. 

Later, when I was incapacitated by addiction, neurons fried by my daily use of speed, cocaine, and weed — with an occasional smattering of harder things — there were pills for that, too. Pills were supposed to fix my brain chemistry, make me sleep at night, and keep me from killing myself. 

Without pills, I was forced to confront myself.

The pain was in my head, people said. I believed them. That would explain the inescapable pressure I felt wrapping around my skull, as though my capillaries were overfilled garden hoses with no outlet. On morphine, I was busy, a rocket, fueled by opioids. My atypical response was one of the many reasons I kept using them. I didn’t feel sick on opioids. I felt like myself. It was a feeling I craved, a fleeting sense of comfort in my own skin.

Without pills, I was forced to confront myself. Although it took over a decade of recovery, self-searching, and failed relationships, I finally realized and accepted that I am nonbinary trans. I was not thrilled to learn this about myself. Like my alcoholism, it hurt to feel like I was different than other people. I knew there were significant risks to coming out, and that surgery or other physical changes were the least of my worries.

I tried everything to get my body to feel right. I dieted. I exercised. I wore men’s clothes. I wore a medical-grade chest binder that flattened my breasts more than a sports bra ever could. I cut my hair off. My attempts helped, but they only prolonged the inevitable: I needed top surgery. Half-measures made me miserable, and I lost so much weight that even my binder was loose on me. 

I knew I had to choose myself, but I was afraid of the changes I knew would follow from physical transition. Waiting hurt. Eventually, I came to the point where delay was more painful than my fear of change. I left the boyfriend who loved my breasts more than my happiness, started HRT, and scheduled a consultation with a surgeon. 

Everything you want is on the other side of pain. I learned that in recovery and I revisited it during my transition. Once a week, I stuck a two-inch needle into my thigh, injecting myself with hormones that made me feel normal. I searched for other people’s stories about post-op recovery: how long it would take, how much help they needed, and — most importantly — how bad the pain would be.

I noticed that opioids didn’t actually take my pain away. They merely made me apathetic. 

When I got sober at 23, I left pills behind. I wasn’t one of those no-pills-ever people, because I knew that the problem wasn’t the pill: it was me. In sobriety, I was able to safely take pain medication as prescribed, under the supervision of a doctor, my sponsor, and a few sober friends. I didn’t enjoy taking pills that way, because they didn’t get me high. I noticed that opioids didn’t actually take my pain away. They merely made me apathetic. 

Still, top surgery made painkillers inevitable. I doubled down on my recovery meetings, created a care plan with my doctor, and looked into non-opioid options. I didn’t want to relapse over my transition — I wanted to enjoy my body. 

Top surgery is a double incision mastectomy with nipple grafts, the aesthetic masculinization of my chest. My surgeon marked my chest with purple Sharpie and folded my breasts like soft origami. She drew the places where she would make the incisions, peel my skin back, cut the excess pieces away, and scrape off the yellow tissue over my pectorals, relocating it higher inside my chest. She drew nickel-sized circles near my armpits. My nipples were trimmed down into smaller circles and then stitched on, with only part of their original nervous structure intact. The whole procedure took three hours.

After, I felt like I’d been run over by a truck. My chest was packed with gauze and wrapped so tightly I could hardly breathe. The pain didn’t show up until the next day, when I woke up on my sofa feeling weak and groggy. My caregivers marked each dose of Vicodin on a sheet of paper on the coffee table, next to the small bouquet of pill bottles. 

I had industrial strength anti-inflammatory drugs, an opioid, and a medication that was supposed to prevent infection and blood clots. I don’t remember the names of any of them. All I wanted to do was sleep and drink water, which is what I did. The pills helped me sleep, but after a couple of days, the pain faded and I noticed I was feeling irritable and sour. I stopped taking them and switched to ice packs and ibuprofen instead, reasoning that I would rather be plain uncomfortable than putting my recovery at risk.

Within two weeks, I was back to many of my normal activities. My bandages were removed after a month and I finally saw the neat, pink scars across my chest. I was healing beautifully — in part, my surgeon said, because I was so healthy, so sober, for such a long period of time before going under the knife. 

“Your skin is in excellent shape,” she told me, admiring her handiwork. “In a couple of years, nobody will know you had anything done at all.”

I don’t regret the things I lost, or gave up, in pursuit of myself and my sense of wholeness

There’s a 3% “regret rate” for transgender people who undergo gender-affirming surgeries. I am not in that 3%. I don’t regret the transition. I don’t regret the things I lost, or gave up, in pursuit of myself and my sense of wholeness. Most of all, I don’t regret putting my recovery first. I was scrupulous in my transparency about my issue with opioids and, as a result, I felt supported during an extremely vulnerable time. 

In life, pain is inevitable. Suffering is optional. My sobriety helped me heal in more ways than one. Although my surgery is over, my recovery is ongoing. Every choice I’ve made has eliminated a different type of suffering from my life. I don’t aspire to painlessness. The happiness I feel at living authentically, without fear or self-criticism, makes the painful moments worth it, every time.