I am a surgeon. I have been specialising in gender-affirming care and top surgery for trans masculine and non-binary individuals since 2017.
Recently I was in a consultation with a trans masculine patient, to discuss their desire to have top surgery. There was nothing remarkable during the sixty minute consultation, until the very end when I asked if my patient, or their fiancée who was present, had any final questions.
When they both expressed an interest to find out “Why I do what I do” I realised that, while I myself frequently reflect on my career choices, I had never until then been asked the question by a patient.
This is my response.
When I was introduced to gender affirming top surgery I felt like I had found my calling. I felt that this was something I was projecting of doing since I decided to apply for medical school admission: To help people be the best version of themselves in any way I could.
My personal journey in medicine/surgery seems to have been leading me here in an almost metaphysical way. During my medical school years I developed a special interest in bioethics – studying in a Romania from 1996 to 2002. This had me thinking a lot about health disparities and universal healthcare. Then I completed an MA in healthcare ethics and the law in 2011. In 2007 I decided to focus on breast surgery for cancer patients, mainly due to positive outcomes compared to other types of cancer work, and the aesthetic element involved.
All this led me to a breast unit with a long history of providing gender affirming top surgery and I did not hesitate when I was asked if I was interested in being involved with this type of work. I have not looked back since and there is not a single day that I am not learning something new, not a single day that I do not feel privileged to be involved in providing life-changing, sometimes life-saving care.
I am a person who cares about offering his healthcare skills to people who need them. This is in keeping with the Hippocratic Oath that I swore to during my medical school graduation ceremony. This is at the heart of observing medicine as a service and not a profession.
The noisy “debate” between women’s rights versus trans rights is completely failing to address a very simple fact: The biological basis of gender diversity is completely irrelevant to offering assistance to those that urgently require it.
There is overwhelming evidence of the positive outcomes of gender affirming care on those individuals who need it. I have first-hand experience of the life-changing impact that the types of procedures I am involved with have, helping people to be happier, more productive and better able to pursue an honest, meaningful life.
It is a privilege to be allowed to operate, not to remove a tumour, or an inflamed gallbladder (and there is no intention here of diminishing the importance of these), but to remove a hurdle, a distraction, from a better, truer and freer life. This is not my interpretation, but the words and feelings that patients (more than 400 by now) have shared with me, both directly and indirectly.
Gender incongruence is not common. The group of people who seek my services is small. Gender variance is conservatively estimated to be 1-2% of the population, about as many people as are natural born red-heads. This creates an additional difficulty for them to access care.
There are those who are against affirming care, but these are few, the majority of ‘opposition’ comes from ignorance. I take pride as an ally in standing side by side with those who are gender variant, in adding my middle aged, white, heterosexual voice to theirs as we call for a fairer society, where the road to care will not be that of years but of weeks, like all other conditions that need healthcare intervention.
It is rewarding to be able to offer much needed care to individuals that really need it and who have been repeatedly let down across the board, not just by the healthcare establishment.
I find it impossible to grasp why gender diverse individuals need to wait years for a medical intervention that is proven to help in improving their mental health, their social flourishing and their overall wellbeing.
I know that people get involved in medicine for different reasons, but I also understand that this reasoning changes over time. Medicine is about improving people’s wellbeing. However, most of the time, medicine only addresses the symptoms and not the cause of disease. I have always struggled to comprehend how we are “allowed” to treat malnutrition, but we are not allowed to discuss the socio-economical causes of poverty that lead to it.
Doctors should be the first in line to argue in favour of a fairer, more open and honest society. Instead, I have come to the sober realisation that among healthcare professionals, the prevalence of conservatism, privilege and oppression, is the same as it is with any other professional group.
Enabling people to be themselves outside the tyranny of whatever is expected of them in a conforming society is my personal act of revolution for a better world.
Patients I have consulted with in the last five years are losing appointments because they cannot afford to travel. They live in cold houses with minimum access to a proper diet. They lose their job or their house when they are diagnosed with a significant illness. They are disowned when coming out to their families and they spend time living on the street. They lose their place in society, just because they want to be themselves.
It is rewarding to be part of a pathway that brings back some of their trust in humanity, in people that are not only willing, but happy to stand by their side. This feeling has become increasingly important for me after experiencing anaesthetists refusing to induce my patients, registrars refusing to scrub-in to my theatre and managers seemingly prioritising anything else but my work. All of this has underlined my conviction that what I do is on the right side of history.
My work supports human beings in need. The fact that some people want to deprive them of this prospect is an additional motivation in my everyday work.
I am often asked by healthcare staff about the undeniable truth of sex chromosomes and my response is clear: The question is irrelevant. Gender affirmative care helps people in need. Anyone that knows about the increased risk of self-harm, suicidal ideation and social isolation that trans individuals face, and still chooses to distance themselves, is acting from a place which is at odds with the fundamental behaviours required of a member of the caring profession.
I suspect that no-one would hesitate to offer their services to someone affected by a war zone, and this is exactly how I see things in gender affirming care.
Being involved in gender affirming care has opened my eyes to a world of creativity and courage by individuals who will work hard to achieve their aspirations in life, despite all the conservatism vitriol and violence they face. I admire them and stand by their side.
It is important for me to do my best to make the world a better place, something which is not always possible in medical environment. Medicine is a conservative, often discriminatory setting, full of frequently restricted-minded individuals. I see what I do as a political act against this entitled and occasionally arrogant status quo.
I am a cisgender, heterosexual white man. I believe in a society where everything is possible, which is filled with acceptance, understanding and fairness. A society where no-one feels forced to follow any role predesigned for them, which understands that gender is a spectrum and people are free to navigate who they love and how they live, in whatever way feels right for them.
This is a society for which we should all be fighting.
Ioannis Ntanos
April 2022