What’s the right age for a transgender young person to have top surgery? As with most non-emergency procedures, there’s no one perfect time. When it comes to FTM top surgery for New York patients, we always proceed with extra caution. Surgery is essentially a mastectomy that can’t be reversed, so we want to be sure the timing is right.
You might think that parents of transgender kids would typically be reluctant to see their sons transition surgically, and some are. We have also seen the reverse: moms and dads pushing for FTM top surgery for their children—some as young as 14 or 15. Why? We think it’s usually with the best of intentions. After witnessing their child’s struggles with gender, and after coming to terms with their own feelings about having a transgender child, some parents may believe that top surgery is the fastest route to happiness for everyone.
In our view, parental support for transgender surgery is important. But, we don’t want to see moms and dads encouraging a son who’s not 100% ready.
The World Professional Association for Transgender Health (WPATH) recommends that FTM surgery be performed at or after the “age of majority,” meaning 18 years of age in the U.S. That seems to make sense, assuming that around the time a person is considered to be an adult, they should be able to make an informed decision as well as give legal consent.
A case can be made for surgery earlier for some transgender youth, however. In an article in Pediatric News two years ago, Dr. Gerald Montano, an adolescent specialist in Pittsburgh PA, noted that delaying surgery can also mean a young person must live with gender dysphoria longer and perhaps be further traumatized by the behavior of others. He also maintained that benefits of performing some procedures sooner (mentioning FTM surgery specifically) can be beneficial in reducing trauma to the body and scarring.
In our practice in New York, each FTM top surgery candidate is evaluated carefully and individually. Keeping in mind that everyone’s journey is unique, here are some angles we consider.
• Psychological: We talk with each prospective patient to get a sense of how well grounded he is in his gender identity. How long has he identified as male? Has he pretty consistently desired the life of a boy? Has he had counseling with someone experienced in gender dysphoria to handle the inevitable issues that come up?
• Social: Before we agree to top surgery, we want to know that an FTM patient has support from others. Ideally, this means family, peers who embrace him as a male, a school or work environment that’s accepting, and so on.
• Maturity: Along with knowing himself well, each patient must understand that top surgery is not trivial. There will be a recovery process, some measure of discomfort to manage and inevitable scarring. FTM top surgery candidates must be ready to handle surgery and the days and months that follow.
• Process: We know that each transgender person chooses to take on their new identity in their own way, and we understand that the process is not necessarily serial or linear. Still, top surgery is not usually the first step in transitioning. When our New York FTM top surgery patients live as males—whether they choose physical measures that help like hormone therapy and/or non-physical steps such as changing their name legally—they help us toward a decision that permanent top surgery makes sense.
Treating the Individual
Just as we do with any patient, our aim is to get to know transgender men and women so we can work with them to make sound choices. Age is certainly a factor we consider thoroughly, but it’s just one factor. There are many other aspects of a person’s life to explore that can also be important.
We like to learn all we can about transgender people and their healthcare needs. Along with following the work of WPATH, we check in with other groups often. If you’d like to learn more, GLAAD (originally known as the Gay and Lesbian Alliance Against Discrimination) offers a list of organizations and resources you may want to investigate.
As specialists in male breast reduction, and as a practice serving women seeking breast surgery for more than 30 years, we are well-prepared to help transgender people with top surgery. Don’t hesitate to contact us to talk it over.