Imagine waking up one day and feeling like the body you were in was not your own. Now imagine doing this every day of your life, leading to embarrassment, depression, or suicidal thoughts. These are some of the ways transgender people describe feeling in the bodies they were born with. On this episode of the Sex, Body, and Soul podcast, I talk with Dr Blair Peters, a board certified surgeon who is one of the only surgeons in the United States today specializing in gender affirming surgery. An incredible advocate for the LGBTQIA community, Dr. Peters spends a lot of his time performing plastic and vaginoplasty surgery, which basically means he builds penises and vaginas with a special emphasis on nerves (as well as facial and chest surgery). How cool is that?
This whole world is really new to me. As a woman in my 50s, I’m working hard to learn how to respect all gender identities when I speak (Dr. Peters’ pronouns are he/they). Fortunately for me, I get to learn from the best! Not only does Dr. Peters help people with body dysphoria become their true physical (and mental) selves, he also works on queer representation both in medicine and society, which means he trains other people how to be more inclusive in their own practices, in medicine and just out in the world in general. If only there were more people like him! Unfortunately, there are only about five specialists in the U.S. performing these surgeries, and his wait list is years long.
Our current best guess is that about 10% of the population are LGBTQIA (although the number is evolving). That’s a lot of people who need health care! Of course, not all will need gender-affirming surgery, but Dr. Peters estimates that about 1% of the people in the U.S. are trans and gender diverse who would be interested in the kind of services he provides. In my travels, I’ve seen people around the world – including many in resource-poor countries – who have been so desperate for their bodies to align with their gender identity that they have opted for less-than-optimal treatments under sometimes risky circumstances. But for some people, this is literally life-saving surgery. The mental health strain of living in someone else’s body is just too much to bear, so a choice between living that way or making a change isn’t a real choice – making a change is the only real path forward.
Of course, this is a generalization. Even I, a relative newbie in understanding the LGBTQIA community, know that every person is different and everyone’s needs are individualized.
One of the many barriers that has been in the way of making gender assignment surgery more common has now started to crack, and that is how it is paid for. An Obama-era policy change made these procedures more affordable, so fortunately, much of the work Dr. Peters does is now covered by insurance (not all, so if you are interested, you’ll want to check the fine print in your policy because paying for it out of pocket is not cheap).
The health care system isn’t going to change overnight, so these barriers aren’t going away anytime soon. Equity in health care is still a long way off. And unfortunately, in some circles, this sort of health care has become politicized. As a thanks for literally saving lives of his trans and gender diverse patients, Dr. Peters sometimes gets death threats from people who believe he is mutilating or killing prepubescent kids. I shouldn’t have to say this, but this is definitely not happening!! Young people seeking surgery like the kind provided by Dr. Peters usually see him only after many years of being denied pubertal suppression treatment, when they are being supported in a multidisciplinary program including pediatricians, pediatric mental health specialist, endocrinologists, and sometimes social workers. Surgery for adolescents under age 18 only occurs under extenuating circumstances, such as in a biological female with a huge amount of chest development who is no longer able to bind their breasts safely, and body dysphoria is holding them back from every part of life. Ironically, attacks on the trans community across the country have escalated even as public acceptance has soared. And, adds Dr. Peters, the success of anti-trans legislation has emboldened this vocal minority to move on to attacking gay rights (we’re pointing to you, Florida, with your Don’t Say Gay bill). Truly scary.
As is always the case, I learned a lot on this podcast. Dr. Peters told me these types of surgeries have been performed for a long time on intersex children. Intersex, you ask (I did)? So apparently about 1% of babies born are intersex, which is an umbrella term for bodies that are not strictly male or female at birth for whatever reason (such as genetic or hormonal anomalies). In this situation, the parents and health care team make a decision about which gender to create or assign the baby so they can be raised as one or the other. Even though you may not have heard of this, it is widely done without any political furor because of the traditional view that gender is binary. Dr. Peters doesn’t work on these cases, nor does he do labiaplasty or penis enlargement. This is sensitive stuff – literally, there is a real risk of damaging sensation when you’re working in that region.
I am so happy Dr. Peters took this time to talk to me and our listeners about his remarkable life-saving work and his journey. I am honored to be working with him to move the needle on acceptance and body positivity. One way I hope to contribute is with my new campaign called BodyNEXT. You heard it here first! (This is the first time I’ve talked about it on air). The campaign is about having people from all different backgrounds share what they love about their bodies and their biggest insecurities. For instance, I had an eating disorder I was ashamed of for many years and hid this from my family and friends. I have realized that if we don’t speak up, the silence and secrecy around our insecurities will continue. DM us on Instagram or email us at firstname.lastname@example.org to learn more about BodyNEXT and how to share your story!
If you’re not ready to tell your story, you can still help make the world a better place by taking care of yourself so you can be and do your best in your world. Another way is to donate a Body Agency Dignity Kit to a Ukrainian refugee for $49 here. Inspired by the United Nations, our Dignity Kit contains much-needed survival items like period and safety products for women and girls living in and evacuated from Ukraine.
Thank you for joining me on today’s journey!
All my love,