Friend wants top surgery

[Jigglypufff]

One of my closest friends is saying they are non binary and has changed their name. I have gone along the route of not making it a big deal, like "ah that's nice pal, which film shall we go to see this weekend."
I don't know if this is the right tactic. I have been vocal about the fact that I don't understand why we would be boxing gender into stereo types- ie. Makeup and high heels does not a woman make. You can wear masculine looking clothes and still be a woman. Etc.

They now are saving for top surgery. Should I just keep with my current tactic? Im worried about side effects? They aren't on any hormones.

I just feel a bit like it's getting away from them, the name change etc has been very quick after announcing they are non binary.

I'm also a bit sad if I have the right to feel that.

"Why didn't an adult say I was doing something stupid?" usually means the professionals who immediately affirm rather than exploring. Not other friends.

And there are plenty of detransitioners who say "nothing my family or friends said could have changed my mind, I wouldn't have listened, I had to work it out myself".

Often people find a bubble, online or in real-life "support" groups, all telling each other that the only reason other people question their decisions is because they don't get it and because they are transphobic. Even saying that a detransitioner who talked about his regrets and the negative consequences to his own body "was paid to say it" (yes, I've been told that)

As a friend you may have to accept that she is pulling away from you to a place where you can't honestly go with her. Maybe you really can't stay that close any more. And grieve that too.

Whilst I loathe the idea of unnecessary surgery and would fear the potential outcomes, I now have to agree with those who say "let them".
My caveat is that this surgery is paid for privately by the individual, and not at the expense of those whose very lives are at risk from cancer (ie waiting lists).

Let them buy the surgery.
Let them have the full experience, whatever that is for them.
Let them handle whatever consequences arise, positive or negative.
Let them.
As long as they're adults and self funding.

I don't see any way of changing someone's mind if they're determined.

Of course an adult is going to make the decision for themselves.

However, some people MAY listen to a friend who raises issues that they have not considered. OP’s friend may consider it. Of course, they may not either.

Sadly, with the lack of honest and long term discussion in the past about the impacts of mastectomies (and I understand why cancer patients have not discussed this by the way ) and the glamorisation of these surgeries in the way young people are showing off their scars as models etc, it is hard to break through the anticipated euphoria this surgery will bring.

@Jigglypufff I can't see that your friend has asked for your opinion. So why give it?

Individually, yes, as friends, we can't expect to change someone's mind. Doesn't necessarily mean the OP can't say anything - it might help but it just might not have much effect, or it might break the friendship. What she says or doesn't say is a judgment call.

It's like when your friend's madly in love with someone you believe is an abusive bastard. Do you say something and risk the friendship? Or hang in there quietly and hope she falls out of love before something bad happens?

Who funds the OP's friend wont make much difference to the OP's feelings about it. We all live with the consequences of getting it wrong. What if it's your friend, your child, your husband or wife?

And as a society we don't just say "let them as long as it's their money" about self-harm, about smokers, or anorexics, or drug addicts. The physical consequences and negative health effects are long-lasting and they will continue to cost all of us. So we have public health campaigns. We train professionals on the difference between caring for people and indulging them in harmful beliefs. But that needs consensus and we haven't got there yet for gender.

(edited for clarity)

I get that, about the long term cost to us all. There's lots of harmful behaviours that cost the tax payer a lot of money. I'd rather we didn't need drug and booze treatment centres, or have people suffer with illnesses created by their lifestyles.
We don't deny smokers treatment if or when they develop cancer. They made a choice to smoke, and paid for the cigarettes themselves. Yet they're treated on the NHS, same as someone who develops a non- contributory cancer. I assume, without judgement.
I guess I'm just wondering why gender surgeries and medication are considered a different type of choice than smoking, or drinking till your liver gives up.
Is it because their injuries are a result of something that is not an addiction? We patch people who have self harmed up in a&e all the time. Some refuse to engage with treatment for their mh issues, and reappear time and again.
I'm not sure I'm making sense here, I'm really just trying to work my way through it myself. I don't think we as a society should pay for the damage to be done and I don't know that we can prevent it, although that would be ideal. However I also don't think we can turn our backs on those left maimed and needing help.
I'm expressing this really badly, sorry.

Edit for further thought.
We could argue that obesity is most often self inflicted (simplistic and I apologise for that) and as far as I know, most of those who are trying to recover with medication are self funding. That pretty much contradicts my entire speil, doesn't it? My friend is paying £160 a month for a weekly jab. Its helping her, hugely, and will hopefully bring her weight to a safe level where her illnesses won't cost the NHS money. She's had to pay for it herself, and I believe that's pretty much the norm.
It does seem to be different strokes for different folks.

I guess I'm just wondering why gender surgeries and medication are considered a different type of choice than smoking, or drinking till your liver gives up.

Perhaps it's because it's the medical profession which is carrying out these harmful procedures. They really ought to know better.

We'd be saying the same if there were doctors offering liposuction and gastric bands to anorexics.

Yeah, that makes sense. Thats the disturbing bit. Even if the "patient" covers the cost themselves, these medical people probably still work within the NHS in some capacity. Tuesday, they try to save a life with a radical double mastectomy. Wednesday they perform the same surgery on a 20 year old with no physical illness. It's really quite sick.

We don't just say "let them" to a friend who is confident about driving home after a night at the pub! We may not be able to stop her, but we have to say something.

The OP didn't ask whose decision it was. She asked, should I try to turn my friend away from this path?
I think the answer is unequivocally yes, but the question of tactics is difficult. The OP has to weigh up many factors, including the risk to the friendship.

The reason to deny "gender-affirming" surgical procedures on the NHS is that they are not effective in treating the underlying issues. They may even exacerbate them.

Good point.
It's a surgical "treatment" for a mental health condition. A lobotomy of the breasts and reproductive organs.

Lobotomies were SUCH a success story, after all.

I get the point about stopping a drunk from driving but think it's not relevant here, really. A drunk driver is not just a danger to themselves, they could kill many others at the same time. We're trying to save others, not just the drunk. Someone who is determined to have a cosmetic procedure of any kind is really just risking themselves. Do we have the right to stop them if they're an adult and self funding and able to understand the situation, etc. Then again, I'm going to contradict myself by saying that simply wanting this kind of surgery pretty much implies that the individual is NOT mentally capable of giving informed consent. Isn't that what the detransitioners mostly say? I was too unwell to really understand. I didn't really appreciate what was going to happen. I didn't let myself have any doubts. Everyone said it would make me feel better. I was egged on by my friends online. My therapist said I'd be my true self afterwards.

I had a breast reduction and augmentation as a young adult. I thought it was what I wanted. I regretted it for a number of reasons

1. I was on a ward with a lot of women who had had surgery due to cancer. I had a huge amount of guilt being in with them post surgery.
2. It was extremely traumatic afterwards. The pain was unbelievable. The bruising and wounds immediately afterwards was shocking. I could not have imagined how much time it took to recover from the surgery and the drugs used during it. I developed infections and had to be readmitted.
3. I had children 10 years later and was unable to breastfeed. I did not think I wanted/would have children at the point I had the reduction.
4. I lost a lot of feeling in my breasts which impacted my sex life.

I liked having smaller breasts and that they were a better shape but all in all I'm not sure I'd make the same decision again. But it's not a reversible decision. Your friend doesn't know what she can't know. Hindsight has 20/20 vision.

Yes this is the conundrum. Weighing up the risks. They are self funding the surgery. Not using NHS.

A drunk driver is not just a danger to themselves, they could kill many others at the same time. We're trying to save others, not just the drunk.
That's a point, but I don't think it's a strong one, if you don't mind me saying so. It's really a question of dissuading people from decisions which could cause harm. The harm being to them or someone else.

Someone who is determined to have a cosmetic procedure of any kind is really just risking themselves. Do we have the right to stop them if they're an adult and self funding and able to understand the situation, etc.
We don't have the right to stop them - no-one is saying that. It's their decision. I think we should attempt to dissuade them if the potential harm is great enough - like a Brazilian butt-lift which has a very high death rate. Nose jobs (I am told) are straightforward but even there a friend might want to make sure that the person is going to a reputable and experienced surgeon. And in non-gender related cosmetic surgery I believe there is a much better pre-operative psychological assessment and occasionally patients are refused. But that might be wishful thinking on my part!

Thanks for your honesty - really valuable.

I think there is a difference though depending on the cosmetic procedure too.

The correct comparison would be an extreme cosmetic procedure that involved a great deal of scarring and in a site in the body that will involve limitations to future movement and and that will respond to weight loss and gain with irregularity.

A nose procedure would be wholly inadequate as a comparison. A butt procedure may be a good comparison but even then to make it comparable, significant amounts of tissue would also have to be removed that will never be replaced and the scarring would need to be all the way across both butt cheeks.

You don't know how much you use the muscles in your chest and therefore your arms until you are operated on in that area. Afterwards you can't do anything with your arms at first. You can't lift them, brush your hair, wipe yourself, get dressed, use a knife and fork etc... At 6 weeks I still couldn't push a shopping trolley or pick up anything heavy. I have had 2 c-sections and recovery from these was a walk in the park compared to surgery on my breasts.

And sorry to bang on but this thread has brought a lot of it back. Afterwards, I lay in bed and looked at my bandaged chest and felt like I had been butchered in the true sense of the word. No one can prepare you for that. It took a long time for me to even be able to look at the wounds. I am not overly squeamish and took out my own staples after an appendectomy as a teen but this was something else. Maybe because breasts are such a sensitive part of the body.

Every time I hear of a person having these extreme surgeries I think about how afterwards they have to wake up and live with the reality of what they have done. It is no longer a thought and a dream it is a real bloody living nightmare. It's truly horrific.

And you can't complain because this is what you wanted right? You asked for this. You fought for this. And some one with greater knowledge than you agreed it was a good idea.

The world has gone mad hasn’t it. By any chance is she ND or suspected ND?

"I don't argue that this particular woman is not able or competent to make the decision, it's the wisdom of the decision which is being questioned"

I think either you agree that someone is able and competent to make their own decision or they aren't... you don't get to say that someone is capable of making an informed choice but then questioning them when they make a decision you don't like or agree with.

If a friend wanted to have extensive plastic surgery I'd think- gosh isn't it a shame they feel the need to confirm to xyz beauty norms, that's not something I'd ever take a risk on. But would I question them on it? No , because I respect my friend enough to believe they will do their own thorough research and make the best decision for them. This isn't a minor we're talking about- it's a fully informed, consenting adult who has all the access to the same research we all do but who has come to a different conclusion.

I agree that sometimes people find themselves in echo Chambers but I think that applies on both sides of the coin.

Human beings don’t always make rational decisions, particularly if influenced by obsessive compulsion, ideology, religion, culture or delusion. The libertarian attitude of, ‘let adults do whatever they want because they’re adults’, is not an effective way in which to organise a society. As human beings, and particularly as friends, we have to consider what we owe to each other in terms of responsibility, support and honesty.

If you can see a friend making a decision that will have serious consequences, I think you have a duty (human being to human being) to discuss things with them and see if they have considered all potential outcomes.

In addition, people who you are paying to carry out elective surgery on you are influenced by the profit motive and that conflict of interest can have serious ramifications for patients.

In response, I refer you to this post from UtopiaPlanitia · Today 14:48

The idea that you can never question anyone's decision about themselves is ridiculous.
You seem to be unable to separate in your mind the questions of can she do it? and should she do it?

ETA: It doesn't even matter who is right and who is wrong. The essential question is - should you stand back and let a close friend do what you think is seriously harmful without attempting to step in in the ways suggested. It may be of no use, but I think you should try.

I’m finding the posts from women who have had mastectomies really hard to read, and I am so angry.

The 25 year old daughter of a friend found a breast lump recently, which is thankfully benign, but she now knows she has the BRCA1 gene and is having to decide whether to have a double mastectomy in the next few weeks.

The wish to have healthy breasts removed should be the very reason why a woman should not get this surgery.

OP has received a range of perspectives, particularly from women who have had double mastectomies and brings the euphemistic terminology of "top surgery" back to the material reality of our bodies and the painful consequences of having breasts removed. One thing I would want to follow up on here is whether there are differences in the surgery for breast cancer and for removing breasts for gender identity reasons? Is more tissue removed in cancer surgeries resulting in more severe pain and recovery time, and worse long term consequences like being unable to move arms above your head? Or is a surgery to remove healthy breasts a similar risk level and consequences?

To be clear, I don't think removing breasts due to gender identity is at all a good idea (regardless of whether the surgical outcomes are "better" or less painful than for breast cancer surgery) and the medical ethics of this are highly questionable at best. But I think we should ask these questions so we understand what it is we're dealing with in terms of the actual surgery. And I would want to hear from a breast cancer surgeon and not a gender surgeon. The lack of transparency and honest conversations about gender surgeries by irresponsible advocates and the trivialising of the physical consequences is disturbing.

Obviously for OP question the focus is on how she should approach this with her friend, and there's much food for thought for her in the responses. The bigger questions are around an adult's right to make bad decisions, and where society/the state steps in to prevent harm. OP's friend can make the decision that she wants this surgery and can exercise her autonomy to make that decision, but, to state the complete obvious people can't do the surgeries themselves, and it is the medical profession that is ultimately responsible for the fact that this is even an option now. Where is the line for the medical profession? Even for a private surgery the guiding principles for the surgeon should still be first, do no harm and not buyer beware.