[43 AFAB] Questioning My Gender Identity

[u/WeeklyCouple9444]

I am a bisexual, AFAB but have hirsutism (from having PCOS/PMOS) & body image changes after preventive oophorectomy-salpingectomy/hysterectomy & am currebtly flat following a double masectomy due to having the BRCA-2 gene mutation. Between my hirsutism, removal of my female reproductive organs & removal of breasts, I'm not sure of my gender identity anymore. 😔 I'm seeing a therapist for my depression & have made progress in that area but I don't feel she's been helpful on this issue.

Any insights, thoughts or non-judgemental advice?

[u/stillupforguessing]

Here’s some things to think about:

- I am unsure of what your therapist specializes in. That said, there are therapists available that specialize in helping you process what gender identity mean to you. I can imagine that what you have been dealing with certainly hasn’t been positively contributing to your mental health, so I would encourage you to consider seeking out someone who operates in this specialization.

- If you wish to continue identifying as a woman, the fact that you have had a double mastectomy, health insurance would likely consider breast implants as reconstructive surgery rather than a purely cosmetic procedure if it’s something you would be open to considering (pending that your insurance provider covers this).

- One’s physical characteristics do not have to affect their expression and does not inherently have to dictate how anyone should identify. As others here can attest, your body doesn’t have to meet a particular set of physical expectations for your identity to be valid.

- I am going to say something here that may challenge you, but I promise that this is coming from a supportive place. It’s wholly intended to challenge beliefs. Physical characteristics, as others can attest to here (you’ve certainly come to the right place), don’t inherently dictate gender identity as that is internal to one’s lived experience. There are plenty of people here who haven’t had top/bottom surgery here that still identify with either the opposite of what their bodies indicate to society what they may be; it’s internal rather than external, so I want to pose something here for you:

Forget, for a moment, what society’s expectations of what a woman or a man is supposed to look like, and close your eyes. Do NOT consider your body’s present appearance. Ask yourself this with brutally honest objectivity: “what does my identity mean to me? If nobody could ever see my body or make assumptions about my gender, and nobody expected me to conform to a particular set of characteristics, how I feel most comfortable describing myself?” I think it’s worth separating how you feel about the changes to your body from what those changes mean to your understanding of yourself.

I can understand how losing what connections you have to the physical presentations of femininity in addition to experiencing hirsutism, can change how you see yourself, how others perceive you, and how connected you feel to the image you once had of yourself. I have to wonder, though: do those changes alter your internal sense of who you are, or do they challenge your understanding of what you believe being a woman means? If you feel less like a woman because you no longer have breasts or a functional reproductive system, you will want to consider where this association comes from. Is it a personal sense of disconnection from womanhood, grief over a part of your body that you valued, concern about how other people perceive you, or some combination of those things? Bear in mind that these can have overlapping influence, but they aren’t necessarily the same.

I want to be clear that I’m not suggesting your feelings are wholly (or even partially) the product of social conditioning, or that your identity is somehow less authentic as a result of society having an influence on how you see yourself. Social expectations affect all of us, and sometimes it takes questioning some or all of such expectations to understand which feelings genuinely resonate with us and which ones we’ve learned to associate with who we’re supposed to be.

If you come to the conclusion that your identity feels different as a result of everything, that’s okay. You don’t have to preserve an identity that no longer feels right, but you also don’t have to abandon one simply because your body has changed.

I say all this from the perspective of someone who is also exploring these questions. I’m AMAB, and I’ve spent a long time trying to understand the more feminine aspects of myself that have been asking to be acknowledged since I was a child. One thing I’ve had to confront is the difference between how society categorizes me based on my physical characteristics and how I experience myself internally.

So I want to encourage you to give yourself permission to question the assumptions you’ve made about yourself, including the ones you may never have realized you were making. You deserve to discover who you are without feeling that your body, your medical history, or society’s expectations have already answered that question for you.