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Introduction & Resources Page

While it is impossible to condense all information about sex, gender, and  transgender and non-binary history and general information into a single page, we wanted to do our best to provide a basic introduction on the topic to give you the necessary context to be able to understand surgical information on this website. 

The GCC (Gender Confirmation Center) (or, GCC) is a surgical practice dedicated to providing transgender and nonbinary people high-quality and affirming gender confirming surgical procedures, as well as support navigating the surgical  process. We want it to be as easy for our patients as possible to be able to access these medically necessary and lifesaving procedures. The intention of our practice’s website is to allow anyone who is interested access to the most accurate and up-to-date surgical information, mainly focused on top surgery and gender-focused body contouring.

If you are just getting started on your path to learning more about what it means to be transgender and/or nonbinary and what medical interventions are available, we hope the information on this website will be useful to you. To start off, here are some terms that you should be familiar with:

• Assigned sex – Most people are assigned male or female at birth by a doctor, based on what your genitals look like. This is your assigned sex. 
  • Assigned Female at Birth (AFAB) – A term used to refer to someone who was assigned female at birth. You should not use this term to refer to someone unless given explicit approval to do so.
  • Assigned Male at Birth (AMAB) – A term used to refer to someone who was assigned male at birth. You should not use this term to refer to someone unless given explicit approval to do so.
• Gender Identity – This is a term used to refer to one’s gender, regardless of whether or not this is the same gender/sex assigned to them at birth. Some examples of gender identity include nonbinary, man, woman, agender, genderqueer, etc.
• Transgender – Someone who is transgender has a gender identity that is different than the gender they were assigned at birth.
• Cisgender – Someone who is cisgender has a gender identity that is the same as the gender they were assigned at birth. 
• Gender Binary – The gender binary is the social construct that there are only two genders: male and female. Someone who is nonbinary, agender, or another gender that is not male or female has a gender that is outside of the gender binary.

Gender vs. Sex

While the terms after often used interchangeably, sex and gender have different meanings. Sex is the label “male” or “female” that people are given at birth based on genitals; sex, as it is defined, refers only to physical and physiologic characteristics. Gender is the social construct of sex; meaning, what we think being male or female, or any other gender, means. 

While these are the basic and conventionally accepted defitions of sex and gender, it is important to recognize that these definitions are constantly shifting, and everyone may not agree that this is what sex or gender mean. Some people believe sex to be a permanent characteristic, however  both sex and gender are both changeable, and not  binary. Physical characteristics of sex, as well as how people express their gender, vary widely, whether these characteristics are what people are born with or a result of surgery, hormones, or another medical interventions

Non-binary and other not-binary genders

Genders outside of the gender binary are not new. Many cultures are inclusive of gender expansive people, or people who have a gender that is not male or female. There are also many other genders aside from nonbinary – agender, genderqueer, Two-Spirit, etc. It may be helpful to think of gender as a spectrum, similar to a color wheel, with many, many different varieties. We encourage you not to try to understand all of the different genders if they do not resonate with you or are outside of your experience, but instead to put that effort into respecting people regardless of their gender.

Gender Dysphoria/Gender Incongruence

Gender dysphoria is a term that describes the negative feelings and distress some transgender and nonbinary people feel due to the mismatch between their gender and their body and other phsyical characteristics or expression, and/or how others treat them. This is a diagnostic term used in the DSM-5 (Diagnostic and Statistical Manual-5, which is a diagnostic tool for psychiatrists) that previously was referred to as “Gender Identity Disorder.”

The ICD-10 (International Classification of Diseases-10) still categorizes being transgender as a disorder, with two of the more common medical billing codes within it being “transsexualism” and “gender identity disorder of childhood.” The newer version, ICD-11, which will be in effect starting in 2022, has reclassified these labels as “gender incongruence,” as a way to depathologize transness – or, to make it clear that being transgender is not a disorder and the problem that needs to be treated is the experienced dissonance one has when their attributes do not allow them to recognize themselves or allow others to recognize them as their actual gender. The ICD-11 does not require the experience of distress or impairment as a precursor for someone to be classified as having “gender incongruence.”

This distinction is important. Not all transgender people experience distress as a result of being trans. While gender dysphoria is an important concept for many trans people as a way to describe their feelings, others may find the term pathologizing, and others may not experience it at all. It is best to mirror the words a trans person uses to describe their own experience, whether that be dysphoria, or incongruence, or something else. 

GCC (Gender Confirmation Center) Terms

Language changes so often, and we at GCC try to keep up as much as possible. We are moving toward de-gendering the terms we use to refer to surgical procedures in an effort to make our patients, regardless of their gender, feel affirmed and comfortable with the procedures they are pursuing. We also try to stay current with the latest terms, such as the movement from gender dysphoria to incongruence, so you will notice we often use both as a way to signify that movement but still use words that most people are familiar with in the current time. We hope to continue updating our website as language continues to evolve. 

Here are some common terms you will come across on our website:

• Top Surgery – We use the term top surgery as an umbrella term to refer to both chest reconstruction top surgery and breast augmentation.
• Chest Reconstruction Top Surgery – We use this term to refer to what is also called a double mastectomy, chest masculinizing surgery, etc. These procedures were formerly called FTM/N Top Surgery.
• Breast Augmentation – We use this term to refer to what can also be called chest feminizing surgery, etc.
• Gender-Focused Body Contouring – We use this term to distinguish body contouring that is performed to affirm one’s gender or reduce gender dysphoria or gender incongruence from body contouring done for cosmetic or other reasons.
• Gender-Affirming Facial Surgery – We use this term as an umbrella term for all gender confirming facial surgeries, including procedures typically referred to as facial feminization surgery (FFS) or facial masculinization surgery (FMS)
• Bottom Surgery – We use the term bottom surgery as an umbrella term to refer to genital surgeries, including vaginoplasty, vulvoplasty, phalloplasty, and metoidioplasty.
• Gender Dysphoria and Gender Incongruence – As mentioned in the previous section, common language is slowly shifting away from the use of dysphoria to the use of incongruence. We use both terms to avoid confusion.

Pronouns

Everyone has pronouns. They are words used to replace someone’s name. Pronouns often have a gendered connotation, so it is important to use the pronouns someone desires rather than what you are assuming their pronouns are or what you think they should be based on the person’s presentation/name/etc. 

Here are an example of some pronouns, though there are an infinite number of possibilities:

If you are not sure of someone’s pronouns, you can ask. A good way to ask someone’s pronouns is to introduce yourself with your own pronouns first. For example, “Hi, my name is John, and my pronouns are he/him. What about you?” 

You should not assume someone’s pronouns based on the way they look or dress, on their name, vocal qualities, pronouns, or on anything else. While someone may look or act in a way which causes you to assume they use a certain set of pronouns, your assumption may be inaccurate. The best way to know you are using the correct pronouns for someone is to ask them.  

If someone does not want to tell you their pronouns, that is okay. If they don’t want to tell you, or if you are not sure of someone’s pronouns and are not able to ask, you can use their name instead. 

A way to normalize sharing pronouns is to put them in your email signature and to use them whenever you are introducing yourself. If you are leading a meeting or group, you can set a standard for everyone sharing their name and pronouns at the beginning.

If you forget someone’s pronouns or use the wrong pronouns for them, you should apologize, thank them, and move on. For example, “I’m sorry for using the wrong pronouns, thank you for correcting me.” Making a big deal out of it, or making it about your own feelings and how terrible you feel, can make the other person feel uncomfortable and center your own emotions rather than theirs. It is best to not make a mistake at all, but if you do, correct yourself, move on, and try to not do it again. 

If you would like to learn more about pronouns, here are some additional resources:

• https://springfield.edu/inclusion/gender-pronouns
• https://www.glsen.org/activity/pronouns-guide-glsen
• https://lgbt.ucsf.edu/pronounsmatter
• https://www.npr.org/2021/06/02/996319297/gender-identity-pronouns-expression-guide-lgbtq

What does it mean to “transition”?

Transitioning is the process of altering one’s presentation/expression and/or physical characteristics to affirm their gender. Transitioning is highly individual and means different things for everyone. 

Social Transition

Different ways someone can socially transition include changing their name and/or pronouns, wearing different clothes, cutting and/or dyeing their hair, getting piercings or tattoos, etc. Some people will come out to everyone else in their life as trans/nonbinary, others will only come out to themselves or a select group of people or individuals.

Other aspects of social transition can include changing identity documents, such as a state ID, driver’s license, passport, social security card, birth certificate, etc. to reflect their actual gender and chosen name. Note that some documentation cannot be changed without documentation from a medical provider/and or certain types of medical interventions.

Medical Transition

Medical transition includes hormones, surgeries, and other procedures that can change one’s physical characteristics like hair removal. Other modes of medical transition can include fertility preservation and speech therapy. 

People of all genders are able to decide what modes of transition and gender affirming interventions are best for them. It is best to not assume what types of medical transition or interventions an individual will want. Not everyone wants/needs hormones or surgery. Some people only want one type of surgery, and some people want to access many different types of surgeries.

How do I know if I am transgender?

There is no one test that can tell you if you are transgender/non-binary. No medical or mental health provider can tell you for sure or not. It can be helpful to think of being trans not as something you are or are not, but as something that can describe the way you experience and navigate the world. If you identify with the gender you were assigned at birth and do not feel like you want or need to change aspects of your outward presentation or your physical characteristics, then you are probably cisgender. If you want or need to change your pronouns, or get surgery to change aspects of your presentation that are related to your own gender or how others perceive your gender, then it is likely you are trans. This can fluctuate for some people; how one identifies may change throughout their life. 

If you are unsure if social or medical modes of transition are right for you, it can be helpful to go to a support group (in person or virtual), talk to trans/non-binary people who have transitioned in some way, or talk to a therapist experienced in helping transgender people to help clarify what may be helpful for you. Please see the resources section at the bottom of this page for more resources that may be helpful. 

How to be supportive of a transgender person in your life

When you are unfamiliar with transgender/non-binary people and are not involved in the community, it can feel confusing and difficult to figure out how to best support a trans person in your life, especially if they have newly come out. 

Whether they are your child, partner, friend, colleague, etc., the best thing you can do to support the trans person or people in your life is to use their chosen name and pronouns, and not invalidate their identity. Even if you did not see any signs of this person being transgender before they came out, this does not mean they are not “actually” transgender. It is also important to note that, especially for young people, being trans is not a contagion or something that is a passing fad. Being around other trans people can introduce one to the fact that transness exists, and that it is an option, and if it fits one’s experience of the world, then it is something they will also identify with. Even if being trans does end up being a phase, or if it is lifelong, supporting someone who is trans is more effective and safe than trying to convince someone they are not trans or discourage them from exploring their gender. Research has shown supporting trans people can lessen the risk of suicide and other adverse mental health outcomes. 

Here are some more tips and advice:

• Do not ask a trans person about what surgeries they have had or want, unless they bring it up first and are open to discussing it with you 
• Do not ask a trans person what their old name is
• Do not ask a trans person what their sex assigned at birth is 
• Do not doubt that someone is truly trans 

If you are struggling with your child/partner/friend/etc. coming out as or being transgender, you should pursue outside support rather than talking to them about all of your difficult feelings. Please see the resources section for support groups.

What the rest of the GCC website will cover

The GCC (Gender Confirmation Center) specializes in gender confirming surgery, which is a part of medical transition for some. GCC offers top surgeries (chest reconstruction and breast augmentation), facial gender confirming surgeries, and gender-focused body contouring. Our website has a vast array of information about the procedures we offer, including different types of techniques, preparing for and recovering from surgery, insurance navigation, and more.

We hope by exploring our website, you will gain important and helpful information regarding gender confirming surgeries.

Resources

• General Transgender/Non-binary Information

• • The Matthew Shepard Foundation has a list of youth-specific resources 
  • GSA Network offers resources for trans and queer youth – https://gsanetwork.org/
  • Pronouns
    • https://uwm.edu/lgbtrc/support/gender-pronouns/
    • https://www.glsen.org/activity/pronouns-guide-glsen
    • https://lgbt.ucsf.edu/pronounsmatter
  • Callen-Lorde’s Ways to be an Ally Comic – https://callen-lorde.org/graphics/2018/03/Ways-to-be-a-Trans-and-Non-Binary-Ally-Comic.pdf

• Transgender Healthcare 

• • The UCSF Transgender Care website has a variety of information about medical and social transition, as well as legal document changes – https://transcare.ucsf.edu/transition-roadmap
  • The World Professional Association of Transgender Health (WPATH) Standards of Care (SOC) 8 are guidelines that many providers and health insurance companies base their own practices on. That said, many insurance and healthcare providers still follow the SOC 7 guidelines – https://www.wpath.org/publications/soc
  • Non-Medical Interventions
    • Callen-Lorde’s PUMP Sexual Pleasure & Health Resource Guide for Transmen who has Sex with Men – https://callen-lorde.org/graphics/2021/02/PUMP-TMSM-Health-Guide_Final_V3.2.pdf
    • Callen-Lorde’s Safer Binding brochure – https://callen-lorde.org/graphics/2018/09/Safer-Binding_2018_FINAL.pdf
    • Callen-Lorde’s Safer Tucking brochure – https://callen-lorde.org/graphics/2018/09/HOTT-Safer-Tucking_Final.pdf
    • Callen-Lorde’s Finding Your Voice brochure – https://callen-lorde.org/graphics/2018/09/HOTT-Voice-Brochure_Final.pdf

• • • Gender Confirming Surgery

• • • T4T Caregiving is a trans-led organization that offers caregiving services for trans people undergoing gender affirming surgery; all of the caregivers are also trans people who have undergone surgery themselves, and are able to travel to offer support – https://www.t4tcaregiving.org/
    • Trans Heartline is a San Francisco-based nonprofit that offers housing for people recovering from gender affirming surgery in the Bay Area – https://transheartline.org/
    • Transbucket is a site for patients to share photos of their surgical outcomes – https://www.transbucket.com/
    • TopSurgery.net offers further information about chest reconstruction top surgery (note that the surgeons on the website are paid advertisers) – https://www.topsurgery.net/
    • MTFsurgery.net offers resources on breast augmentation and other gender confirming procedures (note that the surgeons on the website are paid advertisers) – https://www.mtfsurgery.net/

• • • • Facebook Groups

• • • • • Top Surgery Removal/Reduction is a closed Facebook group that you must request to join
    • Mental Health
      • The Gender Affirming Letter Access Project (GALAP) is a group of mental health clinicians who have offered to write free/low-cost letters of support for access to gender affirming medical care – https://thegalap.org/

• • • Financial & Legal Resources

• • • • Point of Pride offers binder giveaways and funds for surgery, electrolysis, and HRT – https://pointofpride.org/
      • The Jim Collins Foundation provides financial assistance for surgeries – https://jimcollinsfoundation.org/#
      • Genderbands offers surgery grants and free binders – https://www.genderbands.org
      • Trans Family SOS offers assistance with insurance appeals – https://transfamilysos.org/
      • TLDEF’s Trans Health Project offers a tutorial on using health insurance for transgender-related healthcare – https://transhealthproject.org/trans-health-insurance-tutorial/
      • The Movement Advancement Project has a US map of insurance coverage – https://www.lgbtmap.org/equality-maps/healthcare_laws_and_policies
      • The NCTE has information about health insurance coverage and how to navigate legal document changes – https://transequality.org/know-your-rights/medicare
      • Healthy Trans has an insurance for surgery 101 guide – https://www.healthytrans.com/insurance-101
      • You can contact the ACLU about cases of discrimination – https://action.aclu.org/legal-intake/report-lgbtqhiv-discrimination
      • Lambda Legal has a help desk for issues related to discrimination and may be able to offer referrals –  https://www.lambdalegal.org/helpdesk

• Support Groups 

• • • PFLAG is a nationwide organization that supports and advocates for LGBTQ+ people and their families. They have chapters all over the country and offer support groups – https://pflag.org/
    • The Gender & Family Project at the Ackerman Institute in New York City has resources for family therapy – https://www.ackerman.org/gfp/

• Emergency & Crisis Support

• • • Trans Lifeline offers an emergency support hotline – https://translifeline.org/
    • The Trevor Project offers a 24/7 crisis phone line, chat messaging, and text messaging services – https://www.thetrevorproject.org/
    • Callen-Lorde Community Health Center, a New York City-based community health center, offers a text-based crisis helpline for everyone, you do not have to be a patient to utilize this service – https://callen-lorde.org/helpnow/

• Local San Francisco Resources

• • San Francisco LGBT Center – https://www.sfcenter.org/
  • San Francisco Office of Transgender Initiatives – https://sf.gov/departments/city-administrator/office-transgender-initiatives