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Gender Affirmation Does More than Affirm—It Heals

When River Jude August arrived for surgery, they faced yet another challenge in their long journey to align their body with who they know they are. River, who identifies as agender—or outside the female/male binary—had already changed their legal gender to X. They had transitioned socially, opted for several medical treatments, and now faced their biggest surgery yet. River was about to undergo phalloplasty, the construction of a phallus. They turned to the Transgender Health Program at University of Utah Health. The procedure, which took place at Huntsman Cancer Institute (HCI) at the University of Utah, would end up lasting more than 15 hours. And the road to recovery would be long.

"With this type of surgery, someone comes and checks on you every hour for the first several days," River explains. "For many nurses and certified nurse assistants, this was the first time they had a phalloplasty patient because I'm only the third phalloplasty patient in Utah. But I felt very safe and taken care of—and for a transgender person, that is hard to find in society, not to mention in a medical setting."

In the days after surgery, caregivers at HCI printed out a sign with River's pronouns (they/them/theirs) and asked River if they could hang it above the bed.

"The fact that they were willing to have conversations and make sure I felt safe and supported was really meaningful. Trans folx often get harmful and violent narratives placed on them," River shares. "To have people take care of my wounds and not shy away from me and not be uncomfortable around me—it was so formative. I was visible and treated like every human should be treated."

U of U Health's Transgender Health Program was officially launched in 2017. Since that time, the program has grown to include more than 40 gender affirming providers across eight specialties. Each provider follows WPATH standards of care. The program's volumes have tripled since opening, and 12% of patients are from out of state since it is the only multidisciplinary program in the mountain west.

Like many people who are transgender, River recalls feeling out of place in their body from an early age. At four years old, they remember their first experience of gender dysphoria—the feeling that one's gender identity does not align with their physical sex. "I've waited four decades for this," River says. "I'm just so grateful these providers are so dedicated and have helped me achieve what I've wanted my whole life."

River credits the care at University of Utah Health and Huntsman Cancer Institute, not just for the procedure, but also for making the process so meaningful.

"I had an affirming surgery, but it was really the people who made it healing. Parts of my soul and my younger self did a lot of healing because of the way people showed up and cared for me."