In 2015, New York became only the ninth state in the country to require all health insurance plans to cover gender-affirming surgery, a fact that underlines how new—and woefully lagging—recognition of transgender health and dignity is in our culture and its institutions. It meant that, for the first time, all transgender and non-binary people would have access to surgery and medical care.
A year later, Mount Sinai Hospital in New York City opened the Center for Transgender Medicine and Surgery, the first major unit of its kind in the U.S., offering broad, multispecialty transgender care in one location and to a diverse population.
Plastic surgeon Dr. Jess Ting was brought in to lead the center, specializing in gender confirmation surgeries. Prior to heading the unit, however, he had no experience performing surgeries on transgender patients. In fact, he had little interaction with the transgender community at all.
“How did I start transgender work?” he says, raising the obvious question at an early point in Born to Be, a new documentary about the center. “Essentially they started to ask everyone and everyone said no except for me.”
Born to Be, which will be released virtually on Wednesday, is a fascinating look at the groundbreaking work done at the center, at what is an exhilarating time for a community that had long been denied access to its pioneering services. It reveals through a sensitive and specific lens the significance that these surgeries have on the lives of transgender patients, which includes not only the joys but the pressures, weight, and emotional conflict.
“The film speaks about the importance of the change not only happening in healthcare, but the change happening in society at large,” Tania Cypriano, who directed the film, tells The Daily Beast in a Zoom video chat alongside Dr. Ting. “I feel there's so much misunderstanding and misinformation about the transgender community. People need to be educated about it in order to form opinions. We live at a time when our opinions are really speaking louder than knowledge.”
At a time when conversations about the transgender community and the need for visibility, representation, legal protection, and social understanding is finally permeating a mainstream discourse, the hyper-specific lens on surgery offers a point of enlightenment on at least one part of the transgender experience.
“What we do, what we try to restore and what we try to give patients, it's just such an essential part of the human experience,” says Dr. Ting. “Being able to show that in a movie to a large audience increases understanding and empathy for trans people, specifically as it regards to transitioning, why patients want to transition, and why we as a society should support that.”
Through Dr. Ting, who emerges as the film’s central character, it’s made clear just how much of a “brave new world” his work at the center is, and how challenging it remains to rally the broader medical community to see the importance and the opportunity in the work.
“Prior to March 2016, if you were poor in New York City. you had no access to surgery, period,” Dr. Ting says. “Only if you are wealthy and could afford to fly to Thailand or California and pay $20,000 in cash could you have access to care.”
That historic significance takes a toll on the center. At the time Born to Be was filmed, there was a six-month waiting list for a consultation, with 400 hopeful patients on it. Dr. Ting and his staff burn the candle at both ends to accommodate as many patients as safely as possible, but the schedule is impossible to maintain. He needs more surgeons. He needs more doctors willing to be trained. He needs his field to expand.
The hesitance in the surgical community to embrace gender assignment procedures is arguably at odds with the stereotypical ethos of surgeons and their ambitions. Through necessity, Dr. Ting is trailblazing an entire field of surgery. (One surgical method even bears his name.) The work he does is at the cutting edge of medicine, and he’s developing new techniques and processes on a daily basis.
In just the handful of patients he treats in Born to Be alone, Dr. Ting talks through a procedure to reduce the masculine-signaling pronounced curve on one patient’s forehead, a dramatic surgery that involves peeling back the face skin, cutting out a piece of skull and pushing it back into a sinus cavity. He develops a vaginoplasty that can self-lubricate. Another patient receives a groundbreaking phalloplasty in which a penis is created out of a piece of skin and artery from the forearm.
It’s not just that the transgender community is moving to the forefront of our society’s discourse, it’s that the field of transgender medicine is at a thrilling threshold. So why is it that other surgeons and doctors are hesitant to be a part of the center and the work that it's doing?
“Because for a generation of doctors, transgender surgery was just not considered a legitimate field,” Dr. Ting says. “It was not an operation that any respectable hospital would allow to be done on their premises. So for Mount Sinai to say, we're going to start a program, and start offering that surgery within the hallowed halls of this premier academic institution, that was a big deal, and it was a game changer.”
Prior to the opening of Mount Sinai’s center in Manhattan, there were some gender surgeons, but they mostly operated in obscure towns like Trinidad, Colorado, and New Hope, New Jersey, at small community hospitals, Dr. Ting says. There was nothing at large, respected medical centers, it was not a part of the medical school curriculum, and it was not a part of any surgeon’s training.
“So if you went to Dr. X, a plastic surgeon, and said, ‘Can we train you to do a vaginoplasty, a gender confirmation surgery?’ They'd be like, ‘What are you talking about? I'm not doing that. That's shady.’”
That there is so much misinformation about gender surgery, even in circles like the medical community, is part of what Born to Be seeks to correct. But it also charges into some landmines in its mission.
There has been a concerted—and necessary—push among activists to stop centering conversation about the transgender population around surgery and their bodies. A history of objectification and violence has resulted from the cisgender fascination with transitional surgeries and trans bodies, and a failure to move on from that point has done a disservice to the many other facets of the community that demand attention, empathy, and validation. Yet Born to Be is entirely focused on surgery, transition, and trans bodies.
Cypriano was cognizant of this, and was careful not to abuse the access the Mount Sinai patients, who were often naked during consultations and let the camera into their surgery rooms, gave her.
“Just because people give you the access, I don't feel as a filmmaker that gives me the authority to use it,” she says. “We had to reframe to cut nudity from scenes throughout the film.”
As some critics have noted as Born to Be has played at film festivals, it is the laser focus on the specific story of transitional surgery within the framework of a medical center—not to mention a sensitive approach—that has allowed it to sidestep some of the criticisms its subject matter might invite.
“In the final cut of the movie, all the nudity is removed below the waist,” Dr. Ting says. “I think that that was a very careful decision that the filmmakers made. Because of sensitivity to this cis person’s obsession with trans bodies, we didn’t want the film to be about that.”
While only snippets of the surgery footage is included in the final cut, Cypriano notes that the cameras were in the room documenting the entirety of what now count as some of the most historic surgeries in the field. It’s her hope that producers end up donating the footage to the hospital and other medical centers to be used as education tools.
Both she and Dr. Ting have anecdotes about attending festival screenings of Born to Be over the past year and being sought out by audience members afterwards who were desperate to relay how impactful they found the film. One man at the Hamptons Film Festival admitted that he was skeptical of the subject matter and was prejudiced against the transgender community, but the documentary changed his mind. Another woman at a California screening was in tears, proclaiming that “the world is a different world for me right now.”
It’s Dr. Ting’s hope that the film can be part of “a sea change” he’s observing in the medical community when it comes to attitudes about what he does. Older doctors still look at the field with suspicion and antipathy, but he is observing a new generation of medical students and new graduates excited about the program and where the field is going.
“That’s a big target audience for us,” Dr. Ting says. “Every medical center should screen the movie for their administration, for their staff, for the doctors, and for medical students.”