S1E3 - Rudy on Navigating Breast Cancer as a Transmasculine Person

Today, we hear Rudy’s story. Rudy is a transmasculine person and healthcare professional navigating life beyond breast cancer.

This episode we discuss:

 🌈 Advocating for yourself in healthcare
 🌈 The importance of meeting other people like you
 🌈 The intersection of gender affirming care and cancer treatment 

Content warnings
This episode contains discussion of:

Cancer

Medical trauma

Fatphobia

Fertility after cancer

Menopause

Misgendering

Gender dysphoria

Glossary

Breast Cancer - https://www.nhs.uk/conditions/breast-cancer/

Glossary of LGBTIQ+ terms - https://outpatients.org.uk/wp-content/uploads/2024/03/V2-Provider-Pack-OP.pdf (Page 4)

Episode Resources

UK Cancer and Transition Service - https://www.wearetransplus.co.uk/uk-cancer-and-transition-service/

Support

If you’ve been affected by any of the issues mentioned in this week’s episode, please find some links to support below:

Support for LGBTIQ+ people affected by cancer - https://outpatients.org.uk/support/ 

Maggie’s - https://www.maggies.org/ 

Macmillan support line - https://www.macmillan.org.uk/cancer-information-and-support/get-help/macmillan-support-line 

Switchboard - https://switchboard.lgbt/ 

Credits

Created and produced by OUTpatients UK.

Edited by @CRTaudiotech. 

Cover art by @SorrelMilne. 

Follow OUTpatients

Check out our website: https://outpatients.org.uk/ 

Follow us on Instagram: @OUTpatientsUK. 

Follow us on TikTok: @OUTpatientsUK. 

Sign up to our newsletter: https://outpatients.us17.list-manage.com/

Transcript

SPEAKER_00 0:00

Welcome to Outspoken, a podcast by Outpatients, the UK's LGBT IQ cancer charity. Having cancer as an LGBT IQ person can be a very isolating experience, leaving you feeling like a minority within a minority. That's why every episode we're bringing you the story of a real LGBT IQ plus person who has or has had cancer, told in their own words. Today, we hear Rudy's story. Rudy is a transmasculine non-binary person living beyond breast cancer. They're going to be talking about navigating breast cancer, advocating for yourself in medical settings, and their experience of gender-affirming care as a trans person with cancer. They also talk about how being a midwife and working in sexual health shaped their self-advocacy and talk about what it means to rebuild life, work, and well-being after treatment. What's it like when you know the system from the inside as a healthcare worker, but suddenly find yourself on the other side of the curtain as a cancer patient? Please be aware, this episode discusses cancer, medical trauma, fat phobia, fertility after cancer, menopause, misgendering, and gender dysphoria.

SPEAKER_01 1:47

My current job is in sexual health research. So I've previously worked as a frontline midwife across hospital and community and home birth, and then had a number of years working at an abortion provider, and now finally moved into sexual health. My passion's always been about reproductive justice and healthcare. So I think that I've I've taken midwifery in kind of all the directions it can go in, really. But yeah, my current role is running research studies to better expand our understanding of sexual infections, that sort of thing, which means that I'm quite confident in a healthcare setting, which has been really helpful when navigating cancer. Being a midwife by background and now working in sexual health, the main skills that I was taught are things like catching babies and doing examinations of pregnant people. I don't use them in this role. But things like learning to build trust with someone in a very short space of time is really helpful because obviously if you're looking after someone who's in labour, you typically meet them and then have to look after them for the next 12 hours and help them have their baby. So I've got very good at building a rapport, making people comfortable, finding ways to connect with people, which is super helpful working in clinical research because I like to think it makes me quite approachable and means that I can put participants at ease and demystify the research process and make it seem um an appealing thing to take part in. As a physically trans person, I started transitioning after I'd left frontline midwifery and I find it much more comfortable to be out as a trans person in sexual health because it's a more um accepting, diverse space to work in and to receive care. Um I think midwifery is still quite um quite a heteronormative space, um, and there's definitely improvements happening, but I've found sexual health to be way more LGBTQ friendly, which is really great for me as a practitioner. Um, so my move from midwifery to sexual health also lined up with me choosing to medically transition as a trans person. So I started training to be a midwife before I realised I was trans. Um, so I've been out as queer since my teens. So when I when I decided to train as midwife, I saw myself as a queer woman and I wanted a job that felt um politically meaningful and useful, but also that I felt I could enjoy and develop in and have a career to have some degree of security. But yeah, the main thing for me was wanting to do meaningful work that I felt would help people, but that also would be enjoyable for me. So yes, it wasn't a complete selfless vocation. I was slightly kind of savvy about it and thought, right, I need I need a career, what should I do? So I chose midwifery, but then part way through my midwifery training and then qualifying, I started realizing that it wasn't just my queerness, there was also something else to learn about myself or to unpack. Um and unfortunately at that time I didn't feel like I could come out as trans in midwifery. Um, I'd struggled with some homophobia, even presenting as a queer woman. So the thought of then having another thing that made me different um made me delay my transition a little until I was able to move into abortion care. Um, and then came out as trans, worked there for a couple of years, and then saw an opportunity to move into sexual health research, which has been fantastic. And I'd only been working there for a year when I got my cancer diagnosis, so that kind of brings us up to speed, really. I didn't really have any experience of cancer directly before my diagnosis. Um obviously it's impossible not to be aware of cancer, but I think pre-diagnosis I didn't realise how common it is. Um, one thing that I realised once I was diagnosed with cancer, it felt like every book I picked up or every movie I watched had cancer in it. And at first it felt almost like the universe was sending me a sign, but then I realized that it had probably always been like that, and I just hadn't noticed because it wasn't relevant to me. So no, my my first experience of cancer really was my own. I'd had a couple of people in my extended networks who'd unfortunately had cancer. Um, but there was no family history of breast cancer in my family, so it was a real, a real surprise. Yeah, I had testing and there's no there's no gene that's caused this. It's um for other reasons. Um, but in a way that's comforting because it means no one in my family is more at risk of certain cancers, um, which is reassuring for me. So I was diagnosed with breast cancer in May 2024. I found it myself, but not through a routine check. Um, I found it by feeling a lump in my armpit, which turned out to be cancer in my lymph nodes. I'd just been lying in bed reading one evening and just felt a scratch under my armpit and reached and felt, oh, there's a lump there, that's really strange. And then I felt the other side to see if there was a lump on that side and I'd never noticed, and there wasn't. And that was that would have been the moment that I found it. But I I didn't feel strong enough to address it straight away. I did a little bit of Googling and that made me feel anxious and then avoidant. Um, and it took me six weeks to speak to my GP. Um, and at the time I beat myself up about that length of time. But I think actually, in the grand scheme of things, six weeks is really quick from finding something to take any action. I've consumed a lot of literature and memoirs about people's cancers and heard about people who thought something might be wrong for years and years before they felt strong enough to speak to their GP. But I think it's partly because of my healthcare background that I felt able to go to my GP as quickly as I did because I knew that there was a pathway that I could be referred to see someone at the breast clinic. So the process that I went through was that I found the lump myself, managed to get a GP appointment six weeks later. Um to clarify, it didn't take me six weeks to get in at the GP. It was six weeks of me feeling anxious and not wanting to address what was happening. But then once I managed to pull myself together, managed to get an urgent GP appointment, my GP was very reassuring and said, it's probably not cancer, but I want to refer you. Um, and you'll probably be seen within two weeks. And I was I got an appointment at the breast clinic within two weeks. Um at that point, I was still thinking that everything would probably be fine. So I'd even arranged to go to work after that appointment. So I got an appointment at 8:30 in the morning, said I'd be in at work by midday, um, went to the breast clinic, everyone was very professional and friendly. I was initially told, oh, you won't need a mammogram. Um, and then I ended up needing an ultrasound and a mammogram and a core biopsy, which is when they take a small sample of tissue from a kind of hollow needle, and then another ultrasound and then another mammogram. And by this point, I realised something was quite wrong. I was there for about four and a half hours, and I left with my diagnosis that day, which I understand is quite unusual. I think often in cases like this, people go in, have some ultrasounds, but they have to wait for more results before they can be told whether it's cancer or not. But in my case, it was so obviously cancer from the imaging they've been able to do that day that they were able to tell me, um, which was a big shock to me, um, especially because as I'd said, I was planning on just going back to work. Um, and I think as well, if I'd have known there was a chance it could be cancer, I would probably have taken someone to that appointment with me. Um, but then actually knowing myself I'm incredibly independent, so maybe I still wouldn't have done. Um it meant that I was by myself when I received the cancer diagnosis, which was a bit tricky. Um, but luckily I've got a lot of very good friends around me. Um, I've got a lot of friends that work in healthcare and midwifery actually, and I'd been texting a midwifery friend that very morning, and she told me that she had a day off, um, and also that she was having quite a bad day. So I called her on the basis that she was free and already having a bad day, and I wouldn't ruin a good day. And she was amazing. She came and got me from hospital, um, took me back to her house, we chatted, we went for a walk in the woods, the bluebells had just come out, um, because I guess it was that kind of sort of springtime, and I just felt completely in shock because whilst I was diagnosed with cancer that day, they weren't able to give me a prognosis. So I knew that I had cancer, but I didn't know if it was treatable, I didn't know what stage it was at. Um, I just knew that I had cancer, and that was quite scary, but I also felt quite calm. Um so yeah, that was that was the day of my diagnosis, and it then took six weeks before I was able to find out what my prognosis was. And part of how they found out what that prognosis was was by doing surgery and sending the tissue to pathology and being able to look at it. So I I had that initial appointment, and the the practitioner I saw was fantastic, and she said to me, You're gonna have treatment within three to four weeks, which blew my mind because in other parts of the health service, like for example, trans healthcare, we have waiting lists of five years and counting. And so for someone to tell me you've got cancer and you're gonna get treatment within a month blew my mind. I I had to get her to repeat it because I didn't understand. I think also because I was in shock because of the cancer diagnosis. But she said to me, You're gonna have you're gonna have treatment within four weeks. It's gonna be either surgery or chemotherapy. I can't tell you which it will be first, but it will be one or the other. Um, and for me it ended up being surgery that I had first. So I had surgery three and a half weeks after my diagnosis, and during that initial six-week period, I also had a CT scan and a bone scan, which was to check if the cancer had spread. Um, because we knew that the cancer was already in my lymph nodes, which means that it had spread to my lymph nodes, and to describe it in kind of simple medical terms, your lymph nodes can send cells around your body. So once something is in your lymph nodes, you're at a high risk of cancer having spread. So that first six weeks, in some ways, was the most difficult time. Um, but I I managed to cope quite well just by kind of telling myself that I didn't have enough information to panic yet. Which if you're someone who's currently having a health panic or freak out, that is completely useless advice because I don't think it's something you can just choose to do. But I was somehow able to access that level of calm and logic and just kind of reassured myself that you know, we don't know what's going to happen, we don't have information yet to panic about. Um, I did also access some therapy that time. I had a therapist that I'd seen a few years ago who was really helpful and had some sessions with them to help me in that kind of in-between period. And then six weeks after my diagnosis, so I guess sort of mid-June, I was able to get the results that the cancer was treatable and it hadn't spread to other parts of my body. So that was a huge weight off my shoulders. The other interesting thing about the surgery that I needed to have. So I had breast cancer in my left breast and my left lymph nodes. So the surgery that they offered me when I met with a surgeon was a single massectomy on the left side and what they call lymph node clearance, which is when they remove the lymph nodes that are cancerous. Um, but I'm trans and I'd actually been planning to have private gender affirming top surgery later that summer. So this made the whole process really surreal. So this was happening in May. I'd already saved up the money to go abroad to Spain to have gender affirming top surgery. I'd even paid my deposit, and as far as I knew before I got that diagnosis, I was going to be going abroad in a couple of months' time to have gender-affirming top surgery. So when I had the consultation with my surgeon and he told me that the plan was to give me a single mastectomy, I found that challenging initially, but because I'm quite good at advocating for myself, and I'd also taken a friend to that appointment with me who was prepared to advocate for me too if I needed it, I felt able to ask for a double mastectomy rather than a single. And I kind of framed it in terms of my mental health and well-being. I explained to the team that I was coping really well with having cancer and how quickly things were moving, but that I'd been planning gender-affirming top surgery later that year. And if I came out of all this with a single mastectomy and still had one breast left, which then made it much harder to access gender-affirming top surgery in the private sector because of my history of breast cancer, I didn't think I'd be able to cope. Um, and I was really impressed by the kind of empathy and professionalism that my surgeon showed me, and he immediately just pivoted and was like, Yep, that's fine. In that case, we can offer you a double massectomy. Um, I can frame it as wanting symmetry across both sides. Um, so that was really great for me. Um, the only compromise that I had to make is that originally I'd been planning a type of top surgery where I kept my nipples because I wanted that appearance-wise, it felt more natural to me. But because of the cancer and the type of procedure they were performing, I wasn't able to keep those. But in the grand scheme of things, that felt like a small sacrifice to make to have um this procedure that I'd wanted for years to kind of feel more congruent with my gender, that had now also suddenly become life-saving because of the presence of cancer. Since having breast cancer, I've met a lot of other people who have breast cancer, which has been really helpful to have people to talk to. And the majority of them have been women, but that's because breast cancer predominantly affects women. But speaking to a few women with breast cancer who had cancer in just one breast, they've told me that they weren't able to readily access a double mastectomy. They had to go through NHS psychologists to show that they were fully understanding the repercussions of removing healthy tissue. So I think in some ways, the fact that I was trans and I'd already gone through the entire thought process and dealt psychologically with the fact that I wanted to have a flat chest, and I'd even gone as far as arranging private surgery acted in my best interest as well because it meant that I could show that I was of sound mind and I understood that I was wanting to have healthy tissue removed. And that wasn't something that I even appreciated at the time. It was just something that I became grateful for later on when I spoke to other people who sort of said, Oh, well, I only had cancer on one side and I would have honestly liked to just go completely flat, but they told me we couldn't do that right now, I'd have to do it in the future if I wanted to. Because for me, um, obviously I can't explain strongly enough how how strange and hard that first six weeks was. But once I knew that I wasn't dying of cancer, and I'd had the top surgery that I'd been wanting for years, and I felt really happy in my body, like I hadn't for many years, and it was healing really well, I felt pretty euphoric really, which is a super common experience for people who've had gender-affirming top surgery, but a really unusual experience for people who've had a masectomy through breast cancer. So a lot of the literature that I was given is aimed at cis women who've had breast cancer, and it would say things like the first time you look at your scars or your body after having surgery, after having a massectomy, you might want to have someone with you just for moral support. Whereas for me, I just kind of looked down the front of my top and went, Oh yeah, it looks great, thanks. Um and it almost felt quite lighthearted. Um, so I was aware that I was having this really surreal experience where obviously I I wouldn't have wanted to have had cancer, but the the positives that threw up for me as a trans person were really, really surreal. It I I spent a little while being upset that I had a cancer that was so feminized because it led to some misgendering of me. Um, I don't think on purpose, just because people are expecting a patient who has breast cancer to be a woman. Um, but then I thought to myself I could have been diagnosed with a different type of cancer where the treatment wasn't a surgery that I'd already been planning for myself, whereas actually I'm getting to have a surgery now and I get to have it in the UK at home for free, funded by the NHS. Um, so I was really grateful about that. So it meant that I had a really had a really positive time the year that I had cancer treatment in some ways because it accelerated my transition, my medical transition, in ways that I couldn't have planned for, wouldn't have asked for, and couldn't have predicted. But once they were happening, meant I was able to really be very glass half full about it all. The people that I spoke to who'd said, oh, I would have liked a double one, but they'd said we'd have to do it later, or they said I'd have to speak to a psychologist about it, they were all cis women who weren't wanting it for gender-affirming reasons. Yeah, so there's been this theme of um my cancer treatment being accidentally gender affirming, and my experience of having breast cancer actually moving along my medical transition in a really helpful, um, useful way, um, which I couldn't have anticipated. And I think, I guess, hopefully, if people listen to this recording, that's something that if there are transmasculine people with breast cancer, it it's helpful to know as a kind of a possibility model that you can ask for a double masectomy if you're offered a single one. And I think this is partly why I'm so I was gonna say I'm so glad that I had breast cancer once I was already a healthcare professional. That's such a complicated sentence. Before I started training as a midwife, so if we go back kind of 14 years before I started my training, I was very underconfident in healthcare settings. Um, I'm a fat person in a bigger body. I often anticipate and experience fat phobia. So for years, my model had just been to not really interact with healthcare unless I needed to. So I'm so glad this happened at a point when I felt confident accessing care. And at each point I felt confident advocating for myself the fact that I even know it's possible that if a surgeon says this is the plan, we're going to do this, that I can turn around and say, Oh, actually, no, I want you to do something else. And I think I maybe only know that because I work in healthcare, because I can imagine that if you don't have much experience of accessing medical care and someone quite senior who's in charge of your care tells you this is what's going to happen, you might not even know that you can say, Oh, actually, I want something else. So I think letting other trans mass people know that if they offer you a single mastectomy, you can ask for a double one if you're having treatment for your cancer. Um, and it might go better than you expect. Unlike a lot of typical cancer patients or typical breast cancer patients having massectomy, I had multiple close friends who'd had mastectomies, but they called them top surgery because they were gender-affirming. So I immediately had people I could talk to about um my healing, what to expect, what not to expect, people to commiserate about like, oh God, drains are really uncomfortable, aren't they? Oh yeah, but don't worry, they'll be out in 10 days. Um, it meant that I had friends around me who kind of understood the surgery I was having, even if not the reason that I was having it, because I didn't know anyone else who'd had a mastectomy for cancer treatment. Everyone I knew had it because they were trans. It meant that that demystified it a bit. Um, I had someone be able to recommend exercises to do afterwards. Um, when I explained to my friends that I couldn't lift my arms. Higher than a certain point, like little T-Rex arms, we were able to make jokes about that because they'd had the same experience. So I think rather than it being this hard traumatic thing that was done to me, it was something I had in common with a lot of my friends, which was really nice. Maybe there could be a lot of kind of solidarity built between like cis women having um lasectomies and trans guys having masseptomies. But I think the really difficult line to tread here is how we feel about it. And this has been a hard thing for me to navigate. Like at one point I was invited to join an online community for breast cancer patients who'd had flat closure, which is what we typically call having a double massectomy and no reconstruction. And I really gently said, Oh, I it's really nice that you're saying that space is for me if I want it. Um I feel so happy about my flat closure and I don't feel anything negative about it that I'm I'm not sure that I actually want to bring that energy into a group with people might that might have a lot of grief or complicated feelings. I've already got all the support and community I need for living a post-misectomy life, and I don't want to I don't want to bring my joy into a space that should be about other people's grief. And this has been a really complicated thing to navigate. Um and I think generally other friends and people I've met through breast cancer are happy that I'm happy. Um no one begrudges me my joy, and people have sort of said, like, you know, get the joy where you can, and it's really great that there have been some positives for you. But I think it's really um it's really starked me when I think last year for me was easy in some ways because it was accidentally gender-affirming, and I got to experience joy in my body that I hadn't since childhood in some ways. And for other people, um, uh well for women, breast cancer wasn't that experience at all. For them, it was a loss of identity, a loss of sexuality, grieving a body. Um, whereas for me it it pushed open a door that I'd been trying to nudge at for years. Um, so that's been a really, a really strange thing. I was allocated a breast care nurse at the start of my um cancer treatment who was really helpful. And I came out to her as trans on our first phone call, because like many trans people, I haven't updated my NHS gender markers, which means that I've gone through all this with an F on my medical records, which means that I have to come out to people if I want them to know that I'm not a woman. Um, and initially, when I was referred by my GP, I wasn't bothered about them thinking I was a woman because I thought I was just going to be in and out for a quick check. But as soon as they diagnosed me with breast cancer, I was like, right, please can you write on my notes that I'm trans because I can see this is going to be a whole process and I would like my care team to have that information about me. Um, so I felt that um I was well supported as a trans patient, but I think that genuinely the people in my initial care team hadn't heard of UCATS. Because when I went to my oncologist, a consultant, and said, um, I'm planning on referring to this service, is this okay? I just need a few details from you. She was like, Oh yeah, that's great. So I think it's just a case of getting the word out that it exists. I had already heard of outpatients before I was diagnosed with cancer because I've been to a queer fundraiser and I'd seen a film that maybe Stuart had made that they were in. And so they were already on my radar. So once I was diagnosed with um cancer, I couldn't remember the name of the charity, but I messaged my friend who'd organized the event and said very vaguely, Oh, can you remember the name of that um charity that supports trans people with cancer? And they they were very good and didn't say, like, oh yeah, why are you asking? They were just like, Oh, yeah, it's this. So I kind of took that. So I was able to access support from outpatients quite early on, um, which I have found super helpful. This is the space that I've met other trans people with breast cancer, um, which has been really useful to me. I've coped with it so well that I think externally some people might think that I've not found it hard, but I've found it really hard. I've just managed to cope with it really well. So spaces where I can speak to other trans people about their experiences have just been invaluable. Because I mentioned earlier that I've met a lot of people with breast cancer, but the majority of those have been cis women. Um, I was invited to event an event by a charity for younger women with breast cancer, and I sort of queried if it was for me as a non-binary person, and I was encouraged to attend, but it was a two-day event, and by the end of it, I just kind of realised that while I was grateful for the support and community, I just didn't really belong in women's spaces at this point in my transition, which um was a helpful thing to realise, but also hard because it then felt like there are some areas of breast cancer support that I could access, but I would have to tell people that I'm trans because I'm at my medical transition where I'm passing, which means that I'm read as a masculine person or a man, which is really great. It makes me feel much more comfortable, generally speaking, um, until I'm trying to access support for a very feminized cancer, and then I find myself having to either make a decision about whether my discomfort is more important than my need for community support. So, yeah, outpatience has been really good because I've not had to choose or compromise. I can just show up. The other thing that's been really interesting, navigating all this as a fat person, I've not experienced any fat phobia in my cancer care at all, which um is how it should be, but is also really refreshing and amazing. Um people listening may or may not know, but there's a BMI cutoff for having gender-affirming top surgery in the UK on the NHS, and my BMI is above it, which is why I was planning on going abroad. So my BMI is such that unless I lost a significant amount of weight, I would never have been able to access gender-affirming top surgery in the NHS without significant weight loss. However, because I needed it for cancer treatment, I was able to access it in a hospital very close to my house, which made my recovery so much easier. Um, not mentioned yet, but I'm also autistic, so I love routines and I love to be familiar with my surroundings and what's happening. So I think that also really helped my recovery as well. That rather than having to travel abroad and have surgery in a foreign country and have my initial recovery happen abroad, I was able to access the surgery in the UK and be home by 7 pm back to my house and my cat. That really helped as um as an autistic person. But yeah, I say I didn't experience any fat phobia. The one thing that was a slight regret with all this is that I was asked right at the start of my cant's treatment if I wanted to access fertility care uh to preserve my fertility because they knew that chemotherapy would likely make me infertile. But my BMI is above the cutoff for accessing fertility care. So that decision was something that I was able to make quite quickly. I think because I work in reproductive health care, I was a midwife and now I work in sexual health, I'm well versed with fertility services, um, and I knew that for me my priority was staying alive, treating my cancer as quickly as possible. I didn't want to be referred to a service that I would have to lose weight to access. Um, but it means that that was one kind of bittersweet thing wrapped up in last year. So, whilst I had a lot of gratitude for the way it accelerated my transition and the fact that I survived cancer, it kind of closed off a decade of me wondering would I be able to have children? And the answer was finally no, because we need to prioritize treating your cancer. And I would do that again. It was it was absolutely the right decision, but it was something that made me think this is more complicated for me than it is for other people. Um, and that was hard, but it's something that I've I've managed to come to terms with. Um, and I, in a way, I was glad that it was such an easy decision, even though it was hard to make. There was never any question of, oh, well, should I delay my treatment because I just wanted the best, the best dogs of survival for myself. One thing that's been really interesting about being someone that was planning what I call top surgery and then ended up having a double massectomy for cancer treatment, is that I couldn't get too hung up on what it was going to look like because I was getting the surgery that I was getting, and I was getting it in three and a half weeks' time, and it had to happen because I had an aggressive cancer that needed removing. And for me, that was quite freeing because beforehand I'd been thinking like, oh gosh, should I be doing more targeted exercises to work out, to strengthen my muscles, to improve the aesthetic results of my top surgery, to make it as good as possible. And I'd started doing that a little bit, but not my heart really wasn't in it. Um, not really a kind of huge gym culture bro. And being told that actually you're having surgery, it's in three and a half weeks. We're sorry, but you can't have a nipple graph, you're just gonna have what you're having. Um, was quite freeing in a way, because it just meant that a lot of the choice was taken out of it and I didn't have to think about what the results were gonna look like. The thing that was such a pleasant surprise is that when I looked at my results afterwards, I still felt they were absolutely perfect because I've not had any what you would call sort of masculinization, so my chest is completely flat. Um, but when I look at it, I just feel incredibly joyful. I think I partly feel gratitude that I found the cancer in time and that it was treatable, but I also feel joyful that I have the flat chest that I've known I've wanted for years, and this is something that I share with friends when they're planning their top surgery. Like I had a friend getting quite sort of worried about which surgeon they should go with, whether they should go in the north or the south of the country. And I just kind of said to them, whichever surgery you get will be perfect because you'll have a flat chest, and that will be exactly what you wanted. And I think, I mean, trans guys we're not immune to kind of body image issues. Like, if anything, it's it's worse for us than it is for cis guys. And I think aesthetic top surgery result can be a place that this sort of this plays out. So I think actually just reassuring people that you'll get a flat chest and it will bring you peace and it will be beautiful and perfect, and it doesn't really matter what type of scars you have, or it doesn't matter what the exact nipple placement is, or it doesn't matter if you manage to work out for six months in advance to improve your pec muscles, just get the surgery. Um, that's been really helpful for me. And I don't know, I I obviously can't speak for everyone, but I think this insight is something that I do want to share with people because I think it causes people a lot of stress and confusion, and actually sometimes it's a lot more simple than you realise. And it feels like there were always going to be other things happening whilst I'm medically transitioned because life doesn't stop. But for me, my cancer treatment and my medical transition are now so inextricably linked. I I couldn't separate them. Like the medications that I take crossover, the surgery that I'd planned ended up being the surgery that I had for something else. I can never separate out these two things, which is quite a strange thing to reflect on. I think it will be interesting to see how I feel as the years go by and I continue to transition medically, and hopefully my cancer treatment becomes a smaller and smaller part of my life. Um, that's already happened to some extent this year compared to last year after finishing my active treatment. Um, but I'm still quite in the system. I have a lot of follow-on oncology appointments, have a lot of reviews, a lot of medications. Um, so yeah, I'm looking forward to a point when I can just be transitioning and not also having cancer treatment. The only thing that has been hard with talking about the crossover between being a breast cancer patient and a medically transitioning trans mass person is that I was quite keen to get the word out in my extended community that I had had cancer because I've lived in the same city for many years. I know a lot of people, and it's a really nice, queer trans community. And people knew that I was planning top surgery, and I didn't want people to think that I just had top surgery. I wanted people to know that I'd had cancer. Um and I can't fully articulate why. I think I wanted, I guess I wanted people to hold me in their hearts and extend care to me and not resent me for being able to access private top surgery when there's other people in our community that can't. I wanted people to know that, oh, they did have top surgery, but it was cancer treatment, and they're now quite unwell, and it's really complicated. And there was a period of time when they might not have been okay. Because I think my fear was that I'd have spoken to someone before I was diagnosed with cancer and then run into them a year later and then just think, oh, you had top surgery last year, oh well done. And I'd have to say, Oh, well, I did, but didn't you hear? Um so yeah, that was a sort of strange dance that I was doing early on in my diagnosis. I was telling friends and then saying, and please tell mutual friends, please share this information. Um, because I think as well I was nervous because early on in my cancer treatment, I actually looked very well. Um I think I looked really happy, really joyful. I almost had a bit of a glow-up because I'd had my surgery, I felt really good, it healed really well, and I hadn't yet started chemotherapy and lost my hair and my eyebrows, which unfortunately I did lose all my hair and my eyebrows. And I was worried about just running into someone much later in my treatment and looking very obviously unwell and then having to have an awkward conversation. So for me, part of the kind of groundwork early on was telling people and getting them to tell people to kind of get the word out. And I think it's different for everyone. Some people do want to keep it private, but for me, I sort of thought I've I've got a lot of community support here. I would like to let people know what's going on and let people show me care and support, and also avoid future potential awkward conversations where I haven't seen someone for a year and they're like, Oh, how have you been? And I'll be like, Oh, well, you know, I had cancer, and then they're like, What? So yeah, luckily I've not had that because I did this work earlier. Accessing community support was one of the best things I did during my cancer treatment because I'm single, I don't have a partner, um, but I do have a lot of really great friends in the city that I've lived in for about 20 years. So one of my friends early on said, You've probably got a lot of people saying, Let me know if I can help, but you know, let me know if I can help. And I said, Oh, well, you know, I do want help, but I don't even know what help I need. I don't know what help I'm gonna need. Um, and this friend had the advice of just setting up a group chat. So everyone who said, Let me know if I can help, I'd say to them, That's really great, actually. Are you happy to be in a WhatsApp group? And I ended up having about 20 people in this group chat. It was called something like Friends of Rudy. And it meant that I could coordinate acts of care basically. Um, we were able to set up a team of people to support me during and after my surgery. So one friend took me and collected me, another friend stayed with me overnight because I was discharged the same day, but on the condition that there had to be someone at home to look after me. It meant that I could find someone to take me to chemotherapy each time because I had six lots of chemotherapy over three months, and I never wanted one friend to feel overly burdened, but I could just post in the group chat, I've got chemo on these days. Can anyone come with me? Um, and it was a really lovely way for people to to show up because I think actually people do generally want to help, they just often don't know how to. So that's one of my other kind of big bits of advice to access the support that's hopefully there. I think I'm really lucky in that I have a lot of support around me, but I think often even a simple thing like setting up a group chat to help coordinate things can really take the strain out of it because when you're having cancer treatment, you're really tired and overwhelmed. And if there's anything that can make it a bit easier, um, it's worth doing. I think it kind of illustrates the way that um queers do support and community and family differently, because I can imagine a lot of healthcare professionals are used to the patient having one partner that they bring to every appointment. Whereas for me, I brought a whole army of people, a whole array of people, um, and very rarely the same person twice. And I think my care team just got quite used to seeing me with like a different person. Um I think it's maybe also worth me mentioning UCATs here. So UCATs are an NHS service, it stands for UK Cancer and Transition Service. Um, as far as I know, it's been up and running less than five years, and I found out about it because someone at one of the Maggie's cancer centres, um, we've got one um near my hospital that I've been accessing care at, um, came over to me for a chat. I've always found Maggie super, super helpful and approachable, and their model is kind of if you pop in, someone will come over, check how you're doing, and then stay in chat if you want to chat or leave you to it if you want space. So someone popped over and asked how I was doing, and I think I was just incredibly honest, and I was like, just finding it really overwhelming being trans and having cancer. And I don't know what I expected the person to say. I didn't expect them to say anything helpful or productive. But she said, Oh, have you heard of this service? I'll go get you a leaflet. And she brought me over a leaflet about UCATS. Um, my expectations were quite low. I thought maybe it might be some kind of talking therapy where I could speak to someone, which would have been would have been helpful. I don't want to be dismissive of that. But actually, what it turned out to be was so much better. It's basically a multidisciplinary team of um doctors and nurses who specialise both in oncology and transition care, who can make sure as far as possible that your cancer treatment doesn't derail your medical transition and the two intersect as well as possible. So I got in touch with UCATS um after I'd already um had my surgery um just because of how things happened. But I think if I'd have known about them sooner and I hadn't have felt confident advocating for myself around my surgery, that's something they could have done and that they could potentially do for other people. Um but no, they're um they they meet, um, I think they meet sort of monthly to discuss your care, and they're able to advise your oncology team on things like for me. I had questions like, I need to be having chemotherapy, can I still be taking testosterone? Um, and they were able to just give a very evidence-based, accurate answer to reassure my care team and myself. Um, they were able to support my GP in um prescribing my testosterone rather than me accessing it from a private service, which meant that my care immediately became more joined up and safer. Um, because I mentioned at the start of this um about waiting lists for trans health care, but I knew that I needed to medically transition faster than I could access care from the NHS. I'm still on the waiting list for the gender identity clinic, and I've currently been on testosterone for three years, and until I had cancer, I was accessing it through a private provider, um, which did the job, but it was it was a cost for me that was difficult to manage. But on top of that, it meant that it didn't show up on my NHS notes. So if ever you access my care record, see what medications I was taking, it wouldn't be there, which presented a problem once I was diagnosed with a cancer that was estrogen sensitive. So I have a cancer that's um fuelled by estrogen essentially. So my transition health care and my cancer care became inextricably linked at this point because I'm on one type of medication to control my estrogen levels, which is for my cancer care, but then I also take testosterone for my transition care, and there's a very kind of delicate dance with balancing those two hormones. And the fact that I'm under a team that specializes in this just gives me such faith and trust in the process. Um I'm not having to figure it out myself like I was when I was accessing private health care, and it just makes me feel really, really looked out for. So accessing that service has been another real blessing of the last year. I imagine it has been quite helpful for my cancer care team within my local trust in the NHS because I don't think they have trans patients or medically transitioning trans patients that often statistically. Um, and I know myself from working in healthcare, we're all very capable of like looking things up and finding them out, but it's not necessarily easy to access. Or if I were to call up and ask someone, they'd have to go away and find out. So I think having this specialist that I can say I've spoken to a specialist, they're happy to send you a letter, has been really great. And there's been some really wonderful collaborative working between my local team and UCATS, um, which is helped by the fact that they're all in the NHS. So all the systems speak to each other. So as a trans mass person, I was assigned female at birth, and because I have an Eastern sensitive cancer, the medication that they've put me to reduce the risk of my cancer coming back has put me straight into medical menopause. Um, so I've been seeing my GP for support with some of my menopause symptoms, and I think it was really helpful for him that I could say, I've spoken to my specialist and they've advised. This medication, this cream, and they would like to see if you can prescribe it. Because I think GPs are brilliant, but like a lot of parts of the NHS, they're overstretched and they can't be specialists in everything. And I think someone coming in for a 7:30 in the morning appointment where it says mister is my title, and then he asked me what I want to talk about, and it's menopause symptoms, but then he's flipping through my notes frantically, and he can see that I'm medically transitioning, and he can see that I've just been treated for an Eastern sensitive cancer. I think it was really helpful for me to say I've had a preemptive chat with my specialist. They said, Would you be happy to do XYZ? So UCATs have just been really wonderful for joining up all the dots and also providing a bit of continuity of care for me. Um I see the same people every time I see UCATs, um, which is really rare in the NHS. So it's meant that I've had a constant that I can kind of just know that I'm gonna see the same person and they know me and they know my gender and they know a little bit about me, and that makes me feel cared for. Um, so yeah, being being under UCATS has been one of the best parts of having cancer. And um, I I recommend the service to other people, I just don't want them to get overwhelmed, but hopefully I'll be able to expand. So basically, I had all my treatment in the space of about seven and a half months, which felt in a way quite quick, but also the time went quite slowly in other ways. Um, so the first month um after I was diagnosed, I chose to carry on working, partly to keep me busy, and then I went off sick from my job in sexual health um and had my surgery, and then took six weeks' sick leave to recover from that. I went back to work very briefly, probably for about 10 days. It might have been better to just stay home and rest, but I wanted to go back for a little bit, and then I went off um for chemotherapy, and that took that took months and months. So my timeline was diagnosed in May, surgery at the very end of May, chemotherapy from late June, early July till Halloween actually. Um and then I had a month to recover from chemotherapy, and then I had four weeks of radiotherapy, which finished just before Christmas. So it it kind of took up most of 2024 for me. Um and I I took that time off work to focus on getting through the treatment because it was quite hard, and then had Christmas, had a couple of weeks at the start of January, and then felt well enough to go back to work. And I've been back at work for seven, eight months now, full-time, um, which I am finding challenging. Um, one of the things that I didn't realise before I had cancer is that the treatment for cancer can make you feel worse afterwards, um, which maybe sounds really simplistic, but like I've now developed fatigue symptoms. Um, the tablet someone that put me in menopause give me poor sleep and joint pain. Um, I've got what people call brain fog or kind of cognitive impairment, quite literally. Um, and I'm juggling all these things right at the start of my 40s, which people will sometimes sweetly say to me, like, Oh, well, have you thought about going part-time if you're finding it hard? But I'm not your typical breast cancer patient who got diagnosed in my late 50s or 60s or 70s. I'm not ready to retire or even go part-time. I'm kind of I'm just at the really good, interesting bit of my career, and I wanna I want to do that and I want to be full-time, and it's it's been really challenging this year. I think last year, my overwhelming feeling was kind of gratitude that I was gonna survive and that I was being so well cared for. And this year, I'm just feeling really tired, and I feel like I'm kind of staring the next 10 years down the barrel of a gun. Because once you finish your active treatment for breast cancer, you're then often put on medications for 10 years that cause uh medical menopause, that cause all the symptoms I've described. Um, and you can stop them, but that increases your risk of breast cancer coming back. So I've chosen to stay on them. Um, but it means that in some ways I'm feeling worse physically than I did during my active treatment, which is really surreal. But I think that's partly because I was able to stop everything in my life and just focus on the cancer treatment last year, whereas now I'm doing everything in my life as well as carrying on with my cancer treatment. Um, so yeah, it's a bit of a balancing act. Um, but there's there's still joy and gratitude there, and I'm still really happy that I had a treatable cancer because as it currently stands, I don't have cancer, which is really wonderful. I do live with the concern that it could come back, um, which it is a difficult thing to manage because it's a literal medical fact that I am more at risk of having breast cancer again and it could come back. And I just kind of have to take that knowledge and put it in my pocket and try and live my life, which I managed to do reasonably well. Um when I was first diagnosed, one of the really nice realizations was that I just wanted to have another 40 years of this, 40 years of this wonderful life that I've made for myself. I didn't sort of think like, oh my gosh, I need to change how I'm living, I need to make amends, I need to move to a different country, I need to change my career. I just thought, oh wow, I really like what I've got going on here, and there's a chance that I might have to stop before I'm ready. So I guess now what I'm trying to do is just live the second half of my life with the knowledge that I've had cancer and could have cancer again, but I've got a really good thing going on here. I'm very happy with my friends and community and my life and my passions and hobbies and my career, and I've had to make some adjustments to carry on doing the things that I want to do. Um, I go to bed a lot earlier, I do a lot less social activities, but I'm still living my life. Whilst I was off sick, um I finally had time to work on a passion project of mine that I'd been working on for years, which was designing and publishing a Diana Princess of Wales themed tarot deck. So um, when I felt well enough, I sometimes spent like up to 20 hours a week just collaging these artworks, designing card after card of Diana represented through the tarot archetypes. And in Happy News, I finally finished the deck and got it published this week. So that feels like a really nice kind of full circle because I could never have taken a seven-month sabbatical from my NHS job to work on this project. But given that I had the time, it let me focus on it on a way that I'd never managed to knuckle down and do before. So a really happy thing to have come out of this period off sick is that I finally finished this project that I've been talking about for about eight years, and I now have a physical, a physical object that I can show people. So that's been really joyful.

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You've been listening to Outspoken, a podcast by Outpatients, the UK's LGBT IQ Plus cancer charity. Don't forget to rate, review, and follow us on Spotify, Apple Podcasts, or wherever you're listening. Find out what else Outpatients is up to on our Instagram and TikTok. We're at Outpatients UK. If you'd like to find out more about the topics and organizations mentioned in this episode, or have been affected by any of the issues we've discussed, please check out the links in the description. If you're an LGBT IQ plus person affected by cancer and you're looking to connect with your community, you found us. Visit outpatients.org.uk forward slash support to find out more.