Underage Transgender Top Surgery

Dr. Javad Sajan 00:01

Ever wonder what motivates people to get plastic surgery? Did they regret it? What can we learn from the stories of plastic surgery patients? We're here to explore those questions and get some answers today with my guest Tyler Burke on the plastic surgeon podcast.

Dr. Javad Sajan 00:34

Hello, my friends welcome back, and thanks to our listeners for the amazing feedback. We have had so much fun so far, and look forward to more of your insights and suggestions. Please rate and review us on Apple Podcast to help us get you more amazing content. On the plastic surgeon podcast, we listen to real plastic surgery, stories of triumph and pain from real patients and providers to further understand the motivations of why they would risk their life under the knife. I'm Dr. Javad Sajan and today my guest is Tyler Burke. We're here to talk to you about your journey, how we came to know each other, the procedure you underwent and how it helped and affected you. How's it going, Tyler?

Tyler Burke 01:13

Pretty good.

Dr. Javad Sajan 01:14

Tyler. I appreciate you being here today. And what we're going to do today is we're first going to talk about you, then we'll talk about the procedure we underwent and then we'll go into how that's impacted your life. That sound good with you.

Tyler Burke 01:26

Hmm.

Dr. Javad Sajan 01:27

So, Tyler, you came to me because you were considering having gender affirming surgery, is that correct?

Tyler Burke 01:34

Yes.

Dr. Javad Sajan 01:35

Now, would you mind sharing with us, what was your gender assigned at birth?

Tyler Burke 01:38

I was born female.

Dr. Javad Sajan 01:40

And then you transitioned, is that correct?

Tyler Burke 01:42

Yes.

Dr. Javad Sajan 01:43

And what did you transition to?

Tyler Burke 01:44

A male.

Dr. Javad Sajan 01:45

When did you start that journey?

Tyler Burke 01:47

So I came out to my friends like sixth or seventh grade, so I was like really young. And then I came out to my parents when I was about what was it like 13 eighth grade. Beginning of eighth grade.

Dr. Javad Sajan 02:04

And how old were you when you decided or when you underwent surgery?

Tyler Burke 02:09

I was 16.

Dr. Javad Sajan 02:10

And you're 16 now, correct?

Tyler Burke 02:11

Yep.

Dr. Javad Sajan 02:12

So you are someone who's a minor who underwent gender affirming surgery by me?

Tyler Burke 02:17

Yes.

Dr. Javad Sajan 02:17

And that's something so thought provoking that people often ask about, many doctors as you may know, don't do surgeries on minors. However, there are some that do and I do because I believe gender affirming surgery, Tyler's medically necessary. It's an operation that changes lives that can help build lives and help people get to their true identity. So tell me, how did you first understand or learn about what it means to be gender nonconforming or transgender?

Tyler Burke 02:47

Well I was, I think one of my friends came out in like sixth grade and I was like, you can do that. Like what? And then, before that I saw like people who transitioned from male to female, but I didn't know you could do it the opposite way because there's a lot more representation for female, I mean male to female than female to male. So I just didn't see that. And then I searched on YouTube, like female to male transgender, and then like a couple of YouTubers came up and I was like, Oh, this is like a real thing. Like I can do that because I was always a tomboy, like always since I've been able to dress myself basically. And like, I just didn't feel right, but yeah.

Dr. Javad Sajan 03:34

And your friend that told you about this, when did your friend where did you have this friend from? Was it from school? Was it family friends, neighbor?

Tyler Burke 03:45

It was from school.

Dr. Javad Sajan 03:47

And your friend transitioned, is that correct?

Tyler Burke 03:49

Yes, not medically, but socially.

Dr. Javad Sajan 03:54

And was it private or public school?

Tyler Burke 03:56

A public school.

Dr. Javad Sajan 03:57

And when your friend transitioned, Tyler, did they talk about it in school? Did the teacher say what was going on or anything like that?

Tyler Burke 04:03

The teachers, yes, all of my teachers. I'm very lucky. I live in a very accepting part of America. So all of my teachers were very nice to him, so-

Dr. Javad Sajan 04:16

Okay. So when this person was transitioning, was it during the school year or did they come socially transitioned?

Tyler Burke 04:22

Yes. He came out mid school year.

Dr. Javad Sajan 04:25

Got it. And did the teacher say this person is transitioning or no one said anything. It just happened.

Tyler Burke 04:31

Yes. The teachers like told people that like respect them and yeah, the teachers were all really cool about it.

Dr. Javad Sajan 04:39

That's awesome. And did your friends start using a different bathroom right away or how did they handle that?

Tyler Burke 04:44

So he didn't use the male restroom, but he also didn't use the female restroom. There's a gender neutral bathroom in the office of the school. So we just went there.

Dr. Javad Sajan 04:58

Okay. And when you heard about this, when your teachers announced it, is that what sparked your thought on it?

Tyler Burke 05:05

No. He talked to me about it first and I was like, I wasn't feeling right already. I just felt so weird. And that was about when puberty hit and that was very stressful for me. And I didn't understand why.

Dr. Javad Sajan 05:18

How were you feeling weird? Tell us more.

Tyler Burke 05:21

It's so hard to explain. I just felt like gross. I felt like not me, like didn't feel that bad until puberty started. And then I just like, I didn't feel like me.

Dr. Javad Sajan 05:36

Were there things that were happening in puberty that made you feel more uncomfortable that you were seeing or feeling?

Tyler Burke 05:43

Yeah, my chest started to like grow, I guess. And I didn't like that. I hated it.

Dr. Javad Sajan 05:50

And did you start binding?

Tyler Burke 05:52

I didn't start binding until like seventh grade and I was binding unhealthily cause I didn't have a binder. I used like ACE bandages

Dr. Javad Sajan 06:02

And then in sixth grade was when this happened, correct? Your friend.

Tyler Burke 06:06

Yes.

Dr. Javad Sajan 06:06

Okay. So you had a conversation with your friend and was this person, your friend before they transition or after?

Tyler Burke 06:12

Yes, before.

Dr. Javad Sajan 06:14

Sounds good. And you all just played together or hung out or something like that?

Tyler Burke 06:17

Yeah, we hung out. I had a very small friend group.

Dr. Javad Sajan 06:20

How did your friend explained to you that your friend was transitioning?

Tyler Burke 06:26

The details are a little bit fuzzy because it was a long time ago. I think he was just like I want you to call me this because I'm not comfortable with this at all like stuff like that.

Dr. Javad Sajan 06:39

That makes sense. And the things, when you say socially transition, because a lot of people may not know that and I think it's so amazing that you're sharing this Tyler and I know it's really hard. And thank you. Does that mean there were changes? Tell us what that means first.

Tyler Burke 06:51

Oh, okay. So socially transitioning is different from medically transitioning because at the time he was in sixth grade, no doctor would like prescribe him hormones. And like, I completely agree with that. Honestly, I don't think you should get hormones that young in my personal opinion, I don't know. So he just like started binding any started. I don't know how to describe it. Sorry he started binding, he asked people to call him by his preferred name and his preferred pronouns. He didn't go by female and yeah.

Dr. Javad Sajan 07:30

And then you had this conversation, it made you learn that something else was possible. And then the year went by, you went to seventh grade?

Tyler Burke 07:38

Yeah.

Dr. Javad Sajan 07:39

And when did you start feeling that this is something that you identified with?

Tyler Burke 07:45

Definitely like late sixth grade, early seventh grade.

Dr. Javad Sajan 07:51

Did you tell your family?

Tyler Burke 07:52

No. I told my family eighth grade. I was really stressed about that. I don't know why they're completely accepting now, but-

Dr. Javad Sajan 07:59

And when you were going through these things, did you do anything more to explore what it means to be transgender?

Tyler Burke 08:05

There's a really great YouTube community for transgender people which really helped me. It helped me like learn how to like pass and like, yeah, like what clothes to wear to like accentuate like my shoulders and not like my hips or my chest, stuff like that.

Dr. Javad Sajan 08:23

When did you start doing this?

Tyler Burke 08:27

Probably eighth grade.

Dr. Javad Sajan 08:28

And was it after you told your parents?

Tyler Burke 08:30

Yeah, after I came out.

Dr. Javad Sajan 08:31

So you struggled with it internally for once you learn a year or two, right?

Tyler Burke 08:36

Yeah. I did tell my friends though. So they were, yeah.

Dr. Javad Sajan 08:39

What do you tell them?

Tyler Burke 08:40

I told them that I was trans and I wanted to go by this name, Tyler.

Dr. Javad Sajan 08:45

But no one else knew at your,

Tyler Burke 08:47

No one else knew.

Dr. Javad Sajan 08:48

What pushed you over the edge in eighth grade to tell your parents?

Tyler Burke 08:52

I just was super dysphoric. And I was like, if I don't tell my parents, I'm never going to tell my parents, and I like needed things to change.

Dr. Javad Sajan 09:00

Did you ever have thoughts of hurting yourself or changing some of the puberty changes that you were seeing?

Tyler Burke 09:05

No. I did use ACE bandages even though I knew it was unsafe, but I didn't ever hurt myself or have thoughts of hurting myself. I'm very lucky. I know a lot of people, trans people did.

Dr. Javad Sajan 09:18

Yeah. I remember during the coronavirus where we were restricted on doing surgeries, I had to cancel all my gender affirming surgeries and I had one patient they attempted suicide and we had to call the police. They called us and said, I'm going to attempt suicide if you can't do my surgery. And we were restricted by the orders by the state that we couldn't do any surgeries, elective surgeries, when the outbreak was really getting started here and we had to call the police to go there and protect our patient, everything went okay. But it was really woke me up more and more how necessary these surgeries are.

Tyler Burke 09:58

Yeah, they are very important.

Dr. Javad Sajan 09:59

So in eighth grade, you came out if you will, to your family. Tell me how you did that? Did you go to your mom or dad first? Or how did that happen?

Tyler Burke 10:09

It's kind of embarrassing. I went to a restaurant with them and I told them, and it was like really awkward. And then I had to like stand outside and just like breathe. Cause I was like, so scared. Everything went, okay. Everything looked good, but I was just like, all the stress was building up beforehand.

Dr. Javad Sajan 10:25

And was there something that sort of pushed you over the edge to tell them?

Tyler Burke 10:33

I think it was just my dysphoria. It was getting so bad that I felt like I couldn't even get up in the morning.

Dr. Javad Sajan 10:38

Did they have any hints? Did you start changing the way you dressed or anything before that?

Tyler Burke 10:42

Yes. I've always dressed very tomboyish since like the third or fourth grade. I don't really remember when. Did you know when? Yeah. Third or fourth grade.

Dr. Javad Sajan 10:55

What were there other male quote, unquote male identifying things that you were involved in before this?

Tyler Burke 11:02

I'm not quite sure what you mean by that.

Dr. Javad Sajan 11:05

You know how some people, I don't know, you know, I don't agree with this, but there are certain social norms that some people think are more male versus female, like blue color more.

Tyler Burke 11:14

Yeah. I really, I didn't like pink for a while. I think I kind of like it now. I think it was just like, I need to be like a boy. I need to be, I need to do everything that a typical man does. And now I'm more chill because I've transitioned to a point where I feel comfortable in myself. So I'm a little chill about that now.

Dr. Javad Sajan 11:37

That makes sense. And that restaurant conversation you had with, was it just your mom and dad who were there?

Tyler Burke 11:42

It was just my mom and dad. Yeah.

Dr. Javad Sajan 11:44

Okay. And you don't think they had any hint what was going to happen?

Tyler Burke 11:48

I think they thought I was a lesbian. They thought that, that was what I was going to talk about. Kind of blindsided them there

Dr. Javad Sajan 11:56

After you told them what was their first response?

Tyler Burke 11:58

They were like, of course I will accept you. And then they didn't really call me by my preferred name at first because we were going on a vacation and we were going to see my grandfather who still doesn't know that I'm trans. So they didn't want to mess up in front of him. So that kind of hurt me, but we're all good now.

Dr. Javad Sajan 12:21

I can understand that. And when you told your parents, did they try to get you in any counseling or therapies? What actions happened?

Tyler Burke 12:30

Yes, I went to my gender therapist who I'm still with today. I love her. She's the best.

Dr. Javad Sajan 12:36

So how did you find your therapist?

Tyler Burke 12:38

We got recommendations from my pediatrician.

Dr. Javad Sajan 12:42

And that was after you told your parents they helped you get some therapy?

Tyler Burke 12:45

Yeah.

Dr. Javad Sajan 12:46

And when you started therapy, how did that impact you?

Tyler Burke 12:50

It made me feel a lot better about myself. She is very accepting. She's really cool. She kind of helped me open up. I had a therapist beforehand because I have ADHD and I really felt like I couldn't talk to her. She just wasn't the right fit for me.

Dr. Javad Sajan 13:08

Your therapist beforehand, had you mentioned to that therapists that you were having some of these thoughts about?

Tyler Burke 13:13

No, I did not. I didn't want to come out before I left going to therapy with her because I just felt like she would judge me or something, which is completely like, not true. Like, I don't know. I had been with her for so long that I felt like she was like an aunt instead of like a therapist, like I felt. Yeah.

Dr. Javad Sajan 13:36

And your new therapist helped you understand your identity, is that correct?

Tyler Burke 13:39

Yes.

Dr. Javad Sajan 13:41

What kind of new insights did you have after you came on? How did life change?

Tyler Burke 13:47

Life got a lot better. It was also a little bit worse because I did get bullied from some of my peers at school.

Dr. Javad Sajan 13:57

How did they handle this at school?

Tyler Burke 14:02

As I've said before, all the teachers were extremely accepting, but my peers were less. So I think they just didn't understand it as much.

Dr. Javad Sajan 14:10

Did they announce it at your class? Like did it for the other student, your friend?

Tyler Burke 14:15

No, they didn't. I don't think so. No. I just kinda told everyone and then I posted something on Instagram and I was like, you guys should call me this now.

Dr. Javad Sajan 14:28

So it just sort of happened without any kind of formal thing.

Tyler Burke 14:31

Yeah. I did talk to my counselor to tell all my teachers beforehand to call me, he, him pronouns and change my name on like the roster and stuff to Tyler.

Dr. Javad Sajan 14:43

And the teachers were understanding and accepting, but there was some bullying, right?

Tyler Burke 14:46

Yeah.

Dr. Javad Sajan 14:47

What kind of bullying was there?

Tyler Burke 14:48

It was just little things like kids would call me like it and like mis-gender me, or like, I remember one time I was like running the mile and some kid was like basically cat calling me and calling me girl. And I was like, are you serious? Which was that kind of hurt. It got a lot chiller at in high school because people are just cooler enough.

Dr. Javad Sajan 15:19

Makes sense. Did you ever get hit or?

Tyler Burke 15:22

No, nothing like that? No physical bullying. I remember one time someone threw like a carrot at me in the lunchroom and that was about it.

Dr. Javad Sajan 15:29

So a lot of name calling?

Tyler Burke 15:31

Yeah.

Dr. Javad Sajan 15:32

Did you lose any of your close friends when you announced that you were transgender?

Tyler Burke 15:38

No, not any close friends. A lot of friends of mine kind of drifted away, but I don't know if that's because I'm trans or not.

Dr. Javad Sajan 15:48

Did any parents talk to your parents say please stay away from my child?

Tyler Burke 15:52

No, nothing like that.

Dr. Javad Sajan 15:53

Good. Eighth grade finished. And during eighth grade, after you started therapy, did you look into more different ways of transitioning?

Tyler Burke 16:03

Oh, yes. I wanted to start testosterone as soon as possible. And I started that my freshman year, so it took about a year to start testosterone. And before that I was on blockers, hormone blockers.

Dr. Javad Sajan 16:15

And you found a primary care who was supportive?

Tyler Burke 16:17

Yes. My doctor, my pediatrician was supportive from the very beginning.

Dr. Javad Sajan 16:25

How did things change? So the journey for transition is you first socially transitioned. Now we're getting into medically transitioning. Tell me how medically transitioning is different than socially. How did you feel differently with medically transitioning?

Tyler Burke 16:41

Well, I myself wanted to medically transition. I know a lot of trans people don't want to and that's perfectly okay, but I was just very dysphoric and I knew that these things could change if I went on like testosterone and I got top surgery.

Dr. Javad Sajan 16:58

People who don't know what dysphoria is. Can you describe it for us please? And tell us what it is?

Tyler Burke 17:03

It's very hard to describe. It's not feeling like complete in your own body, I guess. It's different for a lot of people. I, myself had a very bad before I started testosterone, I wanted to like crawl out of my own skin. I was so uncomfortable with myself in the way that I looked.

Dr. Javad Sajan 17:24

And what are blockers?

Tyler Burke 17:25

Hormone blockers are they stop your female hormones. So I started them while I was in the middle of puberty. So they stopped my period and they stopped my chest from growing more than it already had.

Dr. Javad Sajan 17:47

And then did you start feeling less dysphoria once you're on the blockers.

Tyler Burke 17:52

Yes.

Dr. Javad Sajan 17:53

Okay. And then testosterone started after the blockers?

Tyler Burke 17:55

Yeah, and I felt so much better after my testosterone started to work. I was on a very low dose at first, so my voice would like naturally kind of like settle instead of some people who start like when they're adults and they start on a high dose and then they get kind of like a kind of weird voice. Sorry, I don't want like, say weird voice, but-

Dr. Javad Sajan 18:23

Different voice,

Tyler Burke 18:25

Yeah, different voice.

Dr. Javad Sajan 18:25

I understand. And did that feeling a wiener crawl out of your own skin? Did that change your testosterone too?

Tyler Burke 18:31

Yes, a little bit. I still was very dysphoric about my chest and I don't feel that way anymore. Thank you for that.

Dr. Javad Sajan 18:39

Okay. I appreciate you saying this. My pleasure. It's really a privilege. And we'll talk about that too. Tell me what else. So your voice started changing with testosterone. Tell me what else changed in your body?

Tyler Burke 18:51

I gained muscle a lot of muscle I gained my shoulders got wider, my hips kind of got less wide. I was pretty skinny before I started and my hunger changed. I got a lot hungrier and yeah, more body hair, stuff like that.

Dr. Javad Sajan 19:17

What do you think about people that say that we shouldn't give hormones or let someone decide about medically transitioning until they're 18?

Tyler Burke 19:25

I disagree with that. I don't think you should give it to like very young kids. I think you should give blockers to people who want it. Like, if I had blockers, when I was like in sixth grade, I would be in a very different position than now but yeah, I think blockers, you should give to people maybe wait a little bit, like at least a year after someone comes out to like, know that this is what they actually want to give them like testosterone and stuff like that.

Dr. Javad Sajan 19:57

I personally do agree with you. I think that makes a lot of sense. I don't think you can put a hard line in the sand. This is when you make the decision. I think it has to be individual. It has to be custom and people have to understand what's best and what's safe for them through a process. And that's my personal philosophy on it.

Tyler Burke 20:10

I completely agree.

Dr. Javad Sajan 20:12

The with testosterone, we had physical changes. You have felt less dysphoria. Did you feel some of the other changes include people feeling more aggressive?

Tyler Burke 20:20

I didn't feel that I was very, I wouldn't say it was a calm person but nothing really changed for me. I think I'm more calm now than I was when I started just because I was like an angsty teen.

Dr. Javad Sajan 20:35

And I know you said high school, people were cooler. Tell me where are you getting any bullying in high school?

Tyler Burke 20:40

No, not really. I treat people with kindness now. No, matter what? I'm just like, if someone's mean to me, I'm nice to them. And then they're like, what do I do now? You know, like, so I don't know. If I'm nice enough to people, they'll stop being mean to me.

Dr. Javad Sajan 21:01

That's amazing. Not a lot of people can do that. It takes a special person to really do that. It's amazing. With high school, do you feel people did people know in high school that you were transgender or did they just know Tyler?

Tyler Burke 21:16

So my first year of high school, I didn't really tell anyone because I just didn't feel comfortable with people knowing and then my sophomore year, I was also pretty uncomfortable with people knowing, just because of my dysphoria, but now I'm very open about it. I have a bit of a following and I take talk because I talk about like transgender issues and stuff.

Dr. Javad Sajan 21:41

That's cool. How many followers do you have?

Tyler Burke 21:43

Oh, I only have like 3.8 K, but

Dr. Javad Sajan 21:46

That's a lot, that's awesome. Do you think people just knowing Tyler and not knowing your past identity made an impact in high school?

Tyler Burke 21:55

I think I liked that. But also I could hear like, people talk very badly about like women in front of me. They were like very misogynistic because they thought I was a cis man. And I was like, like this isn't cool, but I didn't say anything. Cause I didn't want to risk people knowing, and I wish I did say something now.

Dr. Javad Sajan 22:18

Were there other people who were gender nonconforming in your high school?

Tyler Burke 22:22

Yes. I don't really have them as friends because they were all in like older years. I have one friend is pretty cool. He's transgender. I've known him since middle school. Not the friend that I was talking about before, but he's really cool. He got top surgery at like 15, 14. He was the youngest person in our state to get approved by insurance which was really cool.

Dr. Javad Sajan 22:51

Wow.

Tyler Burke 22:52

Yeah.

Dr. Javad Sajan 22:53

Well, in high school, what made you want to tell people that you were trance gender?

Tyler Burke 22:58

I think I just started to feel more comfortable in my own body.

Dr. Javad Sajan 23:02

Why did you want to tell people at all? Why not just keep staying as assessed identity that you have?

Tyler Burke 23:06

I didn't like the way people would talk about like transgender people in front of me. They were like blatantly homophobic and transphobic. And I didn't say anything because I didn't want to risk like them knowing, because I saw what they would talk about, but I was tired of them talking about it in front of me.

Dr. Javad Sajan 23:26

How did people in high school start learning about this?

Tyler Burke 23:29

Well I think an LGBT speaker came into our high school a couple of years ago. I'm not quite sure but people on Tik TOK, people on like YouTube.

Dr. Javad Sajan 23:44

So you let social media be your pathway, there was no formal announcement or anything like that. Do people change how they acted around you?

Tyler Burke 23:51

They did. Yes.

Dr. Javad Sajan 23:53

Tell me how.

Tyler Burke 23:54

Well I'm in online school right now, but on Instagram and stuff. People are like, Oh, cool, good for you. And it's sort of like, yeah, the same people who were like blatantly homophobic and transphobic in front of me were commenting like cool.

Dr. Javad Sajan 24:08

No way.

Tyler Burke 24:09

Yeah. They don't want to do it in front of other people who like, they don't want to get called out.

Dr. Javad Sajan 24:15

Did you do anything different around people once they knew? Did you try to be more active or you just thought that identity be out there?

Tyler Burke 24:22

Well I'm in online school right now, so I can't really be active cause nobody's talking about that.

Dr. Javad Sajan 24:28

Yeah. Makes sense. So you started letting people know once there was online school, not once there were in person school. Makes sense. Did you lose any contacts that were staying in touch with you at all or not really?

Tyler Burke 24:42

Not really. I have a very, I have like two friends and I'm perfectly fine with that. I need to really connect with someone to be their friend.

Dr. Javad Sajan 24:49

And did these friends know earlier on, in high school that you were transgender?

Tyler Burke 24:53

Yes. Yeah.

Dr. Javad Sajan 24:54

So then you medically transitioning, you socially transitioned. Now you're starting to think about surgery. Is that right?

Tyler Burke 25:02

Yes.

Dr. Javad Sajan 25:02

How old were you then?

Tyler Burke 25:03

I've wanted surgery, like since the beginning, since I've like talked to my therapist, like the first day I was like, I need you to help me get top surgery. Like I need it.

Dr. Javad Sajan 25:16

As you were getting older, what made you finally want to decide that you want to pursue it?

Tyler Burke 25:20

Well, I was old enough eventually till like actually get it my insurance covers it 14 and up. Thankfully my insurance is really good with that kind of stuff. And I was like, I really need this. Like, I really need this. I was binding unsafely for like 23 hours in a day. I only take it off to shower and I would like wear it to bed. And I had some problems with my ribs eventually because of that.

Dr. Javad Sajan 25:49

How did you ask your parents or did they know about it?

Tyler Burke 25:52

I talked to my parents about it a lot. They were they said they would do it and then they would go like months without doing anything. And then I talked to them about it again and they were like, okay, cool. So I had to, like, I had to really step in and do a lot of the stuff.

Dr. Javad Sajan 26:09

Did some of your family members want you to wait until you were 18 or?

Tyler Burke 26:12

No. I don't think so.

Dr. Javad Sajan 26:14

What did you start doing to make the, get the ball rolling on surgery?

Tyler Burke 26:17

Well, I looked up a lot of surgeons. I looked up you because I went on this site called "trans bucket" that had a lot of results and I really liked yours in particular. They were only like three things, three results for you on trans bucket. So I looked up like if you had an Instagram and you did, and I looked through your stuff and I was like, wow, this is really good. Like the scars look really good. And I was like at first I had another surgeon but he lived in Oregon. He worked in Oregon and he had like a year long wait list and I was like, okay, I can't do this. Yeah. I also talked to my therapist about you.

Dr. Javad Sajan 27:02

And your therapist, had they heard of me?

Tyler Burke 27:04

Yes.

Dr. Javad Sajan 27:04

Okay. And then you what else did you do? Did you call the insurance company yourself or your parents?

Tyler Burke 27:10

I sat down with my mom and I was like, can you please call the insurance company? She was like, cool. And then, yeah.

Dr. Javad Sajan 27:17

And then you got approval to come see me for the consult or something like that, correct?

Tyler Burke 27:21

Yes.

Dr. Javad Sajan 27:22

And what made you want to finally decide, was that the results? Was that the social media that I presence that I have? What helped you decide that you want to come to me?

Tyler Burke 27:32

Like everything, like, I really liked that you were very open about it on social media. I really liked seeing you do the surgeries. I just think it's like really cool how you can like, just do that. I just find it really interesting.

Dr. Javad Sajan 27:44

Sure. And were you watching on Snapchat?

Tyler Burke 27:45

Yes.

Dr. Javad Sajan 27:46

Oh, that's awesome. Yeah.

Tyler Burke 27:47

I downloaded Snapchat just for you.

Dr. Javad Sajan 27:49

Oh, thank you. Did it gross you out at all or not?

Tyler Burke 27:51

No, I don't find it gross. I find it really interesting.

Dr. Javad Sajan 27:54

That's so cool and then you came for the consult. Tell me how that went. Were you nervous before?

Tyler Burke 28:00

Yes. I was extremely nervous.

Dr. Javad Sajan 28:02

Why was you nervous?

Tyler Burke 28:03

At the time I really wanted peri areolar and I ended up not getting that because I couldn't and I was really nervous that I couldn't but your scar results were really good anyways, that I was like, I still want to stick with you.

Dr. Javad Sajan 28:19

So for top surgery, there's three options. Typically there's different variations, but one the most common I would say is double incision. That's we make a cut across the chest. You remove the nipple, it's called a free nipple graft, not free as an it's free. For free as an it's removed and reattached, you remove a lot of tissue. There's a scar across your chest, sometimes connecting in the midline sometimes not. And then you put it all back together and that's the most common, the other kind. And that's most common because people often have a lot of skin and tissue. And if someone has a lot of skin and tissue, you have to remove it in my opinion, otherwise you don't get good results. And you've seen how bad those look online. So most common that's the operation. Second, most common that I do is call the keyhole or pay a Periareolar. That's where you just make an incision on the bottom half of the areola, sometimes all the way, depending on how you're doing it. And you go in and all you do is you move gland.

Tyler Burke 29:13

I find that one, like really interesting. Cause it's like, you pull so much out of such a small hole.

Dr. Javad Sajan 29:18

Yes I did one on Friday. I don't know if you watched it.

Tyler Burke 29:22

Yeah.

Dr. Javad Sajan 29:23

Yeah. So then he just removed the tissue and then you let the skin contract or shrink around. Now that works well it's, there's not too much extra skin. If there is a lot of extra skin and you do that operation, you're going to be botched. You're going to get lumps, bumps, divots, and irregularities. No one wants that. The other more common operation what's called an anchor or inverted T that's basically a CIS female breast reduction done with a T scars and you remove it. Now that operation can work. The challenge with that is oftentimes you have to leave a good amount of tissue behind because the skin and the, around the nipple and the nipple itself has to live from the pedicle and you have to leave enough tissue for that pedicle to be alive. And if you leave too much, it doesn't look right.

Tyler Burke 30:08

Yeah. I've seen results from that one. And that was not really what I wanted.

Dr. Javad Sajan 30:12

I agree. It's not, it's the least common one I do. And so we met and we came for the consult. Did you have any other worries about anything else other than the surgery you wanted?

Tyler Burke 30:21

I don't know. I was very anxious about like I don't know, taking off my shirt in front of you and stuff, but you were very like, chill about it. Like you were very respectful, which I really appreciated. You're very respectful in your consult.

Dr. Javad Sajan 30:38

Thank you. Tell me how the consult went?

Tyler Burke 30:40

It was really good. I was a bit disappointed that I couldn't get Perry, but other than that, it was really good.

Dr. Javad Sajan 30:47

Awesome. And then you went home, you talk about it with your family?

Tyler Burke 30:50

Yes.

Dr. Javad Sajan 30:51

What'd you guys talk about?

Tyler Burke 30:52

I was just really excited to get it.

Dr. Javad Sajan 30:56

And then you book surgery and then surgery day was coming. How were you feeling the night before?

Tyler Burke 31:00

I was so excited. I barely slept at all.

Dr. Javad Sajan 31:03

That's so cool.

Tyler Burke 31:04

I was also a little bit hungry.

Dr. Javad Sajan 31:06

The day, right?

Tyler Burke 31:07

Yes.

Dr. Javad Sajan 31:08

And we don't have people eat before surgery at least eight hours before, because you don't want to vomit and things like that. Right? You can aspirate or choke. So then surgery day. We did the operation for you. We can’t Snapchat people less than 18 years old, obviously. So we couldn't do that. And then the operation went, I would say it was a wild success. We were able to create a form and physique you're still, you know, what day was surgery? Tell people.

Tyler Burke 31:32

September 2nd.

Dr. Javad Sajan 31:33

So just a few weeks ago.

Tyler Burke 31:35

Yeah.

Dr. Javad Sajan 31:35

Right. And the surgery went and then you were in recovery. Were you having a lot of pain?

Tyler Burke 31:41

It was less than I expected. Like significantly less. It was still a little bit of pain for the first few days. And then it was just sore afterwards. I remember a couple days after my surgery, I started getting like a really sharp pain in my left side that wouldn't go away for a little bit and none of the painkillers helped with it. And that lasted for a couple of minutes at a time. But other than that, it was perfectly fine.

Dr. Javad Sajan 32:05

Right after having the surgery. Were you having any different feelings of dysphoria?

Tyler Burke 32:09

No, not really. I felt like really bloated, which kind of made me feel gross. Cause my hips were like wider than they usually were and my stomach was like out. But other than that, I was really good. I was just really, really happy.

Dr. Javad Sajan 32:23

That's awesome. When you came for your post-op and you saw your chest for the first time, how did that feel?

Tyler Burke 32:29

It felt unreal. It was crazy. It also looked a little bit gross cause all of it like scars and stuff, but it was cool. I wasn't bruised at all. I was expecting to be really bruised, but yeah, I looked really nice.

Dr. Javad Sajan 32:42

How have things been since then, Tyler?

Tyler Burke 32:44

I have healed pretty well. I am not in pain anymore. I can, like, I can't really feel I'm kind of numb, like right underneath my scars and I can't put my arms all the way up yet, but other than that, I I'm really good. I feel perfectly fine now.

Dr. Javad Sajan 33:00

That's great. How's your dysphoria?

Tyler Burke 33:02

I feel so much better.

Dr. Javad Sajan 33:04

What feels better?

Tyler Burke 33:05

I just feel like a weight has been lifted off my chest literally and physically, I mean weight literally. And what's the word? Metaphorically, Yes.

Dr. Javad Sajan 33:17

Are there different things you think we'll be able to do now that you weren't before?

Tyler Burke 33:20

Yes. I want to like get into working out and like running. I couldn't do that in a binder and I didn't feel comfortable enough to do without one.

Dr. Javad Sajan 33:29

You know Tyler, we didn't tell people what it means to bind. Tell me what that is?

Tyler Burke 33:32

Oh. so you use a chest binder to make your chest look smaller and it kind of restricts your breathing and stuff like that. So it has a lot of cons with it made me feel better about myself.

Dr. Javad Sajan 33:48

And binding can be really painful number one and you can really cause deformities. So as you know, right, when you bind, you're wrapping your chest and what can that do? We can pull the breast skin and tissue down, stretching it out, causing you to fall lower. It can cause compression on your ribs causing potentially deformities of the chest wall. If you're doing it extremely tightly, continuously, and you can limit your activities as far as exercise in breathing and you're having some of those symptoms, right?

Tyler Burke 34:20

Yes. I did use tape for exercise, but I rip my skin off wanting to get off. It was a tape made specifically for trans people to like tape their chest. I still used it. I was just more careful with it. But yeah, the tape, let me breathe. The only thing was the like ripping off my skin, which was not fun.

Dr. Javad Sajan 34:44

What other activities do you, are you going to be more comfortable doing now or before surgery?

Tyler Burke 34:49

Choir is a lot easier. I'm a choir kid in my school and I can actually take like a full breath in now and my posture is better. Just like a lot of things are better.

Dr. Javad Sajan 34:59

Do you feel more comfortable in your identity?

Tyler Burke 35:01

Yes, I do.

Dr. Javad Sajan 35:03

Sometimes Tyler people think about other surgeries on top of top surgery, is there anything else that you want or have thought of.

Tyler Burke 35:10

Maybe in the future I might want to get phalloplasty but right now I'm fine with how I am.

Dr. Javad Sajan 35:17

What's next for you in life? Tyler? Tell me what you want to do when you grow up?

Tyler Burke 35:21

I have no clue, honestly. I don't know, I wanted to be a streamer for a little while, but that isn't working out.

Dr. Javad Sajan 35:28

So why isn't that working out?

Tyler Burke 35:30

And we got like 53 followers.

Dr. Javad Sajan 35:33

It takes time to build the following. Do you want to go to college?

Tyler Burke 35:36

I am not yet. I don't really know.

Dr. Javad Sajan 35:40

How has high school been right now?

Tyler Burke 35:45

I find it's very stressful. I feel like, I have ADHD, so I need like a schedule to complete things. Like I really need that. And with online school, it's a lot harder to do that. So I fall behind a lot easier than most students.

Dr. Javad Sajan 35:59

Do you think it was better to be in person?

Tyler Burke 36:02

Yes, but I was also very thankful it was online because I had my surgery the second day of school. So I was able to go back to school earlier than I would've, if it was in person.

Dr. Javad Sajan 36:13

A lot of people say that, you know, in this post COVID, well not post in the COVID world, pandemic world that we're living in right now that people are more isolated. They don't connect as much. I know you're an introvert naturally. Now, are you feeling that at all?

Tyler Burke 36:26

A little bit, yes. I don't get to see my friend as often. She lives in Woodinville. She's my best friend. We've been friends since like elementary school. I kind of miss her. I don't get to see her as often. She lives in Woodinville and I live in Redmond.

Dr. Javad Sajan 36:44

Sure, did your friends know you were having surgery? How have they been through this journey?

Tyler Burke 36:50

They're getting tired of me talking about it. I've talked about it a lot.

Dr. Javad Sajan 36:53

What do you say when you talk about it?

Tyler Burke 36:55

I'm just like, bro, my chest looks so good. I was like amazed that like when I put my arms up, I could see like the muscles moving underneath. I've never seen them before. And I was like, Whoa,

Dr. Javad Sajan 37:06

That's awesome. I'm so happy. You know, doing gender affirming surgery is one of the biggest privileges I have. I get amazing people like you, Tyler you come to me and not only am I able to do something that I feel I'm amazing at, but I'm able to really help them get a different life, you know? And that's that really drives me and excites me to do it. And then that's why I do what I do. I love impacting people. I love changing lives. I love helping people get to where they want to be wherever that is. Right? For me, a lot of people ask me my opinions on different things. I always tell them my opinions are relevant. What matters to me is how I can help my patient, how I can help them get where they want to get and how I can help them be who they really want to be.

Dr. Javad Sajan 37:50

And that's what it's all about for me, Tyler, you know, we're so thankful. We have so many fans who watch what we do, who hear our podcasts. And oftentimes they want some level of insight from you. So let's say this is you listening when you're in sixth or eighth grade and you're having these thoughts about transgender or being gender nonconforming and you’re sort of figuring out what to do and you run across this YouTube video or this podcast or IG post and you're looking for some advice. What would you want to share?

Tyler Burke 38:28

I really wish first of all, I really wish I gave my parents time to like understand things instead of getting really angry at them when they didn't call me like my preferred name and stuff like that, like they need time to understand like this is a big deal for them, even if you've known for a very long time, they haven't. So give your parents time. They still love you. They respect you. They're just trying to figure things out. Also I know might suck, but please wait off just a little bit to know if like you really like after you socially transition, wait like a year to find out if you really like this and then go on like testosterone and stuff.

Dr. Javad Sajan 39:12

That's so thoughtful. Sometimes I see that a lot in my clinic, Tyler, where I'll have minors who are undergoing the process. And I literally see them yell at their parents for making a mistake on name or pronoun. And I can see it in the pain, in the parent's face and in the child's face. It's a struggle for everybody. And it's so hard. I think you are very special in that, you know, you said something that was so thought provoking, then people are mean to me, I'm nice to them. And I think you understand more than most and you connect with more than most people.

Tyler Burke 39:44

Yeah. To a fault sometimes. Yeah. I forgive people too easily, stuff like that. But I, yeah, I wish I was nicer to my parents when this happened, because it's a big deal for them and it's a big deal for you. And I know how much it hurts to be mis-gendered especially by someone you love, but they are trying, they're trying to understand. And they're trying to accept you.

Dr. Javad Sajan 40:08

Have you told your parents this.

Tyler Burke 40:10

No, I don't think so. Sorry, dad.

Dr. Javad Sajan 40:13

That's awesome. That's amazing. You're an amazing person, Tyler.

Tyler Burke 40:16

Thank you.

Dr. Javad Sajan 40:17

Thank you so much for being our guest today. Tyler, I learned so much from you. You gave me so much insight and I know our viewers are going to learn a lot and take a lot of way. Your journey is one that's truly extraordinary thought provoking and touching. I know your ordeal will teach our listeners how and what to expect as they start their own journeys. I appreciate your time and an honor to have you as my good patient and someone I've truly connected with. Thanks for listening to the plastic surgeon podcast and please rate and review us on Apple podcast to hear more amazing content for my live surgeries on Snapchat and my adventurous throughout the week. Catch us on all social media @realdoctorseattle. See you next time.