The winter sky remained blue-black as the Navas family arrived at Philadelphia’s Hahnemann University Hospital early on a cold January morning.
Jitters and excitement washed over Jude Navas as his mother, Sandy, hugged him and whispered in his ear:
“You’re blossoming into who you’re supposed to be. That’s all that matters.”
Jude was born Judy. He and his family allowed NBC10 to spend time with them before and after the college student underwent gender-affirming surgery at the Center City hospital, which has become one of the most prominent in the country for the growing surgical procedure.
IN THEIR OWN WORDS
The 24-year-old from Ocean County, New Jersey, spent years pulling his curly hair back and binding his breasts. In recent years, the Stockton University senior began lifting weights to build muscle tone and disguise his chest. In September, he started taking testosterone.
But his added bulk did nothing to hide the one outward manifestation that betrayed how Jude felt on the inside.
“I’m most excited to look down and not have that there anymore,” he said.
Jude was about to undergo a bilateral mastectomy, or chest masculinization surgery. Under the care of Dr. Kathy Rumer, the region’s preeminent cosmetic surgeon specializing in transgender care, his breast tissue and milk ducts would be removed and replaced with more defined pecs, lats and serratus.
Rumer, a former NASA engineer, performed 450 gender-affirming surgeries in one year alone. She performs roughly eight to 10 surgeries per week, more than any other doctor in the region.
In 2016, she switched her practice to exclusively focus on the trans community, whose needs can range from top surgery -- such as Jude’s -- to body sculpting and genital reconstruction.
To undergo any of these procedures, patients must first be diagnosed with gender dysphoria, defined by the American Psychiatric Association as a “conflict between a person’s physical or assigned gender and the gender with which he/she/they identify.”
The question of whether gender dysphoria is a medically accepted diagnosis is central to who will cover the cost of transitioning.
Insurance companies are increasingly open to deeming gender-affirming surgery a medical necessity. But for people who must pay out of pocket, the cost can soar into the tens of thousands of dollars. At least one family previously told NBC10 their financial planner suggested saving the equivalent of one year of private college for their child’s transition.
Jude used her family's insurance to cover her transition, but Rumer bristles at the notion that gender-affirming services are not necessary.
“It’s not elective. It’s not a choice,” she said. “These patients are born in a body they are not comfortable in. They know it from early childhood.”
Jude certainly did.
He grew up in a happy suburban home with two loving parents and a supportive older brother. In the summers, he went to the beach or swam in his family’s pool. But wearing a swimsuit around anyone other than his relatives was unthinkable.
“It would be easier for me if I felt comfortable in the body that I have,” he said.
Jude came out as a lesbian to his parents in high school. They weren’t exactly shocked, already having an out gay son. Jude’s father, Luis, joked that the older boy “broke them in” with the news.
Despite a commonality, Jude did not confide in his brother about being trans. That came much later.
“We struggled separately,” Dan Navas said.
IN THEIR OWN WORDS
While Jude’s family fully supported his transition, many others are not as lucky.
In a 2015 report by the National Center for Transgender Equality, 40 percent of trans adults said they had attempted suicide in their lifetime. More than 90 percent did so before the age of 25.
Trans youth, in particular, are at higher risk of depression, abuse, homelessness and addiction than even their gay or lesbian contemporaries.
Medical experts point to the minority stress theory, which posits that people who experience societal discrimination frequently internalize the trauma. It can manifest through mental health problems and lead to emotional, and physical, wounds.
“I couldn’t even begin to mistreat [Jude] or disown my kids,” Jude’s father, Luis Navas, said.
“What matters to me, always, is my child’s character,” his wife, Sandy, added. “Are they good people? Are they kind, compassionate, loving?”
For their youngest child, life as Jude is slowly becoming normal. After his top surgery and several weeks of recovery, Jude returned to school and will graduate this May. Then, he and his girlfriend plan to relocate to California.
"Anybody I meet won’t know any different,” he said, “and that just seems so nice."