I thought the story was going to be about a surgery. That was the premise, anyway. As far as we know, Tommy Crow is the first person to undergo top surgery fully awake under nothing but local anesthesia. There’s even a video recording of the entire procedure, with Tommy’s voice narrating the experience in real time.

It seemed like a clean story about science and trans health care. But within minutes, it became clear that the surgery was only the most obvious expression of something much bigger.

Truth as an Origin Story  

We sat down together in a small study room at a public library. Tommy’s boisterous energy was immediately apparent: He had laid out a selection of fizzy waters for both of us, and had set up a laptop ahead of time to record for a podcast. 

We got into it pretty quickly: “Just as a way to get into the story, will you tell me a little bit about your background or childhood?” I asked.

“I grew up about 30 minutes south of Madison in the countryside. I was raised in a fundamentalist, religious community and didn’t go to school.” Tommy told me. He picked the name, “Tommy,” at six or seven years old because it reminded him of “tomboy.” But at that time, he didn’t “identify as a boy,” having never conceived of gender in that way. “I just thought I wished I was a boy.”

Tommy’s community was a set of fundamentalist Catholic families spread across south-central Wisconsin who would meet weekly for church and school.

“It was extremely, extremely bad,” he told me. “We’re talking, parents in our literature classes teaching that all marriages should be arranged, or that marital rape isn’t real because once you get married, your body belongs to your husband.

“I had very limited contact with outsiders, but when I was 11 or so, I remember writing a pamphlet for my secular voice teacher that described why she, a Protestant, was the most likely type of person to end up burning for all eternity in the fires of Hell. It is kind of funny, but at the time, it seemed normal to me. I liked her,” Tommy said. “So naturally, I was going to warn her.”

“When did it become a mission for you to start seeking information about the outside world?” I asked.

“I was really passionate about Catholicism,” Tommy said. “And one thing they taught me was that I should believe things because they’re true, not because they feel good. Like they would say, ‘we believe in Hell because it’s real, not because we want to.’ I really took that to heart. In fact, to this day, the only tattoo I have says ‘truth.’”

I didn’t know it yet, but this dedication to the idea of truth was going to become a theme we kept circling back to throughout our conversation.

“I wanted to be passionate about Catholicism because I knew it was true. So, I started reading the history of the Catholic Church and the theological arguments for God. In that process, I uncovered some really thorny questions that Catholicism just wasn’t answering.”

Tommy’s search led him to look outside the texts provided by the adults in his life, something that proved difficult with the limited inflow or outflow of information allowed in his environment.

“We didn’t have Google or Wikipedia,” Tommy said. “But my mom whitelisted Pinterest thinking it was only for recipes. So, I would go to these recipe posts and write in the comments, ‘Hey, I’m in this environment, and I don’t have access to the internet. Can you please get me the Wikipedia article about the Exodus in the Bible?’ And these old ladies would cut and paste the articles into the comment section for me. It just started falling apart from there.”

That sense of curiosity eventually destabilized certainty for Tommy, but the process of interrogation became formative. He briefly ran away from that environment at 17, only to end up returning. 

“My parents supported me financially throughout college,” he said. “This is an enormous privilege and gift, for which I am forever grateful. Family dynamics are complicated. The good doesn’t cancel out the bad, but neither does the bad cancel out the good.” He got his degree in economics at UW-Madison and left permanently.

Recognition Arrives Sideways  

At that point in his life, Tommy’s experience of his body was less centered on gender, and moreso on physical pain.

“Believe it or not, I decided to get top surgery while I still identified as a woman,” Tommy told me. “I was literally disabled. I had triple D’s. I couldn’t run. I couldn’t do anything. Even with the best bra or binder in the world, the weight of them still has to go somewhere. It’s just a hard engineering problem.”

“I decided that when I became professionally successful, I would get a breast reduction. But I was anxious, like to a weird degree, that they wouldn’t make them small enough. And then I thought maybe I just don’t like them at all and want them gone.”

On the day he decided on a full mastectomy, Tommy remembers a sense of elation that was surprising, almost to an alarming degree. “That day, and the next day, and the next, I was so fucking happy,” Tommy recalls. “I would imagine myself with a male-looking chest and involuntarily start to cry about it. Then I would think, ‘Well, that’s weird.’”

There was the pattern: Reaction first, meaning later. It was a theme that had repeated throughout his life, with dysphoria often registering not as clear discomfort but as sudden, disproportionate emotional reactions he couldn’t immediately explain.

“Was there a defining moment where you realized or accepted that you were trans?” I asked.

“Yeah. My partner David said, ‘Your reaction of having extreme euphoria to the idea of getting a mastectomy is making me think you’re a transgender.’ He had been asking me for years if I was trans. I think it was obvious to everyone except me. But in my mind, I just wanted to be a special woman. I was like, ‘Well, I’m just a woman who really wants a dick and to have a man’s voice.’”

“But I will say, I don’t regret giving ‘being a woman’ the old college try. I’m actually glad I did that because I really put a lot of effort into it and feel like I did a good job, you know, whatever it means to ‘do a good job at being a woman.’ Because now I know for an absolute fact that this path is the right one for me. I think that gives me a general sense of confidence in life. I can see that freedom.”

In other words, finding truth set Tommy free.

Refusing Anesthesia

So okay, Tommy had decided to get top surgery, but where did the idea to do it awake come from? As it turns out, that decision was not about bravado. In his constant quest for truth and knowledge, Tommy had taken up the hobby of reading scientific literature for fun. With some pre-existing knowledge of anesthesia, Tommy determined that he was going to get the surgery fully awake, or not at all.

As he explained, “There’s a general rule in medicine: You don’t want to do unnecessary treatments, and general anesthesia is a pretty intensive treatment. It’s hard on your brain and body, and it’s hard to recover from. It just happened to be very clear to me, based on the available evidence, that a mastectomy does not require general anesthesia. I was just not willing to undergo unnecessary treatment for the sake of other people’s convenience.”

But his reasonings extended beyond the physical and practical and into the realm of existential as well. “For the same reason that women typically want to see the birth of their child, this was a huge life milestone for me,” he said. “I wanted to see myself becoming a man. I wanted to be there to see this triumph of man over nature.”

It is an analogy that sits somewhere between poetic and clinical. To think of embodiment as an event is to understand something that I think we often miss in the everyday rush of late-stage capitalistic life: That whether we frame it as truth, freedom, innocence, purity, humanity, or authenticity, to live without the burden of our own inward-facing judgment is a privilege.

Research as Lifeline

The path to finding a surgeon willing to attempt the procedure was long and difficult. But in many ways, this process was a reflection of Tommy’s entire ethos. 

“I don’t do shit the way that I’m supposed to,” he told me. “For example, I spent almost two years being told by every doctor that they couldn’t do this surgery, and sometimes being told by big name doctors that it was medically impossible. But once again, I was just reading the existing literature, and what they were saying just didn’t add up.

“I feel like in some ways, this makes me a hard person to get along with, but it’s also my favorite thing about myself.  I am not going to just take your word for it if I’m seeing evidence of something else.” 

Tommy wants to be right. He wants to believe true things. 

“Since doctors were all saying that it wouldn’t work, I had to get the information myself and feed it to them,” Tommy told me. “I basically studied every imaginable local anesthesia method until I found one I knew would work.”

The turning point arrived through the same instinct that shaped his childhood: To find the source. Desperate and at the end of his rope, he tracked down the phone number of Dr. Jeffrey A. Klein, the man who invented tumescent local anesthesia, which Tommy was convinced would work. Now in his 80s and retired, Dr. Klein took Tommy’s call. 

“He was really excited about it!” Tommy recalled. “We had a nerd moment. He was like, ‘You know what? I think I’ve got a guy for you.’” 

That’s how Tommy met Dr. Gunnar E. Bergqvist, a plastic surgeon in Florida, who performed the surgery. “He was super excited. I was used to doctors giving me a ton of statements about how this would be extremely painful and terrible and traumatizing, but he didn’t do any of that.” 

The surgery as Conversation

Tommy recorded the entire procedure, and narrated the entire thing.

“The main reason that I wanted to record it was because it’s a good tool to make sure that you are treated well and have your pain appropriately managed, but I also really value having the scientific record of this,” Tommy said.

“So, what were you talking about during the 4.5 hours?” I asked. 

“I had a few prepared remarks, like a prayer I had memorized in case the procedure was difficult or scary. I don’t believe in God, but I still like the aesthetic,” Tommy said. “I spoke about some of the ways that I had gotten here, and some of the people that I was grateful for. But in truth, I didn’t really need to do any of that. It was so fun. I was having a blast.”

As somebody who had experienced a C-section, ‘having a blast’ was hard for me to wrap my mind around. I couldn’t help but recall my own experiences: Sterile operating room lights, the infamous blue curtain, having no sense of what that tugging and pulling sensation was. But that wasn’t Tommy’s experience at all. He was lying back in a reclining chair, no curtain, watching every cut and removal for himself. 

“I was literally watching him restructure my chest from a female chest into a male chest; watching it literally take form in front of my eyes,” he said. “So a lot of the time, I was just looking at the camera and then looking back down and being like, ‘This is so cool. This is so cool.’”

I asked if there was any point at which he freaked out watching it.

“You would think so,” he replied. “But I never felt nervous or bad. And I’m confident in saying that, because you can watch the footage.” He laughed. “I think it was largely because I was totally in control the whole time. There was never any loss of autonomy. My doctor related to me so well, and we were having this very egalitarian exchange.”

Freedom and Invisibility

Post-surgery, Tommy describes a psychological shift that echoes earlier themes from throughout his life. He compared it to the lifting of religious guilt, of freedom.

“I would say it almost feels like a coincidence that I ended up being a trans man,” he said. “This surgery did not feel super gendered to me. It felt like getting a surgery that made me not disabled anymore. It’s almost like that quote, ‘The blind will see and the crippled will walk,’ where I’m transcending nature’s chains on me, which is pretty a-gendered.” 

He spoke of gender dysphoria, of feeling disabled, and of religious chains all in the same breath, as burdens preventing him from feeling physical, mental, and spiritual freedom. “When that burden is taken away, it feels light,” he said. “You feel free.”

“It took about a week and a half after surgery before it was clear that my pain level was already less than my natural chest was every single day. So, it literally took a huge burden of pain off of me,” he reported. 

“After that, everything was amazing. I remember getting home from my first day of work, and not having to lie flat on my back to recover. That weekend, I sat at my table, scanned my body, and realized there was no pain anywhere in my body. I hadn’t felt that since I was 13 years old.” 

But the surprising thing for Tommy wasn’t just the newness of physical ability or the appearance of his body. “I just felt so normal,” he told me, “which is weird because I hadn’t felt like I needed to be normal.”

There it was again: Experience first, meaning later.

“I was honestly expecting to feel really hot, you know?” he continued. “And I do feel hot. But moreso, I feel like there’s nothing freaky or unnatural about me anymore. It’s just a deep peace, a feeling in my bones that I recognize this body. I feel so at home in it, and I was not expecting that.”

His descriptions align with what others have called “gender euphoria,” but he never labeled it as such. Instead, he tried to illustrate the experience with words. I wondered how much of that is the natural proclivity of an intellectual personality type? How much can be attributed to having been born in the wrong body, to having dissociated from one’s body, or being raised in an oppressive environment? 

“Whenever someone I love puts their head or hand on my chest, I feel that deep peace. It’s something I will never take for granted, because I went for so long without it,” Tommy said. “I didn’t really feel any gender dysphoria. Or, at least, I was always surprised when those reactions came up. Something about it wasn’t connecting. But then later, after surgery, it was like I could feel my body in a way that I couldn’t before.” 

And then Tommy read something that he had written on his Substack: 

“I know what it feels like to be a man on the inside. There is a distinct feeling of being a man and it’s just, it’s in your bones. It’s in your bones and your chest and your shoulders. It feels strong and red and calm and heavy, and like a horse. Like a big, fast, healthy horse that gets angry when you try to break it. And it feels like a stone on your chest, which sometimes crushes you, but usually calms you. It’s a sense that your bones are big, and strong enough to bear things, and the burden is actually calming.”

We ended our conversation on an appropriately philosophical note: Is it possible to describe the experience of being a gender? Maybe trans people have an unnatural advantage when it comes to understanding that feeling since theirs was wrong. It’s kind of like a fish swimming in water: You wouldn’t really know what water is because if you’re lucky, you’ve always been in it. And the only way that you would understand water, the necessity of it, is in the absence of it.

The Story Bigger Than the Surgery

What surprised me most was not the isolated upbringing or the medical first. It was the coherence, the repetition, the same values resurfacing in different contexts, each time slightly sharper.

Seeking knowledge. Finding truth. Self-advocacy. Freedom.