For years, Deke Wilson, was ambivalent about undergoing a medical transition to male. He felt it was critical for his happiness, but there were plenty of reasons to put it off: the expense, the difficult recovery, the potential medical complications.

But while sitting at home during the early weeks of the coronavirus pandemic, Wilson said he felt the urgency. “You’re trying so hard to avoid getting this one sickness,” he said. “Why? Because you want to live — you want to experience life fully to the best you can. For me, that means being comfortable in my skin.”

Wilson, who works at a logistics company in Cleveland, underwent five surgeries from March through December last year at University Hospitals Cleveland Medical Center, recovering while working from home. He expects to return to in-person work this month.

For some transgender people, the era of remote work during the pandemic provided an opportunity to take the next steps in their transitions, according to interviews with more than 30 transgender people, their doctors and advocates.

Data on medical transitions during the pandemic remains hard to come by, although anecdotal evidence from the interviews suggests an increase in surgeries compared with previous years. No database tracks the total number of people in the United States who undergo medical transitions each year, but seven regional and local health care providers reported stronger demand for transition operations in 2021, compared with 2020, when many surgeries were paused because of the pandemic. Demand was also higher in 2021 compared with 2019, before the pandemic.

While some of the increase can be attributed to operations that were postponed while hospitals were overwhelmed by COVID-19 patients, doctors in the field offered other explanations as well.

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They note that more employers are covering transgender health care in insurance plans, that surgical techniques are becoming safer and resulting in better cosmetic outcomes, and that more hospitals are offering these services to patients.

For example, Mount Sinai, which has the biggest transgender care program in New York City — the Center for Transgender Medicine and Surgery — has also seen an increase. It performed 938 surgeries in 2021, 60% more than the previous year and 43% more than 2019.

“We’ve been scrambling to have the bandwidth for the people who are feeling comfortable who are coming in for care,” said Dr. Joshua Safer, the center’s executive director.

At Northwell Health’s Center for Transgender Care in New York, which was founded in 2016, the number of transition procedures roughly doubled in 2021, compared with the number of surgeries in 2020, which was similar to the number in 2019, according to Dr. David W. Rosenthal, the center’s medical director.

Many transgender people do not feel that costly surgery is necessary. For those who do seek medical transitions, common surgeries include chest reconstructions, genital reconstructions, hairline lifts, lip lifts and removing or adding Adam’s apples.

Even as access to transgender medical care has increased, the subject remains a political and cultural flashpoint in the United States, where Americans are roughly evenly split over whether they believe others should be allowed to legally switch their sex, according to a YouGov poll published in September.

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Some transgender workers face tensions at work

These tensions also play out in the workplace, despite efforts at greater inclusion by some employers, although research into the experiences of the estimated 1.4 million transgender people in the United States is limited.

A McKinsey report published in November found that transgender employees earn 32% less than the rest of the population, even when they have similar or higher levels of education. Nearly two-thirds of transgender employees in the United States remain in the closet in some or all professional interactions with clients or customers, out of fears that they will experience hostility, harassment or discomfort. Transgender adults are twice as likely as other adults to be unemployed, the report found.

Even if a workplace is inclusive, many transgender people are reluctant to come out fully. Erica Mack, a field sales manager for Samsung Electronics America in Grand Rapids, Michigan, said that she has felt supported by her colleagues since coming out as a transgender woman about three years ago. But at times, she said, she overheard mocking comments from customers, such as, “Is that a guy or a girl?”

Working from home during the pandemic was a welcome reprieve. She had time to herself to think about what changes she wanted to make to her life, and what was stopping her from undergoing facial feminization surgery. When Samsung added coverage for transition surgeries in 2021, she said she was overjoyed.

Mack said she had struggled all her life with gender dysphoria, a medical term that refers to the distress or discomfort that occurs when one’s gender identity does not align with the sex assigned at birth. She recovered from her two facial feminization surgeries at Northwell Health in 2021 while working from home, turning her camera off during some calls. Her angst has since lifted, she said.

Now, she said, “I can, without makeup on, just be grubbing it — not wearing earrings, not wearing jewelry — and just walk into a women’s bathroom and not worry, and that has been the most freeing thing on this planet.”

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Increased support emerging in the workplace

Even in the most liberal cities and workplaces, many people are clearly perplexed or feel threatened by efforts at inclusiveness focused on identity, as well as by changes in culture and language, from acronyms to preferred pronouns.

David Baboolall, an associate partner at McKinsey who co-wrote its transgender report and who, as a transgender person, uses the pronoun “they,” said that corporate diversity training programs sometimes focus on the experiences of gay people while glossing over the experiences of transgender or nonbinary people, they said.

“Our experience gets erased or ignored because people simply don’t have the vocabulary to talk about it, or they’re afraid they’ll cause offense by getting the words they do actually know wrong,” they said. “To craft more inclusive policies, it’s important to understand that education is so important here.”

Part of creating an inclusive working environment means investing in employee affinity groups and creating guides for managers, several transgender and gender-fluid people said in interviews

Rae Lee, a teacher from Kentucky who works abroad at a school where she fears she would be fired if she came out to senior administrators, said that remote work during the pandemic gave her space to take the next steps in her transition. She grew out her hair, experimented with makeup and started feminizing hormone therapy.

“Going back into work now feels really difficult,” said Lee, who has returned to in-person teaching and still presents as masculine at work. She said she sometimes wonders why it took her so long to come out to those closest to her. “All those fears I had, everything that was holding me back about transitioning, it doesn’t make sense anymore,” she said. “I didn’t know I could be happy like this.”

Wilson, the man who underwent five transition surgeries while working remotely, said he was somewhat nervous about going back to the office, but also thrilled about feeling comfortable in his own body. He expected his colleagues to be supportive, as they were when he came out to them in December 2019, but he anticipated questions about his new facial hair and increased muscle mass.

“I’m a little excited for people to see the changes,” he said.