Grace is the senior content editor for Hop Culture and Untappd, writing stories and curating content on the diverse voices in craft beer across the globe. She has also organized and produced the largest weeklong festival in the country for women, femme-identifying, and non-binary people in craft beer, Beers With(out) Beards, and the first-ever festival celebrating the colorful, vibrant voices in the queer community in craft beer, Queer Beer. Her favorite accompaniment to drinking beer is reading an Agatha Christie or Louise Penny novel while watching a British crime show.
I laid on my back, the sheets around me damp as a beer cellar. Tubes stuck out of my chest, a throbbing nuisance, like living above a nightclub. For two weeks, I’d been confined to my bed, sometimes knocked out by painkillers, barely able to move. I couldn’t work or even go to the bathroom by myself.
When you get top surgery, you don’t wake up with a new body; you grow into one.
A form of gender-affirming care, top surgery involves removing breast tissue and sometimes reshaping the nipples, creating a more masculine appearance.
Gender dysphoria is a medically recognized deep unease that occurs when your biological sex doesn’t match your gender identity. For someone experiencing it, top surgery or other gender-affirming care can make all the difference, helping transgender and nonbinary people feel more confident in their own bodies.
Lex Laughman, head brewer at Goldspot Brewing in Denver, Colorado, describes top surgery as “a life-saving medical treatment I’ve wanted for a long f**king time.”
But the path to top surgery, especially in the beer industry, is challenging. The average recovery is typically three to six weeks minimum, requiring severely limited physical activity.
Plus, with costs running upwards of $10,000 in the U.S., hourly workers without benefits, like most bartenders and brewers, find it difficult to pay for top surgery, much less take time off without fear of losing their jobs.
Grayson Alexander, a trans man working for the last three years in malt production and bartending at Admiral Malting and the maltster’s pub, The Rake, has known since 2019 that he wanted top surgery. But he found getting treatment difficult.
“There just isn’t access to care,” he says.
As a writer with a supportive partner, I had the luxury of taking time off to recover. But I can’t imagine having to lift 55-lb. grain bags, move kegs, or pour beer for customers soon after surgery.
More importantly, it’s difficult to consider navigating gender-affirming care in a predominantly cis-hetero-male environment.
When you work in the taproom, you don’t just get gender-affirming care or top surgery, wake up the next day, and go right back to work; you fight to be your authentic self and survive.
Why Is Gender-Affirming Care Important?
Gender-affirming care, including top surgery, is life-saving.
Think about waking up every day inside a body that feels foreign to you. It would be like walking into a room where everyone speaks a language you don’t know: They feel comfortable. You don’t.
Gender-affirming care can completely change a person’s view of their body—mentally, emotionally, and physically.
I’ve known from a young age that I felt strange in my cis-female body (cis meaning the gender identity that matches your sex assigned at birth).
Growing up in the 90s, I got by wearing more “masculine” clothes; after college, I coped by cutting my hair short. These strategies helped, but I still felt a disconnect between the body I wanted and the one I woke up with daily.
A week after my top surgery, when the doctor removed my bandages, I looked at my body in the mirror and cried. For the first time in my life, everything finally matched.
I’m 35 years old, and while I’m still exploring my gender identity, I needed three decades to feel safe enough to live in a body that felt natural. And I don’t even work in a brewery every day.
The Challenges of Living as Trans, Non-Binary, or Gender Nonconforming in Beer
Beer is a predominantly straight-cis-male industry. A 2021 audit by the Brewers Association found only 0.2% of brewery owners identifying as non-binary or third gender, with 75.6% reporting as male.
Identifying as non-binary, Laughman couldn’t name anyone else gender nonconforming or trans at a brewery. That’s not to say trans and non-binary people in beer don’t exist, but they are a minority and might not always feel comfortable being out and visible. “I think that’s part of the problem,” they said.
Although Laughman, 35, has been taking testosterone (T) for two years, they knew they wanted top surgery since they were 19. But at previous breweries, Laughman couldn’t find the safety or support they needed, such as supportive management, appropriate paid time off, or medical insurance.
Similarly, top surgery has remained out of reach for Alexander, who started transitioning and taking T in 2019.
Currently, he binds, which involves flattening one’s chest using tight-fitting clothing.
“When you’re raking grain all day, you don’t really want to talk to your cis coworkers about how your underboob sweat is bothering you,” says Alexander.
It’s also why he carefully chooses who to talk to about his transition.
While some coworkers support him, others fall short. When you mix ignorance with beer and social situations, “they’re asking some really weird, invasive questions,” he says, like, “Wait, you mean to tell me you have a f**king p**sy? If you asked any one of your cis coworkers about their genitalia, that would be considered sexual harassment.”
Another trans man, who works for a big brewery and wishes to remain anonymous, says when people learned he was trans, they intrusively pried. Often it occurred after a few beers, “when people get tipsy and confident,” he says.
This trans man, who got top surgery when he was 20 and has taken T for the last seven years, worries. When he goes out drinking with his colleagues—predominantly straight cis-men—he has to endure homophobic and misogynistic jokes. “I’m not so sure anybody would stick up and take my side,” he shares. “It’s the ganging up on you that makes it scary.”
According to Sarah M. Brown, clinical associate professor of law at Northwestern Pritzker School of Law, who has spent 15 years working in employment discrimination, these instances can qualify as sexual harassment, but they’ve been historically hard to litigate.
“It’s comments, things that seem like jokes, dead naming someone [using the name a transgender or non-binary person was given before their transition], misgendering someone purposefully…that build up over time and eventually create a workspace where you are just uncomfortable and don’t want to go to work,” she says. “The question then becomes, is it a hostile work environment?”
Brown says since a landmark 2020 Supreme Court Case Bostock v. Clayton County, which federally extended discrimination outlined in Title VII of the Civil Rights Act of 1964 to sexual orientation and gender identity, the answer legally has more often been yes.
But it’s complicated.
On a basic level, you need to prove that these comments or jokes have accumulated over time. “Pervasive,” says Brown. “That’s the word that the courts use.”
That means reporting each instance of abuse, which for someone who identifies as trans, non-binary, or gender nonconforming and potentially isn’t out to everyone at work, can be very difficult.
“That’s the tricky thing,” says Brown, who says she has seen sexual harassment cases at their worst in the hospitality industry. “You need to find a way to put your employer on notice, but if you don’t say anything, if you don’t essentially out yourself or make the complaint known, then I think the idea is we don’t expect employers to be omniscient. We expect them to train people. We expect them to do what they can to create a good workspace, but we can’t expect them to know about things if nobody tells them what’s happening.”
One measure Brown suggests for companies that want to create a safe workspace is to set up an anonymous reporting system. “An anonymous complaint counts as a complaint,” she says, because, at the end of the day, “you’ve got to engage in order to get some resolution.”
But that is often the last thing on someone’s mind when they’re already contemplating how to deal with getting top surgery in the beer industry.
Taking Time Off, Paying for Surgery, Recovering with Care
Alexander hopes to get top surgery next year, but that decision has meant potentially leaving the beer industry.
“What are you going to do? Go to your manager and be like, ‘I really want to stay here, but there’s nothing that’s going to help me attain my goal of getting surgery?’” he says.
Top surgery isn’t simple. It requires capital and time off to recuperate.
“It’s not a vacation,” Laughman says. “It’s not just an easy two-day recovery, and you’re done. This is a commitment of time, effort, pain, suffering, and struggle.”
The Gender Confirmation Center (GCC), a clinic specializing in gender-affirming care in San Francisco, California (where I had my top surgery), recommends at least six weeks of rest before resuming strenuous physical activity. Most patients take one to two weeks off work, especially since lifting and movement are restricted.
For the first three days post-op, I could barely get out of bed. On day four, when I walked down the hall, I felt like pumping my fist in the air. But I physically couldn’t. My surgeon restricted lifting anything over 10 pounds for a week, but I couldn’t even put my arms above my head until a month later.
What surprised me the most was how drained I felt. After a week, my surgeon said I could start walking for up to 15 minutes. On my first attempt, I barely made it a block before I had to go home and take a nap.
As Goldspot’s head brewer, Laughman spends their entire day on their feet. “Running up and down the brew deck, picking up hoses, it’s very physical,” they said. “I’m moving up to 15 kegs into the brewhouse, filling them manually, and moving them into the cold room by hand.” For perspective, a full half-barrel or sixtel keg typically weighs around 168 and 90 pounds, respectively.
Laughman will need to fully recover after their top surgery before even considering returning to the brewery.
Currently a bartender, Alexander also has concerns.
“Pouring beer seems simple,” he says, “but when you think of top surgery and the tubes or drains getting caught or pulling out your sutures … it’s not as easy as you think.”
Drains are tubes placed into the side of your chest with bulbs on the end that collect excess fluid to prevent infection. They’re slightly bulky and uncomfortable to wear in public.
Another trans man I spoke with, who worked part-time as a bartender when he had top surgery, took three months off after a complication.
“No way I could bartend,” he recalls. Even when he returned, his doctor told him not to move kegs. “I would ask someone to do the heavy work, so I was just mainly behind the bar,” he explains.
According to Brown, the Americans with Disabilities Act (ADA), a federal civil rights law protecting people with disabilities from discrimination, could actually apply here.
“When you come back to work, you’re entitled to accommodations under the ADA,” she says, noting the federal law applies to any company with more than 15 employees. “If you’re a bartender, something like a lifting restriction could come into play with top or bottom surgery where accommodations could be made in the workplace.”
She says it’s just a matter of going to your employer and starting a conversation. “There’s no magical words,” she explains. You just say, “I’m having a medical issue. I’m entitled to accommodations under the ADA. I’d like to start having a conversation with you about what I need.”
Often that “interactive process”—in legalese—will involve your doctor, who can give recommendations on your restrictions that don’t interfere with your essential functions. “If you’re a bartender and you can’t serve drinks, that’s not an accommodation,” explains Brown. “But if you’re talking about ancillary duties, like how often you carry cases upstairs, the employer is supposed to help you find a way to keep your job and assign you different things that are not physically taxing.”
No one I talked to even mentioned the ADA, and I personally knew nothing about it before speaking with Brown. “I don’t think many people know their rights,” she reminded me.
Beyond dealing with the physical limitations and your understanding of your legal rights, though, Alexander adds that hourly employees rarely get full-time benefits, making it challenging to disappear for long stretches. “There is no way I could afford to take that much time off.”
Laughman agrees, noting part-time gigs won’t support your recovery. “They’re going to hire somebody who’s going to take your job,’’ they said. Looking back, Laughman says they would have needed to use the Family and Medical Leave Act (FMLA) “because I’ve never had enough PTO to take off weeks at a time.”
FMLA entitles an employee to protected time away from work for certain circumstances, such as a serious health condition. However, the law doesn’t clearly cover gender-affirming care.
“Patients who are candidates for FMLA are usually dependent on their employer and how long they’ve been there,” explains Jaan Jaime, a medical assistant at the GCC who helps patients navigate these questions daily. “If they are not there for a long enough time or if they are part-time, unfortunately, they don’t qualify.”
Jaime explains he frequently sees patients use PTO or sick time for top surgery, which is “tricky because if you only have 40 hours of both combined, that’s technically only one week,” he says, noting that’s often not enough time for recovery.
That’s why Alexander decided to go back to school. He plans to cut hours at The Rake to qualify for Medi-Cal, California’s Medicaid healthcare program, which can help pay for his surgery.
“It finally got to the point where I couldn’t do it anymore,” he shared. “I want to go enjoy life.”
The Gold(spot) Standard for Gender-Affirming Care
Alexander wishes people would acknowledge the complexities of gender-affirming care. He hopes managers and coworkers can create safer, more inclusive environments.
“It says a lot that we don’t feel like we can say, ‘I’m really struggling, and I’m going to need to take time off,’” he says.
When I asked Courtney Simmons, former diversity, equity, and inclusion director at Bell’s Brewery and New Belgium Brewery and founder of the Inclusive Insight Group, how breweries and bars can support employees interested in gender-affirming care, she went back to basic DEI principles. Employers must create a workplace where staff can speak up for their medical needs.
“Can I say, ‘Hey, I don’t feel like I’m in the body I’m meant to have, and I want to get surgery’?” she asks. “‘Ideally, you’d help pay for that surgery, but if you can’t, I need to be able to take time off.’”
Simmons adds that businesses benefit when employees feel safe and supported. If a rising tide lifts all ships, when you provide opportunities for underrepresented communities—like trans, non-binary, or gender nonconforming people—everyone benefits.
“All organizations, especially in beer, have an opportunity to be intentional about how their benefits care for their humans. Full stop,” says Simmons. “Whether you need support and care because you are not in the body that you’re meant to be in or because life is just really f**king hard.”
A little over a year ago, Laughman started working at Goldspot, which they describe as an incredibly inclusive queer-owned brewery. Owner Kelissa Hieber found a super trans-inclusive health care plan to cover Laughman’s top surgery.
After waiting 15 years, they got top surgery on October 16. Laughman brewed extra beer to cover the four to six weeks they expected to be out. “But realistically, the whole plan is for [Hieber] to cover my job,” they said.
That level of care is rare in the industry.
“I’ve never worked for an employer who’d say, ‘Take up to two months and come back when you’re ready,’” says Laughman. “That’s never been a possibility, which is part of the reason I’ve been so hesitant to pursue [top surgery].”
Laughman says if you need an example of someone doing it right, “Goldspot is it.”
While not every brewery can offer that level of support, Simmons suggests finding creative solutions. “What if you take someone out of this really demanding, heavy labor position and put them somewhere else?” she says, recommending a short-term admin role. “Give [them] space and time to come back.”
Alexander feels bittersweet about leaving an industry he loves. But when it comes to top surgery, he says, “I’m pretty stoked!”
Laughman, who has waited over a decade, was very excited to get top surgery. On the day of the surgery, I texted them to check-in. They responded, “Surgery went perfect! And I feel pretty decent still.”
Getting top surgery has been one of the best choices I’ve ever made. It changed my life. I only wish I could have done it sooner.
The beer industry could use its own facelift…or, dare I say, top surgery. Will it hurt at first? Sure. But at the end of the day, “It’s not only about changing lives,” Simmons says. “It’s about saving lives. Why not protect your top talent with their top surgery?”
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