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Elias Joel Donstad

Elias Joel Donstad is a second-year PhD student at the University of South Dakota. His poetics involve the body and the way it is perceived by the self, family, and medical professionals.

He is the recipient of the 2022-2023 Wolfe Scholarship and 2023-2024 Standing Proud Scholarship. His piece Need(le), chronically the start of HRT and falling in love, is in the 'Red Noise Collective'.



Intention with the Parts


"Intention with the Parts is a collection of poems chronicling my dysphoria, family relationships, and bodily experience surrounding gender-affirming top surgery. Several of the poems are erasures and reclamations of documents and letters acquired and required for top surgery.

The product of Parts is my physical and mental processing of surgery. The experience of composing the poems was intimate and reassuring. While I took control of my body, shaping myself to be my home, I was able to control the narrative through writing. A lot of the recovery process made me feel helpless as I could not dress or bathe myself. Yet, the poems gave me mobility."

Illustration by Dorian Rose / @dori.oki

Pre-Op Dysphoria


Why do facts of physicality refuse to be ignored? 

Because people talk down to you

since you are a little girl.

You don’t like this but don’t know why. 


You are ten.

Mother leads you to the women’s section

in Macy’s to pick out a training bra.

She doesn’t tell you why.

You hate going to the mall

hate picking out clothes

wonder why women and men

are separated in the store

and why you aren’t allowed

to look at the boy’s section.

Mother picks one out though

you swear never to wear the contraption.

You fight the bra until she threatens 

to keep you home from school

if you do not yield. 

Tell your classmates about the bra even though 

none of them understanding 

because they do not develop breasts

until seventh grade.

You’re supposed to be embarrassed when

sharing the facts of your body

but you don’t understand why. 

Do not wear the trainer again until

months later, your breasts grow a cup size.


Become overwhelmed by your body,

by the way your breasts look beneath your shirt.

Buy a binder online and shimmy yourself into it.

Look at your new silhouette in the mirror for the first time. 

Feel like you’re looking at the most beautiful stranger you’ve ever seen.

Want to feel like this always.

Try to feel like this always 

Before you read online:

Don’t bind for more than six hours a day

Don’t bind more than two days in a row

            Don’t sleep in your binder

            Don’t exercise in your binder

Under threat of bodily harm.

Realize being comfortable in your body means 

physical discomfort

            and risk of injury.


Cover the mirrors.

Don’t think too hard when you get dressed or undress.

Avoid the mirrors when you do this.

Don’t look down at your body.

Release the breasts 

you’ve contained by binding for ten hours 

adding pressure to your ribcage 

and compresses your lungs. 

Hope you have not caused permanent damage to your body 


Never leave bed 

without binding

because you cannot handle 

having the silhouette of your breasts 

visible under your shirt.


Go into the kitchen.

            Pick up the knife.

            Put it back down.

            Know you can’t preform

            the surgery yourself.

            Know you could bleed out 

            before the ambulance could save you.

Cry yourself to sleep on nights when 

being trapped inside your body is too much. 

Wonder if self-mutilation is the answer.

Remember some think surgery is a form 

of self-mutilation.

Cry harder.


Call the Sioux Falls Surgery Tower 

to schedule a consultation for top surgery, 

a double mastectomy. 

Get offered several dates and times to schedule. 

Take the first one available. 

It’s in over five months. 

You’ll see the surgeon October 12th at 1:15pm. 

You need surgery scheduled before the first 

of the new year before 

insurance has a chance to change.

Worry you’ll never have a body you’ll love.


Look at yourself in the mirror with your hands attempting 

to cover your large breasts

            pulling them to the side 

            leaving a flat gap in the center of your torso

            creating an illusion of flatness.

Imagine scars where your breasts hang

like the ones you’ve seen on your friends 

and on strangers in online support groups 

or trans celebrities on Instagram. 

Imagine loving what’s reflected in the mirror.


Dear [DEADNAME REDACTED]: an erasure


you probably expected this email

I have hesitated with you for too long,

tried to be gentle, 

afraid of pushing you away

your progression from a girl 

to now wanting to mutilate your body 

be a guy 

completely incomprehensible

We prayed

warned you 

you are 

hell bent

destroying yourself

self destructive

you are [DEADNAME REDACTED], not Elias

you bought a lie  

you will regret this decision 

rid yourself of this community you have put yourself in 

I love you daughter, 

but removing your breasts is not the answer 

you are looking for

I cannot come along side, or condone 

this thing you are contemplating

We cannot walk this path with you, but you will need us when 

things fall apart

and we will be here

come back to The God of the Bible


Your Dad

Irreversible Damage: a gift from my father


Therapist’s Note

June to October

                       months of waiting

                       of browsing top surgery forums

                       typing into search bars

                        questions to ask during surgery consultation

                        how to prepare for a surgery consultation

                        what to do before top surgery

                        requirements for therapist note for top surgery

                        therapist note top surgery templates

                        therapist top surgery note examples

                        what to know before surgery consultation

       months spent in Ben’s office

                       co-writing a letter

                       to bring to the consultation

                       for insurance to cover the cost 

Dear [SURGEON], 

I am writing you today to assert my full support for [DEADNAME REDACTED],* who identifies as Elias, to receive a gender confirming top surgery. Elias is 25 years old living in Vermillion, SD. Elias is an English graduate student working towards his** PhD. Elias has a support system*** of his partner and close friends who will be taking care of him during the surgical recovery. My clinical assessment is that Elias Donstad is diagnosed as having F64.9 Gender Dysphoria.**** Elias***** meets the criteria set forth by the WPATH****** Standards of Care for gender confirming surgeries. He experiences extreme distress and dysphoria as he does not identify 

*I hate seeing that name

on documents

required to help me become Elias

                         **at least I see my pronouns

                         even if I have to be wrongly named

       ***chosen family

                          ****the mental illness required to receive care

******my real name

*******the institution that

                                   judges whether my

                                   mental and physical

                                   distress is enough to

                                   confirm my need for


with the sex assigned at birth and has felt this way since age 12 which is why he is seeking approval for this procedure. I have had an ongoing therapeutic relationship with Elias for nearly a year. Elias has been out and has identified as male for 9 months. *******  He spoke with me about his desire for surgery to ameliorate everyday living. Top surgery would aid in mitigating major dysphoria as well as relieve continuing pain and alleviate potential damage due to chest binding.

Informed consent was provided by [DEADNAME REDACTED], and he has the capacity to consent for treatment with surgery. A release of information is included with this letter.


Elias is aware of the risks, benefits and after care needs of this procedure. Furthermore, I do not see any confounding diagnoses [ANXIETY AND DEPRESSION] that would complicate this process of approving him for surgery.

He will have continued access to my services for care and support. I am available for coordination and welcome any appropriate communication with your office. I can be contacted at [EMAIL AND PHONE NUMBER REDACTED] if you have further questions. Thank you.



                                   I take a printed copy with me 

                                   to the consultation

                                   hoping it will be enough 

                                   for the surgeon 

                                   and insurance

*******this might not be enough time for the surgeon or insurance


Surgery Consultation

Bring the letter to the surgeon

cowritten with my therapist

to meet insurance requirements.


Wear my most masculine clothes:

the men’s jeans I got

before I knew I was trans,

a baggy shirt to hide the contours of my binder

with inconspicuous black and white chucks,

and a black beanie from the men’s section in Walmart.

Try very hard to look like a man 

because I am 

because I want my body to look like a man’s

because I want the doctor to know I’m serious

because I’ve read on top surgery forums

that appearance is important

that surgeons need to be convinced

you are who you say you are.


Wonder how to label myself to get 

the most understanding

whether nonbinary trans man aspiring FTM transmasc

is too complicated and contradictory

to explain to a cisgender doctor

and inaccurate to my transition

since I want all medical interventions

available to change my body.

Decide after remembering my chart marks my gender as

“transgender male”

and my real name is in quotes

like an alias

behind my legal name.

Worry “transgender male” will mean

the doctor will require me to be on hormones

for at least a year before

considering the surgery

like many of the guys on internet forums.

Hope for the best as I enter the surgery tower in Sioux Falls, SD.

Dr. Liu sees me at my scheduled time

spends ten minutes in the room with me

assesses if I am mentally ill enough 

for the surgery to be warranted

but not mentally ill enough for me to be

incapable of making this decision.

I want to cite my therapist’s letter

that Ben does not see

“any confounding diagnoses

that would complicate 

this process of getting approved for surgery.”

Keep my mouth shut

afraid of saying anything wrong

and getting a chance at surgery taken away.

Dr. Liu pauses too long on my list of medications 

for my diagnosed anxiety and depression

questions me about my mental health

making me argue for my (in)sanity to get the surgery.

Dr. Liu and I reflect on my solitary month of HRT

asking why I stopped

(my parents found out and I

couldn’t break their hearts more)

asking if I want to start

(I have an endocrinology

appointment on the books)

telling me HRT is not required by WPATH’s standards

thank god for nonbinary and trans people 

who don’t want HRT

but get top surgery

for making this possible.

I assure him I’m incapable of living with breasts

but not in the way where I’m self-harming


even though I think that should be

the greatest implication

medical action needs to be taken.

Dr. Liu notes on my chart that he

had the pleasure of seeing [DEADNAME REDACTED] 

‘Elias’ in the Plastic Surgery Clinic 

a 25yr old transgender male 

who has lived as his identified gender 

since January 2022 

presents today for consultation regarding 

bilateral gender-affirming chest reduction surgery

has been contemplating mastectomy for a while 

currently binding his chest daily

denies any personal or family history of breast cancer 

has a letter of support for the surgery from his 

current mental health provider.

Leave with instructions:

wait 6-12 weeks on insurance to approve surgery

based on WPATH’s standards

get a mammogram 

schedule a physical 

within one month of the surgery 

once the date is set. 

Panic because it’s October.

The hospital will hear from insurance

the last week of November

leaving a month left to schedule the surgery

because December is the last month I have

insurance that will cover surgery

if they approve it

based on my therapist’s note

and the surgeon’s recommendation.

Rejoice when the surgeon’s office calls

with the news insurance approved it.

Get offered dates to schedule the surgery. 

Take the first one available. 

Go under the knife December 8th, 2022.


Top Surgery

I sent my rack back

subtracted 853 grams from the left 

857 grams from the right

fibroadenomas removed

fibrous stromas reported

with fibrous nodules

lumps biopsied 

at the age of 17

which showed no cancer

but nodules had cancerous potential

pain lodged in my body

I sent my rack back

trading breasts for scars

running armpit to armpit

making it impossible for me to 

raise my arms for weeks

unable to shower

clothe myself

or get in and out of bed 

without assistance


like the pain 

and the opioid prescription

while my scars last forever

I sent my rack back

in exchange for a body

that’s truly mine 

after 15 years of protrusions from my chest

my hands can lay flat on flat skin 

I sent my rack back

like it was the wrong order at a restaurant 

like it wasn’t mine or meant for me

because that was true


First Week Post-Op

The day before my surgery, you showed me your chests, lifting your shirts together like it was a synchronized act, you with two flat lines that intermissioned in the middle and your partner’s Peri-areolar chest with nipples that looked like they’d never been tampered with, scars barely visible. 

I looked more closely at you, hoping that I would look as beautiful as you after surgery since our breasts were nearly identical when we had breasts. 

For the first 72 or so hours post-op, you take turns administering the opioids the doctor provided with the muscle relaxers on the strict schedule prescribed on the bottle, rotating night shifts to assist me when I needed to use the bathroom, helping me out of bed and pulling down my pajamas before I went to the toilet then returning me to bed, finally pulling up the covers since my arms didn’t have the strength. 

Every night you measure my fluid output, empty my drains, comfort me when I wince while you stroke the tube to get all the blood and plasma into the container that dangles by my hips. 

You reminisce about your drains, about how you could have gotten them out days earlier if it hadn’t been Christmas time. Talking distracts me from the process, and I am thankful for the stories you and your partner share about your post-op healing.

Four or five days after surgery, you help me bathe. Your partner’s shower seat for his disability aids us in our endeavor. You tell me to bend my head forward so you could wet and wash my hair for me. I do my best to bend without pain, but everything hurts. Your partner scrubs my back and lower legs. You turn your backs to give me privacy while I clean more sensitive areas 

even though you have seen all there is to see of me.

You and your partner accompany me to the one-week post-op appointment where we submit our paperwork that tracked my fluid output. The surgeon deems me ready to be released from the drains. You offer to hold my hand while the surgeon positions himself to yank out the drain,

but I decline out of a sense of pride. It hurts and creates two new open wounds near my armpits. But now I can see myself.

The surgeon and nurse help me sit up, and you watch as I look at my chest in the mirror for the first time, observing the two scars feeling euphoric, a replacement for the past dysphoria that haunted where my fresh incisions lay.

Now I’m beautiful like you.


Dear [DEADNAME REDACTED]: an erasure II

I do not know if it [THE SURGERY] has happened

I hope not

we do not support this 

it is wrong

1) It is not going to make the difference you think.

2) You will regret this, there is no doubt in my mind.

3) Until they put you under, you can change your mind, and not do this!

4) We are here for you. 

We cannot walk this path with you, but you will need us when 

things fall apart

we will be here

this [YOU] is [ARE] a train wreck that has only one conclusion. 


 we love you and will not leave you

come back to The God of the Bible

Jesus loves you


Your Dad


2-4 Weeks Post-Op Back in my Apartment

Amelia drives me home, 

a stuffed animal protecting my chest 

from the biting seatbelt 

during the hour-long drive 

on icy interstate

Amelia has to open 

my apartment building’s door

to allow me inside  

since I don’t have the strength 

My two cats greet us 

as we enter my apartment 

where I see Jackson the cat sitter’s care

in the filled food bowls 

and clean litter boxes

as well as his and his father’s kindness

in the placement of the recliner

several feet away from the wall

so I have a place to sleep

where I am least likely

to accidentally injure myself sleeping

Before Amelia leaves

they walk through the apartment

with me to check

what necessary items

might be above elbow level

to lower them

so I can take care of myself

As I heal, Jackson continues to

come over to feed the cats

clean litter boxes

take out the trash

Nova who used to be a CNA

comes over to bathe me

after I hurt myself

washing my hair in the sink

They make me gnocchi bake

that yields a week of 

leftovers to sustain me

They take care to wrap and rewrap 

my bandages every day

to make sure I’m sufficiently



Phantom [****] Syndrome

third week post-op

well enough to start to move

out of a semi-catatonic state

still fighting a haze*

feel phantom DDDs hanging from the chest

the sting of the tumor on the left side

move arms to accommodate 

the mass of 850-something grams

that used to protrude 

from each side of the chest

severed from the body

but still holding on**

phantom chest

belonging to a phantom self

made phantom on the operating table

dysphoria turning into a haunting ghost***

ask transmasc friends

if they ever had a buffer period

where the body doesn’t know it changed

and the surgery feels like it never happened

be told no

feel hopeless

look at the mirror to relieve the sensation of breasts

because that’s the only thing that ameliorates the sense of distance from one’s own body

*is it leftover from the opioids

or the abundance of sleep 

mixed with an endless string of bad movies

that just fill the time

giving me something to hear and see

while my body lays still

with sutures and bruises 

fresh under bandages?

**hitting my sternum with my hand while crocheting

without my breasts to thwart the movement

***will I ever be free from my breasts? will I ever be free in my body?

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