Breast Cancer Doesn’t Care About Gender

Welcome to The Breastcancer.org Podcast, the podcast that brings you the latest information on breast cancer research, treatments, side effects, and survivorship issues through expert interviews, as well as personal stories from people affected by breast cancer. Here's your host, Breastcancer.org Senior Editor Jamie DePolo. 

Jamie DePolo: Hello. Thanks for listening. Breast cancer doesn't care about gender. You can be cis, fluid, trans, nonbinary, omni, or pan, among others, and you can still be diagnosed with breast cancer.

My guest today is Ashton Davidson, who was diagnosed with breast cancer during gender-affirming top surgery. He joins us to discuss his breast cancer experience and some of the challenges he faced, as well as his advocacy work and how he finds the strength and courage to live authentically in the face of adversity, especially today. Ash, welcome to the podcast. I’m so delighted to be talking to you.

Ash Davidson: Thank you so much for having me. I am so excited to be here, as well, and can’t wait to talk more and just share a little bit more about what life’s been like for me.

Jamie DePolo: Excellent. So, let’s start, I guess, kind of at the beginning for our purposes. About your diagnosis, how old were you? Did you know or suspect that you had a higher-than-average risk of breast cancer? Did the disease run in your family?

Ash Davidson: Sure. So, I was 42 years old when I was diagnosed, and breast cancer was not on my radar at all. There’s no family history, not in my immediate family. I think there’s some cousins or you know, some people that are a little bit more distant relatives, but cancer at all, in general, neither of my parents have had any issues with cancer, siblings, nothing like that. So, it just wasn’t something that I had a major concern about. No high risk, nothing like that that I knew of before I was diagnosed.

Jamie DePolo: Wow, and so, if you’re comfortable, could you share a little bit of the specifics about, like, what type of breast cancer it was and a little bit about your treatment? I mean, going in for top surgery and then having that kind of be one of the results, I mean, that probably was, as you said, not on your radar and not something you were even thinking about. So, I’m just trying to think about all the emotions that must have gone through you, because, you know, there’s the whole emotional aspect of the top surgery, and then, to have that thrown along with it is...I can’t even imagine.

Ash Davidson: Yeah. There’s a lot there to talk about, and so, you know. First, just the diagnosis, right? I was diagnosed with stage I invasive ductal carcinoma. The good news, it was caught very early, and so, my prognosis and even treatment plan was certainly not as intense as other folks who’ve had breast cancer diagnoses, but by no means was it an easy diagnosis, either. Like you said, being diagnosed as a result of having gender-affirming top surgery is a very uncommon, although not completely...there are, you know, other folks out there who have gone through the exact same scenario, but it’s not talked about a lot.

And so, for me, if we back up even a little bit, I had actually...like I said, I was 42 years old. And I knew the recommendation is once you hit 40, you’re supposed to get a mammogram, right? It took me two years to get a mammogram, and actually, about six months before I had top surgery, I did that. And it was not a process that I was looking forward to, and it was really kind of hard to get myself in there and move forward with getting a mammogram, but I did it because I knew it was important. And interestingly enough, they did the mammogram, and I got called back in for an ultrasound because they saw something.

After that ultrasound, they kind of cleared me. I don’t remember exactly, you know, what the terminology was, but they pretty much said, you’re okay. There's nothing there. So, I don't know if that was actually the very beginning of maybe a small tumor or if that was just coincidental, but I bring that up because I really didn't think there was anything to worry about. I had just had a preventative screening, and you know, while it was a little worrisome there for a minute, I was cleared. I was good to go, and I didn't have that mammogram because I was having top surgery.

It was just, you know, a completely separate thing. But when I decided to transition, I did a lot of work to get to that point. Again, I was 42 years old when I started transitioning. I only had started testosterone about four months before I had my top surgery, and I was on a low dose of testosterone. So, I was very early in transition when all of this happened. But I did a lot of work leading up to that. You know, I grew up in a time when there wasn’t much trans representation, and by the time I kind of even thought of it as maybe a possibility, I just thought I was too old. You know, I thought that ship had kind of sailed.

Jamie DePolo: Oh, really?

Ash Davidson: Yeah, and so, then I did a lot of therapy, and I did a lot of, you know, self-awareness, introspection, all of these things to get myself to the point where I said it’s not too late. Like, it is not too late for me to live this life that I’ve never really thought was possible for me. And so, one of the things that I was...you know, I wasn’t...you know, there are some, you know, effects of testosterone that I was kind of looking forward to and some that I was not quite sure how I was going to feel, but top surgery, there was no doubt.

Like, I was so excited for that, and you know, the interesting thing about transitioning, too, is that if you’d asked me this maybe six months ago, maybe a year ago, I might’ve characterized my relationship to my body a little differently. And as time goes on, the more I’m able to reflect, the more, you know, that comes into focus for me, and it wasn’t that I hated my body or even hated my chest, right? It just never felt like mine, and it never felt comfortable, and I felt very disconnected from it. So, top surgery was this...it was kind of everything, right?

The culmination of years and months, and here I was. And so, I have top surgery done, and having a breast cancer diagnosis as a result of that was not only shocking, it was unfathomable for me. The preparation that went into top surgery and the excitement and the stakes and the expectations were so high. For the outcome to be that, was devastating in a way that is incredibly hard to articulate, and was almost impossible to process at the time.

Jamie DePolo: I can only imagine, and I’m curious. Just sort of one sort of really technical question. Did your surgeon who did the top surgery ask at all, like, whether you had a mammogram? Like, did that person know that you had been called back at all? I’m just curious.

Ash Davidson: You know, I think they may have asked if I had had a mammogram, but it wasn’t...having a mammogram prior to top surgery wasn’t a requirement, at least for my surgeon. So, I’m not 100 percent sure if they even asked that question. See, I can’t remember exactly, to be honest. Yeah.

Jamie DePolo: Oh, that’s fine. I was just curious. And then, I guess I’m curious, too, about treatment, because if the cancer was hormone receptor-positive, that would've been anti-estrogen therapy, which, I don't know, I’m not a doctor, but I’m assuming that would go along with taking testosterone? I don't know that, or does it mess up the whole hormonal balance? And I don’t even know if that was the reality for you. Was the cancer hormone receptor-positive?

Ash Davidson: Sure. So, we could probably do an entirely separate podcast just on how to manage your hormone therapy and...

Jamie DePolo: Probably.

Ash Davidson: And hormone receptor-positive cancer. So, yes, my cancer was ER/PR-positive HER2-negative. So, yes, it was hormone receptor-positive, and it has created some unique complications over time. I was never recommended or asked to not continue with my testosterone hormone therapy. So, I was able to continue that throughout chemo, throughout radiation, but one of the things, post-treatment, that I’ve been prescribed is tamoxifen, and so, you know, tamoxifen, for folks who don’t know, it doesn't exactly block estrogen in your system, but it changes the way that your body uses estrogen.

So, in effect, you know, sort of, you know, simple terms to think of it, is it blocks the way your body uses estrogen. When you’re on continuing hormone therapy, sometimes it takes some adjustments to keep your hormone levels steady. When you add tamoxifen on top of that and some of the side effects that people experience with tamoxifen, things can get really sticky and difficult to navigate, and that has been the case for me. It’s been a real struggle to work both with my gender-affirming care doctor and with my oncology team to minimize those side effects, and it’s not been the easiest road, and I’ve had some really difficult times.

And some of the side effects I’m referring to, too, are often emotional anxiety, depression, some of those kinds of things, brain fog, which, as a lot of folks know, you’re already dealing with a lot of brain fog after going through chemo, and that can stick around for a really long time, which was the case for me. So, trying to manage my own hormone therapy, on top of tamoxifen, has been something that we still...it still is not fully sorted out, and it’s something that just requires a lot of management on a day-to-day basis, and it’s been pretty tough.

Jamie DePolo: A work in progress.

Ash Davidson: Yeah. Yeah, absolutely.

Jamie DePolo: Was it difficult to get your oncology team and your gender-affirming team, the two medical teams, to work together? Did you have any issues with that?

Ash Davidson: No, and you know, when we go back to this idea of gender doesn't care about breast cancer, one of the things that I like to talk about with folks is how lucky I was, in the sense that because my tumor was found during gender-affirming top surgery, my top surgeon was actually able to connect me and refer me to my oncology team. So, I live in Austin, Texas. Austin itself is a pretty liberal and progressive place.

But as I think a lot of folks know, policies and other things here in Texas are not so, and approaching healthcare here in Texas is often a little scary and full of doubt, and I’m not sure how I would've been able to source an oncology team on my own, had I not been introduced via my top surgeon. So, from that standpoint, you know, once...you know, my top surgeon hasn’t been heavily involved since the actual surgery, but she was...you know, she was able to refer me to an oncology team who has been nothing but you know, respectful and you know, really gone out of their way to kind of understand the nuances of my specific case, and so, those...

You know, those two things, between my gender-affirming care doctor and my oncology teams, has actually been a real bright spot. And whether they’ve communicated together or whether sort of through me, I’ve been able to really still foster my own transition, again, because I was so early in transition. I’d barely started when this happened, and so, those first couple of years of transition are tough. I mean, emotionally, physically, mentally, spiritually, in every single way. I think, you know, a lot of people think, oh, well, trans people just start transition, and it’s easy, and they’re so happy, and everything’s great.

Jamie DePolo: They just snap their fingers, right?

Ash Davidson: Yeah. Yeah, and it’s not that. It’s an incredible amount of self-awareness and introspection and work that you do to go through that process. And so, having the added layer of doing cancer treatment on top of that is incredibly difficult, and I was really fortunate that those teams worked really, really well together for me.

Jamie DePolo: That’s so wonderful to hear, because I know that is not the case for everybody. A lot of people sort of flounder with, you know, finding an oncology team that, as you said, is respectful and understands where you are. So, I’m very, very happy to hear that. I’m very happy for you.

Ash Davidson: Yeah, thank you.

Jamie DePolo: That’s great.

You know, you’ve gone through all this, and as you said, big emotional roller coaster. Lots of introspection. How did you decide to be so outspoken about this and really become an advocate? Because I know it’s...I’m so happy that you do, because I like to think of a lot of what we do at Breastcancer.org, sort of sending out these little flares so other people, who may be in the same situation, can see themselves and see, like, oh, I’m not alone. I’m not the only person this has happened to, because I feel like I am right now. But I realize that’s not for everybody to share their story. So, how did you come to that?

Ash Davidson: Yeah. So, in some ways, it was very unintentional, and in other ways, it was very intentional. What you just said about the loneliness involved in being trans or gender expansive or even queer in the breast cancer space, was pervasive throughout my treatment. And while I was incredibly lucky to have a really good care team who treated me with dignity and respect all the way through, I was very lost. I had an incredibly difficult time from a mental health perspective, and a lot of that was exacerbated by the fact that, rationally, I knew I was not the only human being on the face of the Earth who had ever been diagnosed with breast cancer as a result of having top surgery.

Emotionally, I felt like I was the only one. I felt like none of the services and resources and support were for me. I felt sometimes like maybe I was even invading women’s spaces and that, you know, almost my existence in those spaces kind of took away from others. And again, the rational side of my brain knew that that wasn’t true, but that the emotional side really takes over, especially when you’re under so much disorientation and just, you know, just trying to figure out how to navigate all of this. And one of the things that I was left with, through that experience, was that I didn't want other people to feel the same way that I felt. I didn't want other people to struggle in the ways that I struggled.

Having cancer is hard enough on its own, and then feeling like you can’t find the resources that you need to support you through it is even worse, and it’s not that there aren’t resources out there, but oftentimes, as queer folks, you know, as a queer and trans person, when I go to a new city or something, right, or even in my own city, I’m looking for, you know, a queer-friendly barber or a dentist, or you know, anything you can kind of think of, I’m always kind of trying to find, you know, the queer services related to that.

And I struggled to find those because the resources weren’t coming to me. I had to find them. And trying to find resources, while you’re juggling, you know, transition and chemo and radiation is nearly impossible. And so, it wasn’t until after I finished the bulk of treatment that I started to actually be able to have the bandwidth to find those resources, and the moment I found them, things opened up for me. I realized I wasn’t the only person on Earth. I realized that there were other people that’ve gone through this.

But especially right now and especially with the attacks on trans folks, there are not a lot of gender-expansive breast cancer advocates in this space. There are some, but there are not a lot, and when I realized that. Again, the intentional side of me started to take steps to figure out how I could fill in those gaps, but the unintentional side of me had no clue how to do that and even what I was doing. So, I started just reaching out for resources literally for myself, and in the process of that, realized the importance of storytelling, the importance of using my voice, the importance of, if I speak up, even if only one other person hears this, maybe they won’t feel so lonely, or maybe they’ll reach out to me.

Like, maybe we can talk. Like, and that was just where it started. It really came from my own needs and the resources that I needed and didn't have throughout my experience and a really strong desire and sense of passion and purpose that said, I’m going to do this. I’m going to do this until I can’t anymore or until people just refuse to listen to me anymore, you know? Like, I’m just going to follow this path, and that’s what I’ve done for the last, you know, I guess it’s been about a year and a half now. Just following the path and taking every opportunity I can to speak about it.

Jamie DePolo: Well, I, and I know others, are very happy that you are, because it is...I feel like it’s one more thing that gets put on somebody who’s been diagnosed with cancer. I mean, as you say, there are resources out there, but you have to find them. And you know, as you said, when you’re juggling chemo and this and that and trying to work and figure out how you’re going to pay for things, it’s really hard. It’s just one more thing you have to do. So, thank you for putting yourself out there. Appreciate it. 

And sort of piggybacking on...you talked about opportunities. I know that you are a speaker at this year’s American Society of Clinical Oncology annual meeting, and full confession, I stole the title of Ash’s talk at the ASCO meeting for this podcast, which is Breast Cancer Doesn't Care About Gender, because I thought it was so great. So, could you tell us a little bit of what you’re going to talk about? Have you worked that out yet? I know sometimes people like to do that at the last minute, so I don’t mean to put you on the spot if you haven't.

Ash Davidson: No, absolutely, and I’m happy to share a little bit, but I don’t want to give away too much because, you know, I want it to be fresh and new for the audience at ASCO, as well. You know, I realized that ASCO does a speaker series every year called ASCO Voices. And it’s just a purely storytelling event. You know, there’s no slides. There’s no science, necessarily, really. It’s really an opportunity for five people, each year, to get up and just talk about their stories. And it’s, you know, a mix of healthcare practitioners and patient advocates and things like that, and so, again, especially because of the time that we’re in right now, it’s really...

And because of the unique situation that I was diagnosed in, with being, you know, diagnosed as a result of gender-affirming care, I have a very, I guess, unique...I just used that again, but a unique opportunity to speak about the importance of continued access to gender-affirming care. Without it, again, since I had had my mammogram six months prior, it would've been a couple years before I was going to go back and get another one. Meaning I would've been symptomatic by the time I would've been diagnosed. And we know, by that point in time, that diagnosis and prognosis would've been a lot more difficult than the one that I did experience.

The second piece of that, too, is that...like we talked about. My gender-affirming care...or my top surgeon referred me to my oncology team, saving me a lot of doubt and apprehension and concern about how I was going to be treated by those who were treating me. And so, without getting into a whole lot and anymore details, that’s really the crux of it, right? Is that I was diagnosed of breast cancer in the midst of gender-affirming care, and if that care disappears for people, we’re cutting off a conduit for folks who already struggle with medical mistrust and struggle with numerous barriers to healthcare.

And by cutting off something like gender-affirming care, which is a place where a lot of folks actually just get their basic healthcare needs met, it’s not just hormones and surgeries and things like that for trans people. It really is a conduit for basic healthcare, and so, it’s an opportunity to highlight that and you know, how that interacted with my own story and may interact with other people’s stories. So, you know, it's really just a fantastic opportunity for me to, you know, tell my story from my point of view and be able to highlight the importance of gender-affirming care going forward.

Jamie DePolo: That’s great. Thank you for doing that, too. Do you apply for that, or do they ask you? How does that work?

Ash Davidson: Yeah. So, it’s an audition process. So, you submit a three-minute audition, and then they select the speakers from there. So, I was incredibly blown away. I feel very, very fortunate and very grateful to have this opportunity to be on that stage and to talk to the people that will be in that room. Again, when I say things, sometimes things are hard to articulate. It’s difficult for me to express just how meaningful it is to me.

Jamie DePolo: That’s great. Well, I am going to ASCO, so I’m going to be in the audience. So, I’m very excited to hear your talk. Now, on a slightly more positive note, I know that a documentary film is being made about your life. I don't know if it’s your entire life or if it’s about the transition and the cancer surgery, but can you tell us a little bit about that?

Ash Davidson: Yes, and I am so excited about this project. We are making a documentary, and one of the cool things about the documentary...and I’ll get into the details a little bit, but one of the cool things about it is that this is a project that is originating from me. So, nobody else approached me to do this. I’m fortunate to have a good friend who’s been a video editor and post-producer for a very, very long time, who also lives here in Austin, Texas, with me, and we’ve been friends since childhood. And we had a conversation about should we do a doc? Like, does that make sense here?

And he really picked up the beginning of the process and ran with it and helped get, you know, a production company on board and helped get a director on board. And the reason I think it’s cool that it sort of originated from the two of us is because we’re telling a very queer story with a mostly queer and 100% allied group of people, and we’re doing it our way. So, there's no one that’s telling us how to tell this story.

And so, the story really is going to center around a handful of things. It’s going to center, of course, around just my experience with transition and how that intersected with my breast cancer diagnosis. One of the things that, you know, happened, I kind of, you know, referred earlier to having a really, really difficult time with my mental health. And I reached a really low point, and then one of the ways that I kind of got myself out of that low point was I started boxing, and I started working out. And I was in a whole new body now. I was an athlete growing up as a kid. I swam for a long time and then played soccer in college. And so, I’d been an athlete for a long time, and then, as an adult, I’d really struggled to do anything very athletic, and let that kind of part of my life kind of fall away.

And it was this, like, you know, inflection point, where I was at this lowest mental health point in my life, where, all of a sudden, movement and sports came back into my life. And a lot of that was due to living in a body that I felt more at home in and more comfortable in, and also knowing that, if I was going to make it out of all of the things that were overwhelming me, I was going to have to do something and something kind of drastic. And so, we’re also going to touch a little bit about reclaiming my title as an athlete and reclaiming my body in a way that I’ve never sort of been able to do, due to not always feeling very comfortable in it.

So, we’re going to touch on gender-affirming care. We’re going to touch on my transition story, my breast cancer story, and also a little bit on just, you know, what’s going on in the country and how trans people are being treated in sports and you know, across the board, outside of athletics and things like that. So, we’re going to hit on a few things, but we’re really excited because, like I said, we’re telling a very queer and trans and gender-expansive story by queer, trans, gender-expansive people.

Jamie DePolo: Telling it your way. That’s great.

Ash Davidson: Yeah. Yeah.

Jamie DePolo: That’s great. Well, and you mentioned this, and I guess, given the state of the country today, this can sort of be the wrap-up, but it’s very depressing. Well, it’s more than depressing. It’s outrageous, and it makes me irate, but that’s just me. Those are my feelings. I can’t speak for the organization or anybody else. But you know, have you...you do live in Texas. Granted, it is Austin, as you said, which is a little more welcoming of people who are different than the rest of Texas, in my experience. But you know, you’re a boxer. Has that been a problem? Like, at a gym, are people welcoming now? Do people feel like they can...I don't know. I just feel like people think it’s okay to be racist and homophobic and anti-anyone who isn’t a white man right now. So, what are you seeing?

Ash Davidson: Yeah. I mean, you know, the time that we’re in right now, like you said, it’s hard to find the right words for it. You know, it’s devastating in a lot of ways. It feels like there’s far more bad news than good news, and I vacillate between a lot of different feelings. You know, between rage, between indignation, between sometimes feeling a little hopeless, even. You know, it’s hard to wake up every single day, it feels like, and hear another stream of bad news, but the tenor and the temperature is a bit scary, too. I find myself, when I’m in public, being a little bit more self-aware than...And I’m always fairly self-aware, but feeling a little more just kind of trying to keep an eye on the things that are going on around me and how people are perceiving or receiving me.

So, from that standpoint, you know, it’s stressful. It’s not easy to just...you know, and most of the spaces that I’m in, for right now, I generally tend to just stay in pretty welcoming spaces. The boxing gym that I go to, the coaches that are there are very welcoming. They’ve always been really kind and open to me. You know, and I haven't had to face a lot of issues, you know, in that gym specifically, but is it a place where there are other queer and trans people? Not that I know of.

I mean, there’s probably a couple other queer people that go there. I don't know that there are other trans people. To my knowledge, I don’t think that there are. And so, you know, whether it’s in breast cancer spaces and in advocacy, where I’m often the only person in the room who looks and sounds like me, that is very much the case in the boxing gym. I’ve also picked up swimming again, because, you know, I did that as a kid. Going to a pool and having very obvious top surgery scars is sometimes a bit nerve-wracking.

I don't know what I’m going to get into in those scenarios, but so far, I haven't had any issues with people reacting or responding to me negatively, but you know, every time I take my shirt off, which, you know, is both a very celebratory experience, but one that also, you know, comes with a little bit of concern, you know. I don't know what I’m going to get into, and I think that’s the thing that you live with right now, is that you just don’t know. And so, some people make different choices to protect their, you know, physical and psychological safety, and then the choices that I make, and everybody has to make the choices that feel right to them right now.

And there’s no judgment, you know, on what anybody feels that they have to do to maintain their safety. And I think that that’s the most paramount thing, right? It’s great to be out here and use my voice and tell my story and all of those things, but above everything else, you know, I don’t ever want to encourage anybody to do anything that would violate their own safety or cause harm. So, yeah, it’s a really mixed bag right now, but I think, you know, the one last thing I want to touch on there, though, is that, to me, telling my story, making a documentary, coming on podcasts, speaking at ASCO, whatever all of these things are, one of the biggest messages that I want to leave people with, though… And I believe this whole-heartedly, is that by doing all these things and showing up and in the midst of all of the negativity, being...trying to be a bright spot in that, is the fact that there is a lot of joy. And there’s a lot of joy in just living my day-to-day as exactly who I am, as the most whole, authentic version of myself. And that is one of the best ways of exercising resistance and protest against what’s going on, is to show them that trans joy exists, and it exists no matter what anybody else says.

Jamie DePolo: I love it. I love it. And then I guess one final question is how do you...like, do you have techniques to stay positive? Because I feel like I could use a couple of those tips myself.

Ash Davidson: Yeah. It’s really hard, and I’ve had so many moments of overwhelm and so many moments of despair, but I do...part of it is going back to that, is leaning on the fact that, every single day, I get to wake up and look in the mirror, and I’m looking back at me for the first...

Jamie DePolo: And you like it.

Ash Davidson: Yes, and for the first time in my life. And it’s not just the aesthetics, right? It’s not just the shell. It’s everything inside, too, that I get to look at myself every day and know that I am exactly who I am, who I was meant to be. I’m growing and changing and evolving, of course, as life goes on, but I have the satisfaction of being myself in the most authentic, real way I possibly can be, and when I stay grounded in that. 

Yeah, I’ve got to take breaks. I’ve got to do things that just feel like pure self-care for the sake of just pure self-care. I’ve got to baby myself sometimes. I’ve got to shut all the noise off, get off of social media, get off of, you know, the computer or TV, and go out into nature, or go for a swim, right? Swimming, I can clear my mind, swim laps, and just feel my body move through the water, and that feels good. I can go to boxing, and I can hit something, you know? I can literally throw a flurry of punches at a punching bag, and man, that feels good, right?

So, and then, you know, investing back into my community, spending time with my community, having conversations with other queer and trans and gender-expansive folks about the things that are going well, the things that we’re struggling with. Like, all of these are ways that help buoy me in times that, you know, threaten to kind of pull us under, but at the end of the day, it really is standing in the fact that I get to be me, on my terms, in my way, and no one can legislate that out of existence no matter how hard they try.

Jamie DePolo: Well, that is the perfect ending. Thank you so much, Ash. I am so grateful that you joined us, and I’m very much looking forward to your talk at ASCO. Thank you.

Ash Davidson: Thank you so much for having me. Thank you to everybody that’s listening. Thank you to, you know, the entire organization for having me here. Every time I get to tell my story, I say this almost every time. I hope that it helps other people heal, but it also helps me heal every single time I get these opportunities. I’m so grateful. Thank you.

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