Living a livable body: Trans masculinities, surgery, and resistance in the Global South

BACKGROUND: In the Global South, transmasculine individuals often access gender-affirming care within systems marked by structural inequality, limited legal protections, and cisnormative medical frameworks. In Peru, the absence of trans-inclusive public health policies has rendered transmasculine surgeries rare, under-researched, and stigmatized, further marginalizing these experiences in both biomedical and academic discourses. AIM: This study aims to explore the lived experience of a Peruvian trans man-among the first to undergo phalloplasty in the country-to examine how gender-affirming surgery can function as an act of self-determination, resistance, and survival under precarious conditions. METHODS: Using a single-case narrative design, this qualitative study draws from a four-hour in-depth interview and employs a feminist decolonial analytical framework. Thematic analysis was conducted to identify key dimensions of the participant's experience, including healthcare navigation, bodily autonomy, and affective-political meanings of transition. RESULTS: Findings show that surgical transition in Peru is shaped by financial precarity, social stigma, and institutional neglect, yet also becomes a terrain for transmasculine agency. The participant reframed surgery not as correction, but as an embodied intervention toward livability, presence, and gender affirmation. Photography and bodily documentation emerged as practices of self-construction and resistance within a cisnormative and colonial context. CONCLUSION: This article contributes to trans health scholarship from the Global South by foregrounding localized, intersectional narratives of transmasculine embodiment. It calls for trans-centered, decolonial healthcare models in Latin America and highlights how gender-affirming practices can be both personal and political acts of resistance and survival.