Ezra Varley hopes his story will encourage other trans people to feel comfortable advocating for themselves and to seek medical care when something feels off.

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Earlier this year, Ezra Varley noticed his pants weren't fitting right. But the 24-year-old still didn't suspect something was off with his health until he started fielding awkward comments about his appearance.

"The main thing that tipped me off was when people started asking me when how far along I was in my pregnancy after I went back to work in June," he tells Health—and while it's a big faux pas to ask anyone about their pregnancy without them sharing the news first, it was especially distressing for Varley: He is a transgender man. "It was an uncomfortable thing to hear as a very binary trans man," he says.

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But his appearance wasn't the only thing tipping him off to a possible health problem. While Varley says he had noticed that his pants "weren't fitting" and that his reflection looked off, he says, "it took me a while to catch on." He says he was also experiencing uncomfortable symptoms at the time, including pain around his liver, pelvic cramping, nausea after eating, feeling full quickly after eating, shortness of breath, needing to pee a lot, "stabbing" abdominal pains, back pain, and "spontaneous feelings like my insides were being wrung out and exhaustion."

"I know it seems stupid that I didn't go to the doctor sooner, but I got really good at explaining away all my symptoms," he says. "I didn't want to waste anyone's time during COVID, risk getting the virus, and waste $300 on an overreaction."

Varley finally ended up seeking medical care on the urging of his fiancé, but he still didn't think anything could be wrong. "I truly didn't think anything of it until my doctor sent me for an abdominal ultrasound," he says.

During his appointment, Varley says that three different radiologists started looking in areas where he didn't have pain. "Then, they told me they couldn't find any of my organs. That's when I started to get worried," he says. After he left his ultrasound appointment, he says his doctor called and told him to go to the ER "immediately" for a CT scan and blood work. "I got diagnosed that day," he says.

Varley was ultimately diagnosed with an ovarian tumor, which was 1 foot long by 1 foot wide. His symptoms, he discovered, "were related to everything being crushed in there." The diagnosis came a few days before Halloween—at that time, it had been four months since he started noticing significant changes.

Ezra Varley

To understand how this can happen in a transgender man, it's first important to understand what it means to be transgender. According to GLAAD, transgender—trans, for short—is a term used for someone whose gender identity is different from the one they were assigned at birth. So, in the case of a transgender man, he identifies as a male, after being assigned female at birth.

While it doesn't get a lot of attention, "it is not uncommon" for transgender men to experience gynecological issues like ovarian cysts or tumors, Zoe Rodriguez, MD, assistant professor of obstetrics, gynecology, and reproductive science at the Icahn School of Medicine at Mount Sinai, and a member of the Center for Transgender Medicine and Surgery Steering Committee at Mount Sinai, tells Health.

"For the most part, if trans men have their natal reproductive organs intact, all of the same guidelines apply when we refer to screening for malignancies and STIs," she says. However, Dr. Rodriguez says, the recommendations change if the patient undergoes gender affirming surgery, such as a hysterectomy or removal of ovaries. "Internal exam of the genitalia is recommended to assess for dermatologic or other disorders," Dr. Rodriguez says.

But, Dr. Rodriguez adds, "once patients undergo 'bottom' surgery, which often includes vaginectomy and reconstruction of the external genitalia for the formation of a phallus, patients may choose to have their genitals examined by their primary care physicians."

As for his own diagnosis, Varley says he "burst out laughing" when he got the news. "Being told you have a tumor that's roughly a fifth of your size is such a shocking and ridiculous image," he says. "I had a close friend with me, so we spent a good 10 minutes making light of the situation, trying to wrap our heads around what that would look like and how it could even fit in there."

After that, though, Varley says he "went numb" and "cried for a few days" after he came to terms with his reality. "My fiancé and I were separated by the Canadian border because of the pandemic and all of my other family live in Australia," he says. "I'd just turned 24, I'd finally started to get my life on track after a pretty rough run, and I was sitting in a hospital room being consoled by nurses because I might have cancer during a global health crisis."

Eventually, Varley decided to have fun with the whole thing—he just went viral after showing off the tumor on TikTok. "This is Cystina," he wrote, while showing off his tumor in a video. Varley explained his story in the TikTok, and shared pictures of his scans. "Look how squished my organs are!" he wrote.

Varley also did a self-described "maternity shoot," mimicking the photo shoot Beyoncé did when she was pregnant with her twins. "I love Beyoncé and her maternity shoot is one of the most beautiful things I've ever seen," he says. "I figured, if I'm going to be stuck with this tumor for another two months before surgery, why not have some fun with it? If I'm going to look like I'm carrying twins I might as well play into it. What else am I going to do—sit and be sad about something I can't control?"

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Verley says he's "lived with depression for a really long time and that mindset has never served me." The photos, he adds, "were a way to get away from a headspace that is such a slippery slope."

Varley is having surgery this week, and he shared another TikTok about the upcoming procedure that's also gone viral. "Time for the ol' slice n dice," he joked in the caption.

Varley says he's "confident that I'll be okay" and "excited to see what my body actually looks like under there." He's also feeling "grateful" for his support network. "I can't wait to get this thing out and be able to walk up my stairs without needing to take a breather," he adds.

While he's joked about his experience, Varley says he hopes other transgender people learn from what he went through. "Stop ignoring your body," he says. "It's a practice, but you need to start paying attention when things aren't right and doing something about them."

"For trans people, it can be so much easier to avoid medical care because of the lack of knowledge surrounding trans health care and the very real discrimination we face in these settings," he continues. "But if my situation is any indication of what can and does regularly happen, it's essential to explore it and advocate for yourself when you're concerned." Varley also recommends bringing a friend to appointments, adding, "it helps a lot."

Dr. Rodriguez stresses the importance of finding a good care provider. "It is crucial to use resources to source out a competent and trans-friendly [ob-gyn] provider," she says, noting that patients should ask questions that are specific to their concerns and how to best address their needs based "not only on your 'organ inventory' but also on your family history and sexual activity."

"It goes without saying that trans men may find consultation with a gynecologist to be dysphoric and incredibly triggering," Dr. Rodriguez says. "This is why it's crucial to find a provider who is sensitive and competent to address your unique needs."

Varley ends on this note: "I hope medical professionals will ensure they're creating an explicitly safe space for trans people to feel comfortable seeking help. Be conscious of language when discussing reproductive health—it's not just a women's issue."

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