Garnet Rubio moved to New York City from Texas at 19 with a singular mission: transitioning. While her friends attended college, Rubio worked as a model, did her research and saved money for expensive and time-consuming gender-affirming surgeries. “The two years that I’ve spent here have been completely devoted to saving money, affording to live here and then transitioning,” she says on the morning of her vaginoplasty in Born to Be, a documentary about Mount Sinai’s Center for Transgender Medicine and Surgery (CTMS) in Manhattan, the first comprehensive healthcare center for transgender and non-binary people in New York and one of the few specialized centers of its kind around the country.

For Rubio, then 21, and for many of the CTMS patients featured in Born to Be, the vaginoplasty and other gender-affirming procedures offered by Mount Sinai represent the culmination of years of resilience, expectation and navigation of one’s identity and fraught relationships, let alone complex financing, indifferent insurance plans and medical professionals unfamiliar with healthcare for trans people. The camera follows Rubio from her apartment to the center in Chelsea, the final pre-op stages – a last consultation with her surgeon, Dr Jess Ting, on the aesthetics of the procedure, a hug from her friend, last Instagram caption on new beginnings – to the operation table, where the weight of anticipation brings her to tears.

“I needed the surgery, I absolutely fucking needed this surgery,” Rubio, now 25 and a model most recently on Bravo’s Project Runway, recalled to the Guardian of the “overwhelming” moment when she finally made it to the OR. “There was a time when I felt that nothing else mattered. Nothing else mattered but that surgery. I felt that if I didn’t have that surgery, I was eventually going to hurt myself.”

Rubio’s pre-op moment of clarity is one of several poignant, deeply emotional scenes of relief and excitement in Born to Be, directed by Tania Cypriano, which traces dual sides of the center’s groundbreaking medical practice: the work of Ting, the group’s sole surgeon when the center opened in 2015, and the experience of patients who place their most delicate vulnerabilities – their bodies, long roads of waiting to see a different reflection in the mirror, the mental health toll of existence in an often hostile world – in the hands of the center’s staff. The film is at times holistic, as it traces both the journeys of several patients to Dr Ting’s office and the doctor’s evolution from Juilliard-trained musician-turned general plastic surgeon to gender-affirming surgery specialist and advocate. Other times, it’s disarmingly, candidly clinical: how Dr Ting turns a forearm skin graft into a new phallus, the cuts required for facial feminization, can one smoke marijuana when recovering from a vaginoplasty?

The story of a transgender health and surgery center is still itself relatively new; at the time the center was founded in 2015, Ting was working as a general plastic surgeon in New York City, with little awareness of transgender healthcare or experience in gender-affirming surgical procedures. The film-makers hoped Born to Be “could give information about light being at the end of the tunnel, that things were changing regarding healthcare”, Cypriano, a cisgender woman originally from Brazil, told the Guardian. “There’s a discourse about cisgender people’s obsession about the trans bodies,” she later added. But the straightforward medical care and transparent emotion displayed in Born to Be offered a critical information vehicle and “a story that had not been told to that larger audience”.

Born to Be follows a representative, if still small, sliver of the center’s patients: Mahogany, a former male model receiving a long-awaited facial feminization procedure; Cashmere, a longtime New York “queen” who recalls the old days of “Paris Is Burning” Manhattan, eager to amend botched lip injections she received decades prior; and Jordan, who is one of the center’s first phalloplasty recipients, among others. Rubio, in particular, allows the camera into some highly sensitive moments – consultation appointments, discussing desired aesthetics with Dr Ting, first post-op dilation. The decision to allow the camera into the doctors’ office “was necessary”, Rubio said.

“I think it’s very, very necessary for a lot of cisgender, heterosexual people to understand what exactly it is we’re going through,” she later added. “Even though it is 2020 and everyone is so much more educated, I feel like people still have that whole ‘man in a dress’ perspective on trans people. And I really want people to realize that hey, it’s not like that at all, we’re actual human beings. Trans women are women. Trans men are men. Point blank, end of story, period.

“People just need to realize that what we’re going through is very serious and life-changing, and we’re going through it for a reason.”

It’s a realization Ting himself experienced once he began performing gender-affirming surgeries after years as a successful general plastic surgeon and accomplished classical bass player. Born to Be recounts his journey in building up the center, from traveling across the country to observe gender-affirming procedures, to handling burnout due to overwhelming demand for the center; at one point in the film, the center’s staff report a waitlist to book a consultation for a surgical waitlist that stretched for months.

That waiting period is especially fraught given the sensitive relationship between transitioning and mental health; both Ting and Cypriano stated that a main motivation behind the film was the suicide of a patient who was waiting for a surgical procedure during the center’s early months in 2016.

The weight of mental health struggles courses throughout Born to Be, informing not only the relief of enduring a surgical procedure but the long, non-linear recovery afterwards. Rubio, once euphoric in the operating room, finds herself slipping back into depression in the months afterwards; Cypriano’s camera lands with her in a hospital room, as she recovers, with some family by her side, from a suicide attempt.

Rubio fortunately recovered – “I’m doing much better, I have a lot of love and light in my life right now,” she said – and found purpose in the extremely raw, rock-bottom moment now preserved on screen as “something that needs to be seen”, she said. The experience of backsliding – thinking you’ve finally made the change, that this time, the demons are really gone for good – “goes beyond the trans experience. That’s just human beings, that’s just people.”

Still, the center’s handling of mental health concerns was complicated by a presidential administration actively hostile to trans rights – one that instituted a ban on transgender troops in the military, and rolled back protections against anti-trans discrimination as covered by the Affordable Care Act. The impact of the Trump presidency trickled down to Ting’s practice “both in tangible and intangible ways”, he said. “Patients are scared. Terrified. Racism, transphobia were all given free rein in the past four years, and we felt it. It was very real.”

The learning curve at the center was swift and propulsive – six months after beginning gender-affirming procedures, Ting established a pipeline for new talent through a surgical fellowship, the first of its kind; there are now four surgeons on staff. And as discussed in the film, he’s pioneering new techniques for the most intensive surgeries, particularly phalloplasty. But the main barriers for his procedures are not skin grafts or medical limits, said Ting. It’s “the world – there are so many people who don’t accept what we do, who don’t accept trans people and who would just like to delegitimize the whole concept of being trans or being yourself or being able to choose for yourself your own course in life.

“I wish they would see this movie,” he added, “because maybe they would change their minds a little bit, and see that trans people are just like you and I.”

• Born to Be is available digitally in the US now with a UK date to be announced