Content Warnings: Anti-fatness, medical bias, mention of intentional weight loss, bullying, dysphoria

As a fat youngster growing up in the ‘90s and early 2000s, I often felt like an outsider among my peers. I chose Beanie Babies over Barbies, loved my remote-controlled car more than anything, and would walk around with the grumpiest face whenever my mom forced me into a dress. Now, as a fat, nonbinary adult, I understand why I always felt like I had to find my own path.

In middle school, I started shopping for clothes in the men’s section, which my mom attributed to me being plus size. “It's what fits me,” I’d say in my oversized, men’s college football tees and washed-out, carpenter-style Levi's. I felt like I needed an excuse not to conform to femininity, especially because I already knew how gay I was and wasn’t ready to tell anyone about it. But by high school, I realized menswear was more than just a last-ditch option. I found solace in the comfort, the way the boxier cut laid on my body, my hips no longer obvious and my chest muted with a sports bra.

When I cut off all of my hair, it unfortunately introduced me to a new realm of bullying: the transphobic kind! I didn’t even know I was trans at first; I was much too concerned with attempting to hide my fatness, to hide myself. I walked on eggshells, so desperate to go unseen. When a group of guys created collages of my MySpace photos to make one of their friends feel bad for looking like me, this fat ugly thing, I remembered my place: outside. Outside this box and outside that one. 

Being an only child, I spent a lot of time late at night perusing the depths of the Internet, trying to connect with virtual friends. In my exploration, I stumbled upon the phenomenon of time-lapse gender transition videos. These videos included months and even years of photos and videos of trans men documenting their gender transition: the way their facial hair grew, their muscle gains, their “voice drops.” At the end, you’d always see a happy young person recovering from top surgery and wearing their most gender-affirming outfit. I’d fall down the rabbit hole of transition journeys night after night. It excited me to see someone take such joy and comfort in their body and, at 16, I realized this might be what I wanted, that this could be my community.

However, I never came across a fat trans man in any of those videos. The subjects were all thin and I knew my experience would never be like theirs. I had curves and rolls and a double chin. I’d never wake up one day looking “like a cis man.” I’d never wake up looking anything like these trans men either. I felt completely alone in this fat trans experience, discouraged from even dreaming of feeling at home in my body.

Years later, I still live alongside this narrative that the fat trans experience is rare. Representation is still slim, even with the plethora of information, transition videos, and varying gender expressions one can find on social media. And while much progress has been made in gender-affirming healthcare and surgeries including new procedures and expedited recovery periods, there is still one ever-looming barrier in accessing top surgery for fat, transmasculine folks: the surgical BMI limit. 

Gender-affirming care is often labeled as cosmetic or elective. This essentially creates room for medical anti-fatness to gate-keep trans people from accessing the vital care they need. The fit test for surgery is left to the discretion of the surgeon or practice. Although the science behind BMI has repeatedly been debunked, many clinics impose a BMI limit, eliminating fatter outliers from their surgical pool to protect themself if something goes wrong during a procedure. The core argument is that being so fat “increases risk” in surgery, but the science behind these claims is dubious at best. How can a medical professional make a determination about someone’s health without investigating their biological markers beyond height and weight?

These days the “BMI requirement” is a well-known step for transmasculine folks to inquire about when pursuing top surgery. Typically, fat trans folks are forced to lose weight before doctors will approve them for top surgery. Consequently, in every transmasculine space I’ve been a part of, there is talk of intentional weight loss either to look more masculine and buff or to gain access to the coveted top surgery our thin peers can more easily attain. 

I’ve spent the last 10 years as an out and proud nonbinary trans superfat, meaning I wear a 6/7x and am on the higher end of those who experience anti-fat weight bias/discrimination. I’ve worked so hard to radically accept my body. What started as an interest in body positivity turned into fat acceptance and advocacy. My mind shifted from believing my “unruly” body was the problem to understanding that anti-fatness is the problem, and it’s built into our infrastructure from medical care to fashion. With my BMI well above the limit for surgery according to most clinicians, I’d also come to terms with the idea that I’d probably never even see a superfat top surgery in my lifetime. Although I’ve worked to radically accept my very large chest through experimenting with binding and various sports bras, even going braless, my hopes still soared when I heard whispers of a surgeon without a BMI limit. There is a constant push and pull between trying to accept two giant things I carry around while daydreaming about a world where my shirts fit flat against my chest. 

Upon further investigation, these whispers always turned out to be misunderstandings. Most folks even in fat, transmasculine circles have BMIs close enough to an “acceptable” range (30-40) for a surgeon to operate. My BMI is triple that of these patients. It seemed no one would operate on me unless I went in for WLS. The agony of my swinging breasts became more unbearable as my disappointment grew... until I finally connected with a fellow trans superfat, SJ, who somehow had gotten top surgery.

SJ’s BMI was somewhere in the 60s at the time of surgery and they were “in the 400 club.” That’s well above a BMI of 35! I thought gleefully, as someone who is near 500 lbs. Through SJ, I learned about the Gender Confirmation Center in San Francisco. I must have asked them hundreds of questions. “They didn’t force you to lose weight first? Did they ask about your BMI? How much does it cost? How was the healing process? Did they have bandages that went around bodies as large as ours? They really didn’t make you lose weight first?”

Making a connection with someone who had experienced the same dysphoria and access barriers to gender-affirming care changed my perspective entirely. I knew if someone so close to my size could find a way, the tides were changing. I felt hope. Relief. Excitement about my future. It gave me enough courage to contact the Gender Confirmation Center and put this “no BMI limit” to the test. One phone consultation, a few forms, and an insurance approval later, I’ve finalized my top surgery date for October. The best part? The first question the surgeon asked me during the consultation was not about my BMI, my weight, or my unfitness for this particular procedure. They asked, “What is most important to you when it comes to how you feel about your chest post-op?” 

This question baffled me in the best way. To be given such autonomy as a superfat trans person, to not have to be treated like I am the least knowledgeable person in the room about my own body, to be given the floor to advocate for exactly what I wanted… The permission to dream was powerful. I will still need to pass an EKG, stress echo, and blood tests before I’m fully “in the clear” with my top surgery approval, which comparatively feel like tiny barriers.

It still feels a bit surreal and I’m not sure I’ll believe it's happening until I wake up post-op. But I look forward to the privilege of being a resource and an example of possibility to my fellow fat trans babes seeking top surgery, very soon.

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