Top Surgery: Fatphobia & Surgery prep

Top Surgery: Fatphobia & Surgery prep

I have been experiencing fatphobia and medical oppression since I was a wee PREEteen (badumtss for the pun). Fast forward a decade, I’m well along my gender journey, I’m at one of the best parts: I love myself for who and how I am. I physically feel that my external aesthetic conveys exactly who I am -- except when I get misgendered. And I also don’t feel so great when my ankylosing spondylitis is aggravated by the weight of my chest. So I’m getting a minimization and considering top surgery.

For years I was told to lose weight on account of my BMI level. But I've finally found a surgeon that is committed to relieving my pain and making me feel my best. I’m delighted because you see the thing is, BMI is bullshit.

the thing is, BMI is bullshit.

A study published by Journal of the American Medical Association (JAMA) in 2005 showed that overweight people had a death rate similar to normal weight people as defined by BMI, while underweight and obese people had a higher death rate.

Like most trans fat folks, I have been violently gatekept from life saving surgeries. There is countless research to support the claim that gender affirming surgeries vastly improve the quality of life for trans folks. Dr. Jochen Hess, who works out of Essen University Hospital in Germany, designed and executed a research project to create a tool to measure quality of life for trans folks. While this study only reflects the experiences of a specific group of binary trans folks, the results of his work are clear. He explains, “We could detect a distinct improvement of general and trans-specific [quality of life] and psycho-social resources in our transgender cohort within [the] transition process" (Hess).

Photo taken by: Keisha Wapahkesis Image description: Pree is looking in the mirror buttoning up a short sleeved, boxy, button up  with stripes on 3/4th of the shirt.

Why does this matter?

"It's very important that we have good data on [quality of life] in transgender people," he continues. "They generally [have] a worse [quality of life] than non-transgender population, with higher rates of stress and mental illness, so it's good that surgery can change this, but also that we can now show that it has a positive effect" (Hess).

So for those of who might be interested in accessing top surgery, or want to support a loved one in their own gender journey, you might find the following resource helpful. Ayo Tsalithaba (they/them) put together a "Top Surgery Master List" for their own surgery prep - and they’ve graciously allowed me to share it here. Ayo's list was a really helped me put together a comprehensive list of questions (there was a 9 month wait between getting the referral, getting a scheduled appointment, and the appointment itself), for my surgeon. I took my list to my consultation appointment and I got all the answers to my specific questions.

Good luck on your gender journey!

Please get a referral to a surgeon if you’re considering gender affirming surgery, Ayo and I are not medical professionals and don’t claim to be.


Flegal KM, Graubard BI, Williamson DF, Gail MH. Excess Deaths Associated With Underweight, Overweight, and Obesity. JAMA. 2005;293(15):1861–1867. doi:10.1001/jama.293.15.1861

Sandoiu, Ana. “Transgender Surgery Can Improve Life for Most, Study Confirms.” Medical News Today, MediLexicon International, 19 Mar. 2018,

Tomiyama, A J, et al. “Misclassification of Cardiometabolic Health When Using Body Mass Index Categories in NHANES 2005–2012.” International Journal of Obesity, vol. 40, no. 5, 2016, pp. 883–886., doi:10.1038/ijo.2016.17.

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