SRS

BMI Cutoffs are unscientific and harmful

As I’ve written about before, BMI (Body Mass Index) is an unscientific concept that is often used to deny trans people life-saving surgeries. It is treated by far too many surgeons as medical fact, despite the vast body of evidence that it is wildly inaccurate, scientifically useless, and never intended by the creator to be used on an individual basis.

Recently, the only surgeon in Washington State, Geoffrey Stiller, formerly one of the few surgeons who would accept fat patients, updated his policies quietly to exclude people over the arbitrary and oft-used cutoff of 35 BMI. That means that at least two people close to me are now being denied gender affirming surgery without so much as a notification about the change. So I wanted to take the opportunity to share some scientific research recently published on the topic.

  1. Recent research shows that there is no correlation between BMI and surgical complication rates in trans people in either vaginoplasty (bottom surgery) or mastectomy (top surgery)
  2. “Obesity” (aka normal body variation) is very common in trans people seeking surgery (26% at Mount Sinai) and did not change despite efforts to lose weight prior to surgery
  3. BMI is not an empirically based method of denying gender-affirming surgery

Trans people should not have to bear the burden of educating providers about our care but all too often we are put in that position anyway. So next time a surgeon tells you they won’t perform surgery because of “policies”, please feel free to use this research to push back on them. Even if you don’t win a single conversation, hopefully you will plant a seed and prompt them to actually read the scientific literature on the topic. I found these articles with only a cursory review of the topic and I’m not even a doctor.

Citations

  1. Ives GC, Fein LA, Finch L, Sluiter EC, Lane M, Kuzon WM, Salgado CJ. Evaluation of BMI as a Risk Factor for Complications following Gender-affirming Penile Inversion Vaginoplasty. Plast Reconstr Surg Glob Open. 2019 Mar 13;7(3):e2097. doi: 10.1097/GOX.0000000000002097. PMID: 31044103; PMCID: PMC6467628.
  2. Rothenberg KA, Gologorsky RC, Hojilla JC, Yokoo KM. Obesity is Not Associated with Complications or Revisions after Gender-Affirming Mastectomy in Transgender Patients. Plastic and Maxillofacial Surgery. 2019 Oct 1;229(4):sup1. doi: https://doi.org/10.1016/j.jamcollsurg.2019.08.494
  3. Martinson TG, Ramachandran S, Lindner R, Reisman T, Safer JD. HIGH BODY MASS INDEX IS A SIGNIFICANT BARRIER TO GENDER-CONFIRMATION SURGERY FOR TRANSGENDER AND GENDER-NONBINARY INDIVIDUALS. Endocr Pract. 2020 Jan;26(1):6-15. doi: 10.4158/EP-2019-0345. Epub 2019 Aug 28. PMID: 31461357.
  4. Lisa M. Brownstone, Jaclyn DeRieux, Devin A. Kelly, Lanie J. Sumlin, and Jennifer L. Gaudiani. Transgender Health. ahead of printhttp://doi.org/10.1089/trgh.2020.0068

Inheriting a fixer-upper

I just scheduled my jaw surgery to do the first part of correcting my bite for mid-May. It’s something I’ve been dreading for the last 10 years since my dentist identified the root problem. And I’ve been surprised at how many emotions around surgery are coming up for me now that it is an undeniable reality, not just about this procedure but about my plans for bottom surgery.

My original plan was to get my jaw surgery out of the way this year and then go in for vaginoplasty next year. And in the interim I was going to meet with the surgeons I was interested in when they were in town for Gender Odyssey. But now I feel like that plan has come crashing down around my ears (like most plans have in my life).

I found out a few weeks ago that my jaw surgery is so intensive that they need to split it into two separate procedures with a year of expanding my top palate in between. So now I have another surgery on my face to dread but at least I have jaw feminization included to look forward to. Unfortunately that means I have to rethink my whole plan around bottom surgery.

To complicate things further, I found out that Gender Odyssey isn’t in Seattle this year and they aren’t doing a conference for trans adults this year anyway. So now there’s no opportunity to meet with them that doesn’t involve investing in travel. I feel like I need to decide whether to try to attend Philly Trans Wellness where I might meet some potential providers (although not my top choice – Heidi Wittenberg), or whether to travel to San Francisco to meet with them directly.

And trying to figure this all out while I’m also undergoing intensive laser hair reduction on my face (I put electrolysis on hold for now because it was too slow) just feels like so much. I feel totally overwhelmed by how far I still have to go before I’m done with all these medical procedures and honestly I’m feeling pretty despondent and hopeless about it all.

I just want to fast forward to a point in time where I feel like my body is my own. But instead I feel like I inherited a fixer-upper house that needs major repairs to be livable and every time I fix one thing, another breaks. I know that all these surgeries and procedures aren’t going to fix everything but I still have to rest my hopes on life getting easier once I’m past it all. Because without that hope I don’t know how to keep going.

This is one of those points where I really wish I had been born with a brain and body that matched and I didn’t have to go through all this work just to be myself. And sometimes it feels like I should just throw in the towel on life and give up. Don’t worry, I don’t actually have plans to do so but I can’t say I haven’t thought about it.

Anyway, I don’t know where all this is going right now other than hopefully forward even if it takes a painstakingly long time to get there. I know I wouldn’t be able to keep wading into the fray if it wasn’t for my partners and friends so I am very thankful to all of them for keeping me going. I know things have to get worse before they get better but I really hope I turn that corner soon.