Trans people are accustomed to struggling to access sex-promoting health care, but for some, fat phobia is a barrier.

Running a glove at NHS gender identity clinics for hormone replacement therapy և surgeries has become a transitional ritual, especially if you are a colored person or otherwise marginalized.

Being obese is a factor that can reduce your chances of getting a medical. Known as inaccurate, especially for people of color, the Body Mass Index (BMI) is used in the NHS և private health services to determine eligibility for life-changing surgeries. Because the metric can be that: The deciding factor for the availability of the best surgeries or genital surgeries is that you should expect it to be used consistently in health care. But the conflicting application of BMI requirements is common.

Nathan, 25, is a trans man who had an eating disorder after being forced to lose weight for the best surgery.

He could have avoided a tedious diet if he had been told that BMI limits were different for surgeons. “They did not tell me that Brighton had a BMI of 35 and Plymouth had a BMI of 40,” he said. PinkNews:. “If I went to Plymouth, I would not be required to lose weight at all.”

Nathan quickly reduced his BMI from 38 to 35.8 through 20 hours of intense, low-carb exercise a week. He was so active that he began to build muscle at a rate that prevented him from losing weight. This was not satisfactory yet, so he was asked to lose two kilograms in 10 days to qualify for surgery.

Another person I spoke to was prescribed an unusually low dose of estrogen in the NHS. He was told that his weight meant that he could not take the normal dose. He continued to use the hormones illegally sold online for years, until another doctor insisted that there was no risk to BMI by immediately raising the dose to normal.

Inadequate BMI requirements among physicians and surgeons undermine the notion that it is itself a consistent, accurate indicator of health risk when undergoing a medical examination.

BMI is just one (suspicious) measure of a person’s overall health. But this is something that surgeons often focus on, excluding other possible factors. The worry is that everyone I spoke to confirmed the same thing. Eating disorders were not unilaterally voiced or taken into account by surgeons who demanded drastic weight loss from patients. However, it is well documented that trans people suffer from eating disorders at a higher level than their sibling peers.

Some of the people I spoke to had eating disorders that made significant weight loss dangerous. But doctors were pressuring them to try yo-yo or fad diets, and one of the surgeons reportedly suggested a diet to “lose 10 pounds a month.” Another recalled a phone conversation with a receptionist where they were told “they should not eat hummus because it is high in carbohydrates.”

Sometimes it’s just a matter of despair that I just never get the things I need.

Disability is a factor that is often overlooked by surgeons. Lee Hulm, 38, had a knee injury and back pain (later diagnosed as a slip of the disc) when told they needed to lose weight for lower surgery. That was four years ago. The non-binary transmask has since developed sciatica and arthritis. Halm can not be operated on until he has lost weight, despite the conditions restricting physical exercise. Another person I spoke to is in such a boat. was born with a heart defect that makes exercise dangerous.

If eating disorders, dietary risks, and disabilities are strangely absent from surgery-related health considerations, so is suicide. Stonewall says that one in four young trans people has attempted suicide. According to a 2015 U.S. Transgender Survey, the number of transgender people who have attempted suicide in their lifetime is 40 percent.

Becks Stinson, 33, has waited nearly 10 years in the NHS for vaginoplasty, saying “you have to die with those genitals.”

He continues. “Surgeons do not take into account the fact that I have mental health problems, the fact that I have a high risk of suicide, the fact that I have an eating disorder, the fact that I have several comorbidities.” His dysphoria led to self-harm, he was close to dying by suicide attempt. For Stinson և others, if the option is suicide or high risk on the operating table, the latter should be considered.

It goes on to say that most of the people I spoke to thought that BMI requirements were not about health or the needs of the patient. They say that doctors talk about BMI limits, which give “best results” according to their personal aesthetic taste, and not “best results” to alleviate the patient’s dysphoria. I was told about a surgeon who said that his patient’s lower surgery “will not look big; it will not look right until you lose weight.” The surgeon argued that weight loss was essential for the patient to urinate on his feet, but standing up to urinate was not what the patient wanted.

Gender-appropriate bodies are slender։ lean.

Dr. Francis Ray White, a non-binary sociologist and fat researcher, says that losing weight for the best results comes from surgeons who “want to create a body that will pass through the cistern system’s gender, and the fat bodies do not match the gender.” This is due to the fact that “in general, the sex-appropriate bodies are slender» lean. ” The academician claims that “there is a meaning in which an obese superman can never exist, because no one will create them surgically.”

The announcement is unusually related to the story of Mels, the founder of 27-year-old non-binary transmask և Free Black Uni. They have been denied gamete storage in the NHS because of their BMI requirements. This means that obese trans people can not survive surgically, nor can they have offspring.

Of course, reproductive fat phobia affects not only trans people but also immortals. Medical fat phobia harms us all. This year, the Committee on Women’s Equality released a report concluding that “BMI actually contributes to health problems such as eating disorders, mental health, body image, and social stigma.” It also called for an end to the use of BMI and for a “health-friendly” approach.

Until BMI retires, obese trans people will be stuck in the middle of the transition period, with their lives suspended for years. All those I interviewed who tried to lose weight not only returned it, but gained more, leaving them with little hope of reducing surgery over time, making the widely accepted claim that diets do not work for long. I’m thinking about a trans woman I interviewed who has never bathed with her children (now 17) after being rejected for lower back surgery almost a decade ago. There must be another way, based on full health care, patient needs և informed consent, rather than inaccurate 19th century measurements.

PinkNews has contacted NHS clinical launch teams covering Brighton և Plymouth for comment.

Beat is a UK charity for eating disorders. It is a national helpline for people who have or are worried about eating disorders, և other affected people such as family members և friends. Learn more here

Suicide is preventable. Readers who are affected by the issues raised in this story are encouraged to contact the Samaritans 116 123 (www.samaritans.org:), or Thought 0300 123 3393 (www.mind.org.uk:): Readers in the US are encouraged to get in touch National Suicide Prevention Line By calling 1-800-273-8255.