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Written by Priya Rehal.

Art by Priya Rehal.

I have been experiencing fatphobia and medical oppression since I was a wee preteen. Fast forward a decade and I’m well along my gender journey, 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 (a type of arthritis that affects my spine) 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 to prepare for surgery, 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, BMI is bullshit. A study published by the 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.

I’m delighted because, you see, BMI is bullshit.

Like most fat trans folks, I have been violently barred from life-saving surgeries. That’s not an exaggeration. 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.”

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.”

Like most fat trans folks, I have been violently barred from life-saving surgeries.

For those 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.

Below are some examples of questions to ask at your consultation from Ayo’s Top Surgery Master List. Please get a referral for a surgeon if you’re considering gender-affirming surgery. Ayo and I are not medical professionals and don’t claim to be.

Questions To Ask at Your Top Surgery Consultation: 

  • What should I look out for with recovery? What kind of things should I be concerned about and contact you about?
  • Iʼm undecided about nipples. What is the likelihood that theyʼll take or not take?
  • Is it cheaper not to get nipples? Cheaper not to get contouring?
  • What will my chest look like if I donʼt contour?
  • What are my options for scar placement and shape?
  • What are my options for nipples? Will I regain sensation in them?
  • Do my other scars give any insight into how Iʼll heal?
  • How do I avoid keloids or predict whether or not my scars will keloid?
  • How long until I can lift my arms above my head?
  • How much time should I wait before any physical activity (weightlifting, working, swimming, filming, boxing)?
  • Are there any things I can do during recovery to slowly regain full range of motion?
  • When should I start scar care? How should I massage my scars?
  • How long until I can shower?
  • How will the post-op compression vest affect me if I have asthma?
  • How long before should I stop smoking marijuana? How long until I can start smoking again?
  • Should I change my diet before surgery to include more protein and less junk food?

Good luck on your gender journey!

About the Author

Priya “Pree” Rehal was raised in Tiohtiá:ke/Montreal and went to school in Tkaronto/Toronto. They are a child of immigrant settlers from Punjab. As and artist educator who is trans, multiply disabled and racialized, Pree’s work is about folks who look like them. Read more about their work on

Follow on IG: @preezilla

Contributing Author: Ayo Tsalithaba

Instagram: @ayotsalithaba

Ayo Tsalithaba is a visual artist originally from Ghana and Lesotho. Their primary mediums include film, photography and illustration. They enjoy exploring issues of identity, specifically societal expectations of race, gender and sexuality through their films. Read more about their work on