My wife struggled with weight her whole life, had bariatric surgery a few years ago, lost 60+ pounds. Honestly, give it due consideration. It worked very well for us.

True, but it is an avenue to explore with qualified medical professionals. Maybe it won't be appropriate for me, but I do see your point.

Thanks so much! I don't have any better suggestions than the other folks on this thread provided, but I wish you success in your journey. Weight loss is just such a fucking struggle sometimes.

Nope, disagreement with reasonable discussion is always welcome. I think a good discussion is how we make progress in healthcare. Someone says “why not?” Or “I disagree” and I’m good with it if it improves outcomes.

And granted my surgical experience is not with the Gender affirming procedures. However, I have worked and still work (albeit in a different capacity) with surgeons. They are a special breed of physician, you may know that.

Remember, that there’s a lot going on here.

1. The policy of the hospitals who do the surgery, which may limit due to (currently more evidence showing the increased risks) which may limit what procedures are allowed and under what circumstances.

2. If the hospital is in the US they are penalized for surgical infections. Value based care looks at all surgical site infections, (also falls, urinary tract infections caused by Foley catheters, respiratory infections from ventilators, etc) if the hospital’s percentage passes a certain level, Medicare reimbursements drop, so we’re threatening the hospital bottom line, so the C Suite is going to be risk averse and avoid adding any more percentages. They will wait until the “other hospital” does it and if things work out then they will look at changing, but money talks in a hospital, and surgeries are a huge money maker.

Another (but last) hospital point. We show up on public rating systems in addition to the surveys that are sent out. Don’t like something? It goes everywhere wether it’s warranted or not. My unit once had a very public complaint that no one would bring them a coke. Well on investigation I found that 1. We were in the middle of a code blue trying to save a life at that time. (2) it was a renal failure patient who can’t have colas and it was in their orders. But that’s not the story that everyone read. They read about the poor abandoned patient who couldn’t even get something to drink. Again, people read that review and say I am NOT going there.

We also have the individual “right to practice” of the physicians to consider. If you get to med school (and I sincerely hope you do) you will have the right to made decisions regarding what your willing to do vs what you aren’t. You’ll of course have your training to guide you, but you will also have position statements of your respective professional organization too. Such as this one anesthesia position statement from 2015

It’s something to consider also when that percentage point is no longer a mathematical representation but a living, breathing human being. If we’re talking about 19% each one of those is a person… if you’re going into the healthcare field, it sure isn’t for the money, it’s because you care, and if you can shave even one person off of that I’m betting you would.

And sample size does matter, you know this because you pointed it out. If the sample is too small to be representative of the larger population, it’s certainly a call for a more in depth study, but not enough to draw a conclusion from. Also, and I believe you know this too, there’s going to need to be multiple studies showing the same results.

I could go on, and in the end analysis I don’t completely disagree with your points. You make several good ones. And maybe you will be the one who finds a way. We can hope so. But with so little clinical research into us (we are in this case considered a protected class when it comes to human trials) providers are understandably cautious when it comes to us. At this point they only have vaguely similar things that they can use.

Thanks for the great points you presented. Good luck in your pursuits!

I had my orchie in December, no prob. I expect my FFS to be done in June -- they're clearing insurance now, then will call to schedule. I have a consult for BA and zero-depth after that. I'm 5' 6" and 240 lbs.

I'm in Wisconsin, and working with the gender clinic at UW Madison.

Good luck, the insurance maze down there is by all accounts appaling to deal with. Hope you find a set of solutions that works for you.

edit afterward makes it seem like you think OP is so dumb they didn't understand that exercise and a calorie deficit was needed to lose weight.

What ? I'm talking specifically about the people who were downvoting me previously.

I literally made my comment in good faith and support . Obviously it's NOT easy to lose weight, it takes commitment and consistent effort. I tried supporting her by telling her, it doesn't need to be 100% of your effort or no effort . I tried being empathetic by giving her 'obvious' yet helpful advice someone else gave to me.

I'm not trying to shame her or whatever hell shit you're reading into my comments. The edit was there because I left that comment and came back the next day to see it in the negatives. I couldn't fathom why I got downvoted so I edited in an assumption of why it may have happened. The internet definitely makes it hard to read tone and intent but I think my comment was kinda obvious I meant well for OP.

Anyways, thank you for coming to my TED talk. Peace.

Yeah lots of people treat fat people as lesser than or unwilling or unable to change. It is garden variety fatphobia and stereotypes about laziness. I hope no matter what path you take you're able to achieve things that you want. I definitely believe life doesn't have to revolve around being or looking to be a certain size.

I hesitate to mention it because I do not want to give you more unsolicited health advice so I guess skip this next paragraph if you can not tolerate any sort of weight or nutrient reccs. I won't feel bad I want to give you an out I just also think maybe as someone who hates diet culture maybe my idea might be more tolerable to you. The last paragraph does not talk about weight loss stuff.

If you struggle with apps and diets that restrict your eating I personally keep track of my eating habits with chronometer. You do have to have an account (there is a free and paid version I use the free kind) but I primarily use it for tracking my macronutrients (like fiber, B12, etc) and it's very easy for me to switch focus from the calorie counting aspect of things to the macronutrient part of things. Focusing on a different thing I got from the app helped me soothe my feelings on food (I have recovered from an ED). I'm logging stuff to make sure I get enough fiber I don't care about calories. It also helps me focus on "I want to eat this to get more B12 I don't care about calories" as a mental thing. I'm not lying either. I do go over some days and it's fine I'm still losing weight which is the important part. it also gives you realistic calories based off your current weight. I eat about 2600 calories working a manual labor job being about 270lbs and that's still enough for me to lose weight. It helps me not feel hungry bc my deficit does not need to be the like 1200 diets people go on that are very restrictive and hard to tolerate because I'm bigger and on testosterone.

I think you're probably fine the way you are. I think that maybe there is a higher risk for surgery at some weights but I also think people are eager to tell fat people they need to lose weight even if the risk is insignificant or small. I don't know what you weigh but I just got done with a consultation for top surgery at 270lbs at 5'5" and it was no problem and didn't even come up. If there is no way you can have surgery and you still want it and you're hearing it from other doctors I would hope that there may be some basis for that and it's not a one off cruel doctor thing. That being said if you do decide to pursue surgery I hope you're able to meet arbitrary goals set out for you by others to get the things you want. If they become unobtainable I hope that you are able find peace in what you can have. I promise not everyone out there has brain rot but in general I just would not talk about fat topics on Reddit. There's a lot of dieting and weight loss subs and the brain rot is so so bad here lol.

I'm really sorry people are throwing unwanted dietary tips at you.

And surgeons should absolutely meet you and assess your health before telling you you can't have surgery. BMI is not meant for looking at individual people. The same BMI looks sooo different on different people. I don't know why it's still used this much in the medical field.

The only advice I can give is to get your thyroid levels checked if you haven't already. I've tried in the past to loose weight while I had undiagnosed hypothyroidism and it's ridiculously hard or even impossible.