Surgeon gave me a BMI target before they'll put me on the list. Is this a real safety thing or just another hoop?

So I promised I'd report back after my July assessment and here is the report: it went fine, letter is being written, and then the surgical side sent me a follow-up saying they need my BMI under a certain number before they'll list me for chest surgery. I'm about four points over it.

I did not see this coming. Nobody at the assessment mentioned weight once. And I can't work out how to feel about it because half of me is "ok that's a medical thing, fine" and the other half is "I have jumped through every hoop for three years and NOW there's a scale involved". The letter didn't explain why, it just gave the number and said contact them when I'm there.

Genuine questions, not just venting. Is BMI actually a real safety issue for surgery or is it a box-ticking thing? Why is the number what it is, is it the same everywhere? Do I lose my place while I'm working on it? And has anyone actually been given a target like this and got there, because right now it feels like the finish line moved.

Real thing, not a hoop, but also not the same number everywhere. My surgeon's cut-off for top surgery was noticeably more relaxed than what a mate was given for lower surgery at a different centre, which I only found out afterwards. Chest tends to be the flexible one.

Four points is doable. Ask them for the "by when" as well as the "what". Mine never gave me a target but I know someone who was told the number and not the date and spent months guessing.

Elliot, first: the finish line has not moved, you just found out where it actually is. That sounds glib but it helped me reframe something similar.

I wasn't given a weight target myself, but the woman I waited alongside for vaginoplasty was, at her pre-op, about five months out from her provisional date. What struck me was that the number came WITH a referral to a weight management service in the same appointment, and with a clear "your date stands if you meet it". She did, with weeks to spare. The fortnight before she got that clarity was worse than the five months of actually doing it, because she'd assumed the number meant no.

So my advice is boring: ring them and get three things in writing. The number, the date it has to be met by, and what happens to your listing in the meantime. Then it's a plan and not a verdict. Also, and I say this gently, "nobody mentioned it at the assessment" is because the assessment is about the pathway, and the BMI thing is the surgeon's own safety policy on top of that. Two different layers, two different sets of people.

Elliot, a fair question and a common one, and I want to answer the "is this real" part plainly, because Annika is right that it lands very differently once you understand where it comes from. Your own team's number is the one that applies to you; I can only explain the reasoning.

The direct answer: yes, body weight is a genuine surgical safety factor, and no, there is no single BMI limit for gender-affirming surgery. WPATH SOC-8 (2022) sets the eligibility criteria, the referral, the informed consent, the hormone timing where relevant, and says nothing about a BMI number. Thresholds are set by the individual surgeon or service, and in practice most sit somewhere between about 30 and 35, with some teams accepting higher with conditions and some holding a lower ceiling for particular operations. Chest surgery is often the most flexible; genital and flap-based surgery the least, because the healing demands are greater.

What the number is protecting against, named specifically. Higher body weight is associated with longer operations and more anaesthetic complications, and with higher rates of wound infection and delayed healing. For chest surgery it also affects the technical plan: which technique suits your chest, where the scars sit, and how the contour settles. None of that makes surgery impossible above a threshold; it changes the complication rate, and every surgeon decides where they are comfortable drawing that line. Two competent teams can draw it in different places, which is why Sam's friend and Sam were given different figures.

What it depends on, so you can see why your number is yours. The procedure, as above. The anaesthetic team's view of your overall risk, which includes blood pressure, blood sugar, any sleep apnoea, and your fitness, not just the scale. And the service's policy, which is an institutional decision and not a judgement of you. A raw BMI is a blunt tool and most of us know it; some teams will look at the trend and the whole picture rather than a snapshot, so it is worth asking whether yours does.

On your practical questions. In most services a health requirement pauses the date rather than removing you from the pathway, but ask that directly rather than assuming, because the answer is administrative and differs between services. Ask for the target as a number, the date it must be met by, and whether they can refer you to support. The site's guide to the health requirements surgeons set goes through the same list for smoking, which is the other one that commonly delays a date, and the eligibility article explains what SOC-8 actually requires so you can see the two layers side by side. Four points over is a modest gap, and a realistic one to close with the right support and time; your GP or the service can help you do it safely rather than by crash dieting in the last month, which is its own risk before an anaesthetic.

Mr Tobias Lindgren said:

it changes the complication rate, and every surgeon decides where they are comfortable drawing that line

This is the bit I'd have wanted to hear. It's not "you can't", it's "we won't yet, because of what we've seen go wrong". Different thing entirely.

Elliot, I got a "not yet" of a different kind (hormone timing) and the thing that saved my head was writing the date I'd be eligible on the calendar and treating it like the surgery date. Gave the waiting a shape.

Update, four weeks on. Rang them, got all three answers. The number stands, the date is my pre-op assessment in the new year, and I keep my place on the list while I work on it. They also referred me to a weight management programme through my GP, which I hadn't known was even a thing I could ask for.

Down just under two points so far, slowly, which the nurse said is exactly the pace they want. Still don't love that there's a scale involved. But it stopped feeling like a hoop somewhere around the moment someone explained what it was for, so thank you all for that.