Sitting in the waiting room of a pediatric office I felt too old for, my mom and I watched toddlers climb on a grimy plastic play castle. “I wonder how many shots they’ll give you,” she said, smirking.
It was time for my back-to-school sports physical, an annual hassle, but at least I got to leave class early. A nurse called my name, and I walked back to an exam room. Soon afterward, a doctor I had never seen before joined me. It was clear that she was the sort of person who enjoyed giving children shots. I was 16, 6 feet tall and hovering between a women’s size 14 and size 18, busting out of the paper gown provided for me. From the moment she saw me, I was a problem for her to solve.
The doctor smiled, lips pulling back to reveal Chiclet teeth. Under the fluorescent lighting, her highlights looked unnatural, zebra-like. She started asking me a lot of questions about what and when I ate, how much I exercised, my family history of illnesses relating to diabetes and heart disease. I looked up at the ceiling, counting tiles.
After my exam, she cleared her throat. “I’m going to be honest with you,” she said. "You’re obese. And you need a serious intervention to avoid future health consequences.” In her hand, she held a printout of a BMI chart, a diagonal line running from corner to corner, dividing the healthy from the unhealthy. The doctor pointed above the overweight line, so high and so far above the line it looked like I was about to fall off the chart. I felt my cheeks turn red.
Women were supposed to be dwarfed by men, and it was clear I never would be.
As the doctor kept talking, I looked around the room at the half-empty soap dispenser, the dust on the jar of tongue depressors, the poster for the HPV vaccine taped to the cabinet with its ends still furled, fighting to retain its shape.
Obese. What a hideous word.
After the doctor left, I put on my clothes and tried not to cry. The girls on the HPV vaccine poster smiled back at me. All of them were thin.
I went to meet my mom in the lobby. We were around the same size, and I wondered if she might fall above that red line, too. No, I decided. I’m a lot bigger, broader.
It didn’t occur to me that my dad or brothers could be considered anything other than brawny or powerful. They defied a BMI chart. As my mom said, “It’s different for boys.”
Men were supposed to take up space — like Fabio taking up two-thirds of the covers of romance books at the grocery store. Women were supposed to be dwarfed by men, and it was clear I never would be.
At the Chinese restaurant that night, I insisted I just wanted steamed broccoli and brown rice. My mom ordered us both egg rolls anyway, shrugging at me while the waiter wrote the order.
For much of my life, my mom was treated for breast cancer. Her chemotherapy was a medically necessary yo-yo diet: The chemo itself made her nauseous and paper-thin, like she’d been poisoned. To counteract those side effects, she was prescribed courses of high-dosage steroids that made her retain water. Back then, she sometimes referred to her clothes, in those days, by the medicines she took when they fit her.
My mom knew how I felt after my doctor shamed me for my size. Over General Tso’s chicken, she reminded me, “Everyone in this world is a Prednisone prescription away from gaining 40 pounds. A lot of them don’t want to admit it.” I thought of a doctor she saw once, who paused in the middle of an explanation of test results to ask caustic questions about her weight.
Women of size seeking medical care aren’t strangers to this kind of treatment. Many avoid going to the doctor for fear of being judged for their weight. Even when attempting to receive medical care for an unrelated condition or injury, health care providers will often mistakenly attribute those conditions to the patient's weight. While all people of size report disparate treatment, this is compounded for women and for people of color.
My mom spooned some of her chicken onto my plate. “We have to be tough,” she said, giving me a sad, close-lipped smile. “It’s not like we have a lot of other choices.”
About a year later, I came out as transgender and started having a new kind of doctor’s appointment: ones that involved getting on hormone replacement therapy and prepping for reconstructive chest surgery. My interactions with health care providers became more frequent. Testosterone is classified as a controlled substance where I live, so I require periodic blood work and paper prescriptions every couple of months.
Six weeks after my reconstructive chest surgery, I went to see a doctor because I was having minor back spasms. I was shocked when, not two minutes into the appointment, the doctor prescribed me a low-grade muscle relaxant without somehow attributing my condition to my size, or more crudely to “carrying extra weight around.” Instead, he clapped his hand on my shoulder and said, “You just had a surgery! Don’t worry too much about it.”
He examined how my chest was healing, and I shivered as he ran a gloved finger along the incision, stitches still swollen, angry and pink. “You look perfect,” he said. "So, when are you getting the bottom done to match?" I didn't answer. A moment passed, then he asked: "Do you lift weights?"
My time as a young butch woman of size faded into memory as I took on a more traditionally masculine appearance. No one thought I was fat anymore.
My time as a young butch woman of size faded into memory as I took on a more traditionally masculine appearance. No one thought I was fat anymore. I knew this when I stopped getting the fat look: that stare hovering between disgust and pity before the looker quickly turns their eyes away. Fat. It’s the look of someone writing you off.
My stature is nearly unchanged, aside from some minor weight loss after starting testosterone, when my body redistributed itself. Once my sex was recorded as male instead of female, combined with that minor weight loss, I slid under the scary red line on the BMI chart: cured of obesity.
Now that I look like a man to most people, strangers don’t give me a second glance. My barrel chest and broad shoulders aren’t a liability like they used to be; I am instantly forgiven the gentle slope of my stomach. To doctors, my physique is evidence that I am physically acclimating to being a man, that I never should have been assigned female at birth in the first place. For awhile, I was happy to accept this bonus without comment to offset the indignities of being a transgender person at a doctor's office.
Early this year, snapping off her rubber gloves after giving me an exam, another doctor told me, “I would never know that you weren’t a man, unless I...” I could sense she was about to make a joke, like, Unless I saw you without pants. She saw my grimace and changed course. “Unless, of course, I was looking at your chart.” Her laugh was shrill and nervous, and it rang in my ears.
I wanted to say something, but she still hadn’t written my prescription yet. So I laughed too, and decided to find a new doctor.
Near the end of my first appointment with yet another new health care provider a couple of months ago, she began to input information about my visit on a computer. The doctor forgot to record my weight and I told her. I wasn’t tempted to fudge the numbers because I knew she wouldn’t really care.
After pausing to write up my prescription and hand it to me, the doctor went back to tapping away at the keyboard, and asked me if I had any questions. I looked down at the slip of paper in my hand — I was home-free.
“What do you think about my weight?” My voice was calm and steady, though I was surprised to hear the words come out of my mouth.
In my everyday life, I choose to be out as transgender. I talk frankly about gender identity, in large part, because I see firsthand the benefits of being out: It makes more space in the world for people like me to acknowledge our differences, and it makes cisgender people better supporters through exposure. In coming out as trans and nonbinary, I do what I can to shun male and masculine privilege, to challenge assumptions about my gender identity and its relationship to my body. I do that everywhere else in my life except the doctor’s office, I realized.
While you don’t have to come out as fat, you do have to come out as fat-accepting.
I felt like a traitor: Not so long ago, when I was read as a woman of size, I didn’t get to opt out of the weight conversation with doctors; I was forced to shove my way through their conjecture, being tested yet again for diabetes or warned about heart disease. Now, I couldn't bear to coast through another doctor’s appointment: It was time for me to pick a side. While you don’t have to come out as fat, you do have to come out as fat-accepting. I realized I could come out as body positive to a health care provider — it was within my rights as a patient to make that as non-negotiable as my transgender identity is in every other part of my life.
“I don’t understand.” The doctor looked up. “Do you want to lose weight?”
“No, I don’t want to,” I said, feeling sheepish. I tapped my feet, uneasy, and the waxy paper underneath me crinkled, like the sound of unwrapping a present. The doctor turned from her computer screen to look at me.
I could drop this whole thing and leave the office with my prescription in hand, right then and there. I could walk down the street and away from this messy subject that I didn’t even mean to bring up and was now bumbling through.
Then I thought of how my mom’s face fell when a doctor began to go through that well-worn weight interrogation script: So, what do you eat on a typical day? Her mouth would flatten into a frown like a fjord. After a second, she would open it to answer, unable to hide the disappointment in her voice. Those moments of her too-short life were wasted.
I couldn’t just drop the subject — I had to speak up.
“I want you to know that I am happy with my body, as it is,” I said. “I just want a doctor I can see and get a prescription from for hormones and a physical once a year. I like myself as I am — I don’t want any more gender-related surgeries and I don’t want to lose weight. If you’re going to be my doctor, I need for you to know that up front.”
I sighed, positive I’d burned this bridge. I can always find another new doctor.
She knitted her eyebrows, confused. “I don’t think any of that’s a problem.”
“All right.” I nodded. “That’s all I needed to know.”