Thanks for helping bring to light the struggles of fat trans folks. I am not what most modern US-Americans would describe as fat, but like many transmasculine people, I have gained some weight since beginning testosterone therapy. As I do not wear a binder (and am not seeking top surgery), I find myself always thinking about how my weight affects the size of my chest. It was interesting to read the perspective of S. Bear Bergman on this (who I’ve met in person and is awesome).
I’m concerned about the well-being of large-chested trans folks who do bind. Denying them top surgery, should they desire it, could cause or exacerbate serious health issues. That a medical professional would tell a trans person that they don’t look like a proper man/woman, or wouldn’t look like one following surgery, is repulsive and should be grounds for ethical sanctions. Demanding that a person who is suffering from gender dysphoria lose weight before being treated for said dysphoria is counterproductive, demeaning, and potentially life-threatening.