This is Thin Privilege

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Is my doctor oppressive when she tells me to lose at least 2 kilos to have hormone blocker therapy? (Ah, I'm transgender) Surely not?

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Why wouldn’t she be oppressive to tell you that? 

I’m not a doctor and I don’t know the ins and outs of hormone blocker therapy. Is this a dosage issue? I’m befuddled as to why there would be a weight cutoff to get this done. Is it just that the therapy has been tested and developed on thin people exclusively, so it isn’t optimal for the body chemistry of a fatter person?

It’s either your doctor being oppressive, or the medical research community, who doesn’t consider fat bodies worth developing therapies for. So yes, definitely oppression. Perhaps someone with greater knowledge of the therapy can state exactly how.


Yep, flat out oppressive. I’m cis, but my wife is trans. I’m guessing that since you’re on blockers, you’re a trans woman (trans men don’t take them, AFAIK), and we’re talking about spironolactone or one of the other anti-androgens.

Here’s what my wife wants people to know about this:

The single biggest risk of death for trans people is suicide, even more so for people who cannot or have not transitioned. Among trans people who survive long enough to be surveyed about these things, something like 41% of them have attempted suicide at least once.

The most prominent health risks for going on blockers are <I>low</I> blood pressure, and that some of them can cause buildup of one or another minerals in the system (spiro is a potassium-sparing diuretic; potassium is not washed out of the system in urine).

The risk that a trans person will commit suicide for being denied transition treatments is far, far higher. So are risky behaviors and drug use.

This is straight up body policing, and part of a long tradition of policing the bodies, not only of fat people, but of trans people. Trans people, especially trans women, have been denied access to transition because they are too fat, or not pretty enough, or just not attractive to the doctor. Standards of treatment are moving away from this, but there are absolutely still doctors out there doing it.

Yes, HRT can cause weight gain in both men and women. Denying them HRT can be deadly, though. Denying people HRT is incredibly dangerous, and is nothing but bigotry, or bigotry combined with paternalism and possible fear of legal risk.

We strongly, strongly recommend you find a new doctor. There may be a local organization of trans people who can recommend you a better one, although you may have to travel to reach them. Do not trust any doctor who places more importance on your weight than on your life and health. It is very common to have to try several doctors and therapists before you find one who knows all of the above and is willing to give you the hormone prescriptions. Keep trying.

Good luck. It’s rough out there, but it can get better.



  1. ghagiel said: Yes, your doctor is being oppressive - fat people can have HRT and can go on hormone blockers (this coming from a fat guy who has been on testosterone for over a year).
  2. las-fuentes said: artoftransliness.tumblr… You might want to direct this question at these guys, they’re really well informed and generally give good information on things like this.