Hey,
So after a bad bout with my mental health which keeps deteriorating I am trying to get the NHS to fund facial feminisation surgery for me. I hate to be one of those girls but I seriously do not pass without it and the constantly being gendered as male is really getting to me.

Anyway I have been scouring NHS England resources to find their exact policy on the matter as I know it is an uphill battle to get them to fund FFS. I've basically got enough information (some of it very hard to find - I wonder why) where I can practically quote the NHS's policies word and gospel on the matter. Basically, I can put forward a strong case via my GP and although I was discharged from Porterbrook GIC over a year ago they have said they will be more than happy to provide backing evidence if need be in a very helpful conversation over the phone. They said at this point though it should go through my GP.

So strong case aside the one issue I have is since GRS I have put on some weight. I used to be on the heavy side of healthy and now I am according to the NHS and BMI indicators obese. The NHS guideline is clear that for funding to be awarded I need to be 27 or below.

The irritating thing is, I'm not even obese. I wouldn't call myself thin but I am in the range of being medium build and I tried the BMI for both male and female, both classify me as obese.

I just worry with the strong case I have in other places my local CCG is just gonna use my BMI as a convenient excuse to refuse funding, given I meet all their other criteria.

Anyone else had experience with this?

Maybe a little help. The problem with BMI is that it's form is weight / height² as such it would be better termed "body surface area index". Volume (a reasonable proxy for mass) varies according to the cube of linear dimension, not the square. As such, taller humans with similar build and the same actual body fat by percentage have a higher BMI. There's a further penalty for being muscular vs slightly built.

The local practice (Boston medical) I was considering limited BMI to 25 or lower for GCS. A while after I'd finished surgery in SF, they called to say they were considering using a different, more valid measure, I don't remember what. You can research it and bring them the evidence would be my only suggestion.

What is your actual body fat percentage.  You can get really inexpensive calipers and check yourself.

BMI can sometimes classify people improperly.  But I often see people objecting to it that obviously could lose some fat.  I would have had to plead guilty to that myself a few years ago.


Sent from my iPhone using Tapatalk

Don't get me wrong. I do need to lose a bit of weight and I go to the gym but I'm not obese.

About 18 months ago I had a full-body dexa scan with BodyScanUK. It's about £150 ( had a voucher deal [emoji5] that saved on this), and you'll get a full detailed breakdown of your body composition fat, muscle, bone etc.. And also how you compare to standard male/female groups. I wasn't their first trans* customer and they were very courteous.
This would give you excellent evidence to present to the NHS that you are healthy (or not) for surgery, despite your BMI. X

Sent from my MI 5s using Tapatalk

According to BMI I am overweight and nigh onto obese at a 27.4 (170lbs, 5'6") here:



BMI Categories:
Underweight = <18.5
Normal weight = 18.5–24.9
Overweight = 25–29.9
Obesity = BMI of 30 or greater

BMI is a farce.

It's rubbish. It's like the taller people are, there's no difference in volume per unit of height. Body fat percentage is much more accurate metric. The difference between my BMI and body fat percentage is at least 3. Still have a ways to go. Down 123lbs, 29lbs to go to my first goal. I might have 5-10 after that, but there will be a lot of skin that should go, which is a more difficult proposition.


Sent from my iPhone using Tapatalk Pro

I'm overweight according to the bmi too at 190 5'8"

Sent from my SM-G930T using Tapatalk

My bmi tells me I'm morbidly obese (5'8", 230lbs). My actual body fat percentage is in the teens (15-18 depending).  Every time I go to the VA doctor they practically insist I start a weight loss program.  Bmi will never accurately reflect body fat for a real person (except by coincidence), much less if you exercise at all.  I would say demand a more accurate form of measure.  That said, it is the government, and they might just tell you tough luck.  It's a difficult position you're in, and my heart goes out to you. Good luck.

Freyja

Sent from my LG-H830 using Tapatalk

Yes I fall into this too my family doctor says that I should be about 130 to 150 pounds I am 5'7 and a half I am right now 173  last time I weight that much I just got out of the hospital for being bulimic.  I was 120 when I went into the hospital I would I hate the bmi scale like really yes I have a bit of a belly yes I am working on it but it is unreal.

BMI is just a height/weight index that is easy to measure. People who are muscular will have a higher BMI than than a thinner person. BMI does not differentiate between fat and muscle.

Body fat % is a much more accurate measure of obesity

I don't know any decent doctor that puts stock in BMI anymore. It's lazy medicine, plain and simple.

Body Fat percentage is a better measurement from what i've read. BMI would show a man like Arnold Schwartzeneger in his prime to be obese, when of course he was packed with lean muscle. It would show a "thick" woman MMF fighter, weightlifter or even softball champion to be the same..same issue.

Fat percentages can be measured by caliper, scan or even from a cheap smart scale (at least the scale would be reasonably accurate) 

The issue is there are not a lot of guidelines published on any of this for trans people. Just opinions from what I've seen.

Here is one of the few studies mentioned from a google search:

http://openmindedhealth.com/2015/06/quickie-body-weight-and-transgender-hormone-therapy/

Quote from: LilyRobinson241092 on May 01, 2018, 08:42:28 AM
Hey,
So after a bad bout with my mental health which keeps deteriorating I am trying to get the NHS to fund facial feminisation surgery for me. I hate to be one of those girls but I seriously do not pass without it and the constantly being gendered as male is really getting to me.

Anyway I have been scouring NHS England resources to find their exact policy on the matter as I know it is an uphill battle to get them to fund FFS. I've basically got enough information (some of it very hard to find - I wonder why) where I can practically quote the NHS's policies word and gospel on the matter. Basically, I can put forward a strong case via my GP and although I was discharged from Porterbrook GIC over a year ago they have said they will be more than happy to provide backing evidence if need be in a very helpful conversation over the phone. They said at this point though it should go through my GP.

So strong case aside the one issue I have is since GRS I have put on some weight. I used to be on the heavy side of healthy and now I am according to the NHS and BMI indicators obese. The NHS guideline is clear that for funding to be awarded I need to be 27 or below.

The irritating thing is, I'm not even obese. I wouldn't call myself thin but I am in the range of being medium build and I tried the BMI for both male and female, both classify me as obese.

I just worry with the strong case I have in other places my local CCG is just gonna use my BMI as a convenient excuse to refuse funding, given I meet all their other criteria.

Anyone else had experience with this?

I'm sorry to hear you're experiencing this. It sounds especially frustrating because, as you say, you're not obese and, as others say, BMI isn't much of an indicator here.

Still, if you need to lose a little weight before surgery, there's no reason you can't take care of that relatively quickly.

Also, while I haven't had quite the same struggle, I can relate. After I became very depressed about a year and a half ago, I quit exercising and, although I probably ate fewer calories, I started eating a lot of sugary foods, simple carbs, and the like. Whenever something bad happened, I headed for the drive-thru for a little fast food feast. I wound up gaining 15 pounds or so, all of which went to the wrong areas.

Over the past month and a half, I've started exercising and eating toward losing the unwanted additional weight. Weight loss can be tricky, in that your weight can really fluctuate depending on the time of day, etc. Still, overall I've lost weight at a healthy pace, I sleep better, and I have some of the energy back.

I'm not a dietician or training expert, and even if I were, I couldn't recommend a regimen via an Internet forum. What's worked for me so far may not work for you. I just know that once I started eating well again, I had more energy, etc. and it was easier for me to sleep and exercise. The one bit of general advice that absolutely has worked for me: Get the eating in control, and the exercise and weight loss come more easily.

Best wishes,
Veronica