I always hated my breasts, but I can't get top surgery because the surgeon said I'm too fat. I'm enraged.

• I always hated my breasts and when I came out as nonbinary, I finally understood why.

• I want to get top surgery, but the only doctor in my state won't operate on me because I'm too fat.

• My insurance won't help me, so I'm worried my mental health will deteriorate.

I've always had complicated feelings about my breasts. I developed early --- around 10 years old --- and by 13, my chest was already massive.

As my breasts continued to grow, I came up with all sorts of reasons why I hated them: I had to special order bras, my shoulders and back ached all the time, and I got rashes under my breasts whenever I didn't wear a bra.

But when I eventually came out as nonbinary and decided I wanted top surgery, I learned there was a lot standing in my way.

In my mid-30s, I figured out that I'm nonbinary

Though I was assigned female at birth and raised female, I'm not a woman. But I'm not a man either. I'm definitely more masculine than feminine, but my gender identity doesn't exist on the binary gender spectrum.

When I figured that out, my complicated relationship with my breasts finally made sense. I actually hate my breasts because they don't belong on my body. My feelings about my breasts escalated from discomfort to distress. I was so anxious and upset about their mere existence that I frequently sobbed in front of the mirror and had panic attacks.

My trans friends assured me that this is a fairly normal experience for newly out trans folks. When we finally realize that our bodies don't match our identities, a lifetime of suppressed distress comes crashing in all at once. They also told me that there's a name for the intense distress I felt about my breasts: chest dysphoria.

I started chest binding using garments called binders or medical tape specially designed to flatten my chest, which was no easy feat with F-cup breasts. Though I've found some techniques that sort of work, binding doesn't fix the fact that I still have breasts that don't belong on my body.

I started researching top surgery and was surprised by what I learned

Top surgery is when a surgeon removes breast tissue and reshapes the chest to appear more masculine. When I Googled "top surgery in Vermont" for the first time, I discovered that only one surgeon in the state performs the procedure. But that surgeon won't perform top surgery on people with a body mass index higher than 35. They wouldn't even schedule a consultation until I lost 75 pounds.

I was devastated because I knew I couldn't lose weight. I spent more than a decade of my life battling anorexia and compulsive exercise, and I can't diet without ruining my physical and mental health.

After a few days of feeling despondent, my misery transformed into rage. In the past, countless doctors blamed my medical issues on my fatness --- only to later discover I had legitimate conditions that had nothing to do with my weight. I've been told I couldn't get certain treatments until I lost weight, and the delayed treatment made my medical conditions worse. My physical and mental health has been repeatedly eroded by doctors who won't provide adequate medical care simply because I'm fat. And I wasn't going to let it happen again.

I started researching other surgeons --- only to run into more obstacles

On social media, I found an active community of fat trans folks sharing information about fat-affirming surgeons. After doing some research, it became clear that I might have to go to an out-of-network surgeon in a different state.

I asked my insurance company if I'd be able to get an "out-of-network exception" to cover surgery --- which would cost $10,000 --- because the surgeon in Vermont wouldn't work with me. They flat-out told me that I wouldn't qualify because I *could *get top surgery from the in-state surgeon if I lost weight. Even when I mansplained my eating-disorder history, the insurance company insisted I could just lose weight and go to the surgeon in Vermont.

I vacillated between misery and rage for a few days, and then I dove back into the emotionally exhausting work of trying to determine if any of the surgeons in-network for my insurance operate on fat people, the exact requirements for getting top surgery covered, and my options for appealing if insurance won't cover the procedure.

As of right meow, I don't have any solid answers

If insurance won't cover top surgery, I can't afford to pay over $10,000 out of pocket, and my mental health will continue to deteriorate.

If I was thinner, I could just schedule an appointment with the surgeon in Vermont, and the procedure would be 100% covered by my insurance. But because I'm fat, I might not be able to access the care I desperately need.

Nobody in our healthcare system really seems to care because they've deemed my fat body unworthy of medical care.