Gender-affirming care: Battling unsafe body enhancements

The use of silicone injections and other unconventional fillers like cooking oils have gained traction within the transgender community as a method for body enhancement. These substances, often used in non-medical settings, are offered as cheaper, quicker alternatives to professional, medically supervised gender-affirming procedures. While these treatments may seem like a lifeline for some people, their consequences are far more complex.

Imagine living a life wearing a suit that doesn’t quite belong to you, explained Dr. Natalia Zhikhareva, better known as Dr. Z, a gender psychologist in Los Angeles. Every day, you step outside, and people see only this body suit—responding, interacting and defining you based solely on what they perceive. But inside, there’s someone else, someone with a different identity, a different gender, and each time people misgender you based on that outer shell, it feels like an invisible punch. It’s not just uncomfortable; it’s painful—a constant reminder that who they see isn’t who you are.

This psychological distress is known asgender dysphoria. For many transgender individuals, altering their appearance can be an essential part of alleviating  dysphoria, enabling them to feel more at home in their own bodies and engage with the world in a way that authentically reflects who they are.

According to a 2023 study by theWilliams Institute at UCLA School of Law, “81% of transgender adults in the U.S. have thought about suicide.” This alarming statistic highlights the urgent need to address the systemic inequalities and societal pressures that transgender individuals face. From discrimination in healthcare to pervasive stigma in everyday life, transgender people are navigating a world often hostile to their identities. 

The emotional impact of body enhancements

 “I started to transition when I was about 19. At that time, they were using cooking oil [for body enhancements]. And I had that procedure done on my body. I got the oil injections because I looked at my trans friends, who were so beautiful and slender. And it was easy for me to agree to do it,” Maria Roman-Taylorson, vice president & COO of theTransLatin@ Coalition, said in Spanish.  The procedure involved injecting oil into different body areas, creating pockets under the skin. 

Her body later rejected the procedure, and she found herself in the emergency room. “It seems either the liquid was infected or the technique was flawed, and I got infected all over my lower back and hip,” she explained. “The doctor had to cut each pocket to drain it, which was incredibly painful.” 

Why trans people turn to these methods

Dr. Z explains that many people endure prolonged mental anguish to the point where they are willing to sacrifice their physical health to recover their peace and sense of self. She reflects on how access to gender-affirming care is both limited and costly, and in the current socio-political climate, it is becoming even more restricted. Dr. Z noted that in her practice, she has witnessed individuals taking extreme measures to alleviate their distress, such as self-administering silicone injections or traveling to other countries without knowing if the practitioners are qualified, all in a desperate effort to find relief. “When society doesn't provide treatment options, people have no choice,” she stated. 

“The trans community is part of society. I pay taxes, I contribute, and as such, I should have a place where they can provide me with services that respect my life and focus on helping and offering me with the best quality of services,” affirmed Roman-Taylorson. 

Dr. Z believes that some people struggle to understand the complexities of gender, mainly because many of them don’t think about it in their daily lives. However, just because some may not fully grasp the concept doesn't mean it doesn’t exist, nor does it negate the profound pain and unhappiness it can cause for some individuals. Often, people seek concrete facts—like a specific gene or medical evidence—to explain gender identity, but she feels this is the wrong approach. 

Instead, she emphasizes the importance of recognizing when a fellow human being is in deep distress and pain, even to the point of contemplating suicide. Dr. Z believes that when witnessing such suffering, the compassionate response is to offer help in whatever way possible. For her, in today’s world, gender-affirming care is one of the most effective means of providing that support. 

The risks of unconventional fillers 

In a 2016 study, theNational Library of Medicine indicated that liquid silicone injections could cause serious complications, including “chronic cellulitis and abscess formation, ulceration, pneumonitis, cosmetic irregularities and asymmetries, perforation or injuries to critical structures, foreign body reactions and migration of silicone. These can present even years after injection.” 

Silicone, in particular, can migrate over time, distorting the intended body shape and potentially leading to embolisms (blockages in blood vessels) if the substance reaches the bloodstream. 

Roman-Taylorson describes that at 55 years of age, she was recently hospitalized due to complications from her body's ongoing rejection of silicone. She shared that in her case, one of the effects of the liquid silicone injections is cellulitis, which leads to a severe infection. The condition causes her skin to turn black or red, swell, and become hot as if she has a fever. At times, the pain was so intense that it prevented her from walking, requiring hospitalization. Reflecting on her experience, Roman-Taylorson acknowledged that she has paid a high price for the body she has today. 

She said that desperation for acceptance can lead one to disregard fear, even in the face of considerable risk. Rather than dwelling on the dangers, she emphasized that her decision to accept liquid silicone injections was driven by the possibility of finally being accepted by the world. She longed to be recognized as the woman she truly felt she was. For her, the surgery she underwent was the sole accessible option to achieve that sense of recognition and validation. 

When visiting the emergency room, doctors often lack the knowledge to address complications from these injections properly, said Roman-Taylorson. In addition to medical challenges, trans persons face judgment from healthcare providers, who subtly question their decision to undergo such procedures. This leads to a sense of guilt and discrimination in the way they are treated. She emphasized that dealing with these biases only adds to the difficulty of managing their already serious health issues. 

The unpredictable journey 

Yahni Ross, intake specialist and research assistant the TransLatin@ Coalition, expressed that despite having undergone the procedure herself, she would not recommend it to others due to the risks involved. At 32, she lives with loose silicone in her body and acknowledges that anything could happen. She explained that in the event of an accident, the silicone could shift, leading to severe complications. She shared the story of a friend who was attacked and left with a deformed body after being stomped on. Ross noted that if the silicone in her body were to move, especially to sensitive areas like her eye, it could cause blindness. She stressed that the risks posed by silicone are significant and unpredictable. 

An analysis by the National Library of Medicine reveals that many trans women turn to fillers not just for enhancing their appearance but for safety. By using fillers to achieve a more feminine look, they aim to blend in and avoid being recognized as transgender in situations that could potentially put them at risk for transphobic violence or harassment, being unwelcome in women’s spaces, like bathrooms or locker rooms, or experiencing misgendering. 

The threats of using liquid silicone and other harmful substances as body fillers highlight the urgent need for nationwide, accessible, and considerate gender-affirming care. Providing safe, affordable, and supportive medical procedures can save lives—not just by preventing dangerous physical complications but by ensuring trans individuals feel seen, understood, and respected. 

“People are born experiencing gender dysphoria, and as a result, [they] sometimes suffer decades and decades,” said Dr. Z. She advises that people don’t have to change their views to show compassion and kindness towards trans people.