Aim: To explore the impact of body mass index (BMI) on the outcomes of gender-affirming vaginoplasty. Methods: A cohort consisting of all gender-affirming vaginoplasties in our practice between September 27th, 2018, and September 1st, 2022 were identified, and data were retrospectively collected. Patients were classified as obese if their BMI was ≥30 kg/m 2 at the time of surgery and nonobese if their BMI was <30 kg/m 2 . Complications were assigned a Clavien-Dindo grade and grouped as Grade ≥2 versus Grade ≤1. Patient-reported functional outcomes of intact erogenous sensation, tactile sensation, ability to achieve penetrative vaginal intercourse, and cosmetic satisfaction were assessed.Results: A total of 58 patients with a mean follow-up time of 6.9 months were included. Seventeen patients (mean BMI = 36.8 kg/m 2 ) were classified as obese and 41 patients (mean BMI = 25.1 kg/m 2 ) were classified as nonobese.No significant differences in outcomes were identified in the obese versus nonobese groups in terms of the incidence of complications. Patient-reported functional outcomes did not differ significantly between the two groups. Conclusions: Similar results can be achieved with gender-affirming vaginoplasty in obese patients when compared to their nonobese counterparts.Eligibility for this procedure should not be restricted based on BMI alone.