Rob Waltman tried to tell his partner, Peter Dovak, he looked fine. He didn’t need to look any different. He especially didn’t need to inject himself with silicone to look bigger.

“Peter had the worst body dysmorphia out of anyone I ever knew,” Waltman tells Rolling Stone. “For years it was me shooting him down when he wanted to get silicone injections. He wanted to go to Mexico to get it done because he was too squeamish to inject himself and I sure as f–k wasn’t going to do it.”

But eventually Waltman gave in, and Dovak went to California to get his first injection in early 2017.

By November, Dovak was dead.

Four years ago, the American Society of Plastic Surgeons witnessed a disturbing and deadly trend among those within the trans community: Many were injecting silicone into their bodies to achieve the perfect curvy look. But the trend — “pumping” — has continued to be a cause for concern as it grows in popularity among gay men who want to appear larger — a subgroup called “gainers.” But there are dangers to the illegal practice, as often it’s not just silicone being injected into the body. And now, the gay community is calling for more visibility on the practice now that two internet-famous gainers within the last year — including Dovak — are dead.

Among trans women, silicone injections are a well-known way to achieve the ultimate body: curvy butt, thick thighs or larger breasts. But over the past five years, there have been a number of news reports exposing “pumping parties,” where groups of trans women pool their money to get injected with silicone, and the practice has become more underground and riskier.

And much of that has to do with what’s being put in the mixture, which many times is unknown by those who receive the injections. In one Florida woman’s case, tire sealant and cement were both injected into her face.

It makes health experts reticent to even call the mixture “silicone.”

“When people come in and say ‘silicone,’ they don’t really know what they mean because it could be anything,” says Asa Radix, senior director of research and education for Callen-Lorde in New York City, an LGBTQ-focused health center, adding that some of his patients even had quick cement or peanut butter injected in them. “You’re desperate to change your body, people will go through great lengths [to get that done].”

Though the trend has appeared to decline recently — at least among trans women in New York, according to Radix — as quality care for trans-identifying people continues to grow, it’s become more visible among the body-modifying subculture of gainers.

The community lives online, mostly, with Tumblr blogs dedicated to idolizing bigger guts and monstrous testicles. But the community isn’t only based around fetish — the gainer community is well known to encourage body positivity, which is sorely needed among LGBTQ communities.

Compared to straight men, gay men are more prone to focus heavily on their weight and appearance. Gay men are also more prone to eating disorders and other body dysmorphia conditions that result in poor self-image.

But until the gainer community became more popular with the introduction of Grommr, a niche hookup app dedicated to them, larger gay men had few places to find satisfaction or admirers of their bigger appearance. The site calls itself a place “for guys of a similar mindset — that bigger is, most often, better. It’s a site for all the guys who spent their childhoods stuffing pillows under their shirts or staring a little too long at big-bellied men in the supermarket.”

It’s this community where Dovak found the most solace in his size. It’s also where he gained his internet fandom for growing huge, or “a monster,” as Waltman put it.

“He took more steroids and he definitely got bigger and stronger, but he never felt good about it,” Waltman says. “Whenever we left the gym, he would feel like s–t about it. He would just flog himself over it. I eventually stopped working out harder than him so he could feel better about his progress.”

According to Waltman and other sources, Dovak reached out to an online acquaintance — another popular online gainer named Dylan Hafertepen — who told him where to go to get the illicit procedure. But the man Dovak went to wasn’t a doctor. (Hafertepen denies that he told Dovak where he could obtain the procedure.)

“He was just a guy who had a connection to black market, industrial-grade silicone,” Waltman says.

And that’s not uncommon.

“Aside from being illegal, it’s clearly unsafe and these practitioners are not licensed physicians and they’re certainly not board-certified plastic surgeons,” Dr. Malcolm Roth, former president of the American Society of Plastic Surgeons, told NPR in relation to trans pumping parties.

Silicone freely injected into the body travels through the bloodstream into the lungs, which can cause death.

Among the people dead from injecting silicone were Dovak, who died last November; a Miami trans woman who died from injections to her butt (Oneal Ron Morris, the woman who injected her, was sentenced to 10 years for practicing medicine without a license); and last month, Tumblr gay celebrity Jack Chapman — the partner of the man Dovak allegedly went to for advice — who died of a lung hemorrhage caused in part by silicone injection syndrome, according to his death certificate, obtained by Rolling Stone.

“I talked to Tank about it and I expressed interest in getting work done myself,” says Donick Slaick, a friend of Hafertepen’s. “But no one ever told me I could die from it. I didn’t know that until I heard someone had died — and then Tank had died from it.”

There has been ambivalence among many in the online gainer and fetish world to discuss the problem of silicone injections to avoid the appearance of sex shaming. Multiple Tumblr posts that denounce silicone injections are met with pushback from those within the gainer community.

“My goal with this post isn’t to kink-shame anyone. My goal is simple: I want to make men aware that large-volume silicone injection [sic] can be fatal — not just during and immediately after the procedure — but as a ticking time bomb for decades to come,” wrote one Tumblr blogger, referring to Hafertepen’s death. “This is tragic and senseless and awful. No one deserves to die in pursuit of an aesthetic ‘ideal.’”

And the dangerous trend among gay men choosing to inject silicone has changed the perspective of clinicians and researchers like Radix, who proposed, “This is something that maybe we should recognize we need to be asking about this [among our male patients]. And not wait for people to disclose.”

For Dovak, though, the risks of injecting silicone were well worth his pursuit of a bigger appearance.

After his fourth injection, he ended up in the hospital with respiratory issues, and soon after was placed in a medically induced coma. Three days later, Dovak’s mother was called and told her son was dying.

“Over the course of Tuesday evening I watched [his oxygen levels] go down and down and down. His lungs were so inflamed, they were pretty much useless,” Waltman says, adding that it took 90 seconds for Dovak’s heart to stop after they unplugged him from life support.

“I held him, and he got so cold and still,” Waltman says. “I read that 98 percent [of silicone injection syndrome patients] survive after a month. Not so lucky me that my partner wasn’t one of them.”