January 2023 Update: New Inclusive & Body Positive Content

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Author: Nicole

The latest Sims 4 patch brought new CAS content to expand player representation for members of the deaf community, as well as Trans and Nonbinary sims.

Sims 4 January 2023 Content Update Details
(PC: / Mac: / Console: Version: 1.69)

The most recent update/patch for the Sims 4 rolled out on January 31 and brought with it a handful of new content, primarily for CAS. This content focuses mostly on sims with disabilities and those with nontraditional gender expression. It’s another step in the right direction for inclusivity within the world of the Sims, though there are some quirks to know about.

I’ve previously covered custom content for sims that are underrepresented, such as the disabled community and those who are overweight, as well as a collection of body positive content that everyone can enjoy. While it’s great that we have so much pro-body CC out there, console players and PC players who don’t/can’t use CC get very little to choose from by way of representation. This is a welcome update for vanilla players who want a more inclusive gameplay experience!

EA has made two other major inclusivity updates in the past, first by removing the body frame and clothing limits for sims’ genders and then with the pronouns update, and hopefully they will continue making strides towards representation over the remaining life of the game.

Medical Wearables – Hearing Aids & Glucose Monitors

The update brought a small selection of wearable medical items for sims who are partially or fully deaf and sims who require blood glucose monitoring.

Hearing Aids

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The new “Medical Wearables” category in facial accessories

First on the docket we have one style of hearing aids, which are available for sims of all ages for one or both ears. They come in a variety of colors, from bright hues to subtle flesh tones; however, the hearing aids cannot be worn in combination with standard lobe earrings.

Players who want deaf or hearing impaired representation in their characters will have to decide between having that representation, and accessorizing their sim’s ears. Your characters can at least wear facial piercings so they’re not completely without accessories, and eyeglasses are still wearable with no noticeable clashes.

Glucose Monitors

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“Medical Wearables” for the body

A new category in the Body section of CAS introduces us to a collection of glucose monitors that can be accesed by Child sims and older, and are available to be worn on the arms, torso, or both.

Unfortunately the arm monitors will conflict with arm tattoos. It seems that EA decided to reuse the tattoo layer for the glucose monitors, though the stomach monitors do not appear to conflict with chest tattoos. If you choose the “Remove” option in the Tattoo category, any monitors on your sim’s body will also disappear.

Before we continue, this author wants to note that I identify as a cisgender female. While I will be discussing the gender identity spectrum moving forward, I am by no means an expert on the subject. I encourage you to do your own research to gain a better understanding of this complex matter.

Gender Identity and Expression

While gender identity is a complex issue beyond the scope of this website, you should have a basic grasp of some concepts:

  • Female/Cisgender Female – This is a person born in a female’s physical body who feels like and identifies as a female. They typically use the pronouns she/her.
  • Male/Cisgender Male – This is a person born in a male’s physical body who feels like and identifies as a male. They typically use the pronouns he/him.
  • Trans Female – This is a person born in a male’s physical body who feels like and identifies as a female. They sometimes use she/her pronouns but also may choose other pronouns that feel more appropriate to them.
  • Trans Male – This is a person born in a female’s physical body who feels like and identifies as a male. They sometimes use he/him pronouns but also may choose other pronouns that feel more appropriate to them.
  • Gender Non-Conforming – This is a person born in a male or female’s physical body who identifies beyond the male/female binary. They may be nonbinary, multigender, transgender, or a variety of other identities. They may use a variety of pronouns.

Now that we have these basics covered let’s go over the rest of the new CAS content.

Top Surgery Scars

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Top Surgery Scars

If your sim is given the gender of Male and the Feminine physical frame, you will have access to a category for Body Scars where there is currently one option available. Scars like this are seen on Trans Males who have “top surgery”—removal of the breasts for a more masculine physique.

Sadly there are no chest scars for feminine frames so Trans and Cisgender Females cannot represent breast augmentation surgery and Cisgender Females cannot represent breast reduction surgery. At least now that the new category exists, we know it’s likely there will be more body scars in the future; stretchmarks, maybe?

The latest update unlocked gender options for your sims beyond their initial creation so players are now able to change a character’s gender at any time, but strangely the new top surgery scars are inaccessible after your sim has been created. Luckily it’s easy to get this access back with the cas.fulleditmode cheat; be sure to enter it before you go into CAS.

Binders & Shapewear for Trans Sims

Binders and shapewear are undergarments that modify the shape of the body. The following pieces can be used by any sim aged teen & up in any combination of gender identities & expressions, though you will probably find them most beneficial for Trans and Gender Nonconforming characters.

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Left: binder & shapewear on Male sim with Feminine body frame | Right: binder & shapewear on Female sim with Masculine body frame


The way it’s worded in the update announcement makes it sound like the shapewear is supposed to affect your sims’ bodies, but I looked over this piece multiple times with all gender & body frame options available in the game and it doesn’t seem to be anything more than a regular undergarment. At the very least it’s a really cute article of clothing, and shapewear is worn by lots of people so this new item will get plenty of use in players’ games. It looks good on everyone!

Binders for Trans Males

A binder is worn by someone with breasts who wishes to flatten them which can be for a number of reasons such as gender expression, comfort, costumery, etc. While it does reduce the visible size of the breasts on Male sims with Feminine body frames, it doesn’t fully flatten the chest.

The binder is classified under Tank Tops—not as an accessory or in a new category—so if you’re not down with your Trans Male sims wearing the same style of top for every single outfit category, then unfortunately their breasts won’t be reduced in any meaningful way. Hopefully we see more clothing options in a future update that make use of the breast reduction effect.

It would be nice to see padded tops in a future update for our Trans Female sims or any sim who wants a bit more “oomph” in the chest area.

On the Right Track

Luckily the issues with the new content are all minor things that can be easily fixed. Hopefully EA hears enough feedback and includes improvements to this content in the next big update, with additional options for sims of all gender identities!