Post-op depression can occur following any surgical procedures that involve general anesthesia and strong pain medication. Withdrawal from both can bring on depressive symptoms. Although WPATH SOC v7 require readiness as part of being approved, what that includes from appointments to get referral letters to the consultation with the surgeon doesn’t include any of the health professionals mentioning post-op depression, as noted in this great article written by a trans woman.

I struggled with post-op depression, post-op care burn out, horizontal hostility, stigma and the rest of in between my lower surgeries. Every time I wrote in to the biggest phalloplasty forum asking fellow post-op guys for input I heard nothing from them. instead, I received many questions from pre-ops (both on and off the forum) that I could not yet answer because I wasn’t far enough along recovery or they were posed in problematic ways.

Click here for suggestions of things that might help someone struggling.

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Stuff I struggled with included:

– grief over everything I put on hold as part of “managing” my dysphoria for so long, to have surgeries.

The longer and harder studies I didn’t pursue, knowing I couldn’t complete them while struggling with dysphoria. Not having kids when I was younger because I didn’t want my parenting compromised by me wrestling to achieve basic functionality for myself, never mind take good care of little ones. I made the right decisions for me, but they were still difficult to live with while watching people around me pursuing the goals I wanted for myself as well but had to put on the back burner. A lot of this had been simmering in the background, bottled in no small part to be approved for lower surgeries and from anxiety something would somehow go wrong up until I was put under. It all spilled over once I was post-op and it was finally safe to unravel.

There was resentment for how long I’d had to wait and everything it took to get to surgery. There was resentment it had taken “so much” to feel this peace with myself. The surgeries “worked” and yet it felt outrageous that it had taken them to get to this peace. In the vanishing of prior dysphoria, I suddenly wondered why I hadn’t been able to make peace with my body as it was before (this was tied to the split that occurred in the relationship between body and mind mentioned below.) I rationally knew I’d tried everything else first, that I aught to focus, if anything around this, on the part where thank goodness the surgeries worked because damn, that was the last resort. Instead it was surprisingly easy to dismiss how hard it had been before hand, and I caught myself wondering if all the struggle afterwards had really been necessary.

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– feeling pointless in continuing post-op care the longer it went on between surgeries, knowing I was heading back to the OR. This lead to…

– feeling a real riff between mind and body. My dear body felt totally betrayed that my mind was putting it over and over again through such trauma. From the anesthesia, through the antibiotics disrupting my gut, the catheters irritating my bladder, to the gauze, surgical tape and glue over this, that and other body parts, my body was a wreck. It’s ironic, in some ways, I was closer to feeling “at home in my skin” than ever before, but on the way there, I felt further apart.

There was resentment for how the impact to my donor sites impeded my life, especially around exercise (not just lost training time, tournaments I couldn’t compete in, but the loss of flexibility and muscle mass) as well as in terms of getting around as walking, cycling and riding my skateboard are my chief ways of commuting. My donor sites remain numb in some areas, my body felt that was a great cost to bare forever more in order to address a comparatively small part of my body.

[Photo by Jack Finnigan on Unsplash . Description: 2 people sitting on benches underneath street lights at night on Baker Street. One has his head down, looking at a smartphone. The other is looking his way.]

– great frustration with the horizontal hostility aka shitty intra-community dynamics. Many pre-ops (it’s not all of them) ignored my humanity over their need for information. This was especially angering when I was not yet in a position to answer their questions. To add insult to injury, my contributions were often dismissed because I’m not from the US, half my surgeries weren’t done by US surgeons, so my experience was devalued within US centric forums. In between 2 of my stages, came the guys asking why I hadn’t gone with Crane… answer: because I began having surgeries before he finished his training… as if it was a statement of my feelings towards Crane. So many implied I had gone to lesser surgeons.

To be clear: My choice to go to surgeons other than Crane, Chen, and co are temporal 1st and far most. Also, the surgeons I went to literally have 10 or more years of experience than the currently more popular surgeons. It’s impressive to be told I “sold myself short” by going to “lesser surgeons.”

Crane’s fandom (it’s not everyone who goes to him), the dominant one at the time, left a sour note in my desire/ability to engage in the few forums around at the time. Some people whispered around me that I must have been disappointed in my results to not worship the ground my surgeons walk on, and to switch surgical team between stages. The reason I switched have nothing to do with how I felt about my surgical outcomes. Rather it was due to a change in circumstances outside my control. Besides which, I’m generally not into brand worshiping/fandom level of care about anything; it would be out of character for me to do that. Plus, I knew guys who were less than enchanted with their experience with my surgeons. I care more about their struggle than a surgeon’s ego. I was confident my friends’ struggle and complications in no way devalued my surgical experience and outcome. I was struggling to be honest about my mental health and I didn’t have necrosis, fistulas, a stricture, or dislodged implant. I didn’t want to contribute to the silencing or victim blaming of those with less than gum drops and rainbow filled experience.

[Photo by Francisco Gonzalez on Unsplash . Description: a person dressed in green and black, sitting on a stool in the middle of a field with their hands over their face.]

– Reproach from other people’s cis partners, furious I was reporting general satisfaction with my surgical results. This was boosting their trans partners’ desire for lower surgery, which they did not support. Some of this is perhaps unique to those of us considered community leaders or living in urban centres.

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– the dynamic between the surgical staff and myself. While I was generally happy with my results, it felt like from their perspective, showering them with anything short of high praise was failing to be grateful they were making a living off my body. I applaud their work, but there were legitimate concerns and complaints along the way. These include: atrocious communication between admin staff and myself with regards to the timing of upcoming surgeries. Virtually no communication with my primary care team or health insurance despite repeated requests from both of them. Needing a minor revision to part of the scar on my donor site causing discomfort.

This was reinforced with the inability to express discontent with X or Y element of the process among trans guys, who bounced on anything short of “100% satisfied, dream come true!” reviews to establish whose fault it was: the choice of surgeon, my health, my post-op care, whatever. Often it felt blame had to be assigned to someone no matter what, so I guarded myself against this by sharing little when I most needed to connect with others.

[Photo by Lily Banse on Unsplash , Description: looking through a window into a public transportation vehicle in the rain. 3 people are seated, 2 of them concentrated on their smartphones. 1 of them has his head against the back of the seat in front of him, hand covering his eyes from others.]

– Loss of control over virtually my entire life. The first few weeks I was struggling to pass a bowel movement (I had all the probiotics and stool softeners there were to have), I couldn’t pee (because of the catheter) or not properly (because of post-op swelling or from the penile implant being left inflated to heal, making it impossible to aim my penis down), I lacked energy, basic mobility, even sitting was a struggle. When the worse of that was over, I was still not able to resume my hobbies or do anything else that involved lifting more than a few pounds.

The worse was the quest to find out when the next surgery would be. Appalling communication from the surgical teams is echoed from guys getting surgeries on both sides of the Atlantic ocean, probably around the world. Not being able to plan much more than a few months out, in some cases this can last for over a year, is demoralising. Not being able to book travel further in advance for greater savings, have more time to set up out of hospital accommodations, the list goes on, is difficult and increases costs.

Eventually I made peace with having to take things one day at a time, constantly disappointing friends who wanted to plan attending a concert, birthday party with me because I was always answering “sure, if I’m still in town.” But that honestly felt like cisnormativity had broken me.

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I understand surgeons are important people with busy lives, and many of them struggle to retain better administrative staff. But the staff aren’t the ones living with a catheter, wound dressing changes, the inability to masturbate for lengthy periods of time, having recently acquired a fair bit of scar tissue, temporarily losing some use of a limb or two. On top of that, to not be able to plan much of anything both between surgeries and in relation to the procedures themselves is atrocious. It constantly felt like they didn’t care they were making a living off my body, not enough care anyway to let me have faint amounts of quality of life in between procedures or appreciate that the surgeon’s last minute choice to attend a conference, head off on vacation, whatever meant that I was having to coordinate last minute pet sitting arrangements for an extended absence, last minute arrangements for work coverage, out of hospital accommodations, flights, so on.

Surgeons are great, but I happen to matter to me, and to have no ability to reflect that, to have so little control over my own life for so long was dreadful. All these, mostly cis, people make a living off trans bodies, but left me with little life of my own to have in between great trauma to my body and utter indifference at all times about my mental health. Not one surgeon mentioned post-op depression as a possibility. I get they don’t address it, so in that sense, it’s not their problem. But they contribute to it with this apathy towards my worth as a human being. I’m not just the next scheduled procedure after your administrative staff ignored my insurance’s request for billing information well after the insurance’s deadlines.

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– Similarly to this cis author in her piece on post-op depression, these surgeries altered my understanding and relationship to mortality. Esp in the first few months, I wasn’t suicidal but I felt an uncomfortable apathy towards death. As though I was closer to it in some way than other people, and that felt comforting at the time.

– My relationship to pain and fear dramatically changed. These surgeries caused pain over a bigger amount of my body than anything before. Some parts were in pain or discomfort for over a year. Sometimes when things started to feel better, it was time to lay back down on the operating table. I knew these surgeries came with significant risk, and following stage 1, with some of its hick ups and growing uncertainty of what the final outcome might be coupled with post-op depression, I questioned my ability to foretell dangers. I felt I took this massive gamble and until the end of stage 2, was not certain if I could live with how things might turn out. This led to a near constant feeling of being a coward, becoming afraid of even relatively banal things like the unlikely chance that I would fall off a bike going downhill on a well paved road. Coming from someone who practices a contact sport, loves roller coasters, and has been strapped to more than one bungee cord, it was quite upsetting to become frightful about so many every day things. Suddenly my life came with enough pain I didn’t choose, I found it hard to justify stepping into a sparring ring or starting a kink scene. Either of those could get me hurt or potentially have me hurt someone else and neither thought was bearable even if the risk was calculated and everyone consenting.

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– I struggled with suddenly having an external symbol of virility (aka my balls) knowing I was infertile. This one might be different for those who started off with a functioning reproductive system (esp if they kept it.) I learnt as a child I was congenitally infertile, but there were no external visual cues indicating my (in)fertility to others. Now, suddenly, I had a scrotum, and even though it’s filled with silicone, that threw me off. I worked through it, and now adore my scrotum but there was an adjustment period.

When I mentioned struggling with my balls to a surgical staff member (thank goodness not the surgeon or a therapist!) she thought I was expressing regret and started panicking. I doubled back on my words to get out of trouble, but along with everything else, one more thing had to be handled alone, hush hush, for reasonable fear of being misunderstood or negatively judged. I didn’t want funding for future surgeries compromised until I was done. It felt I had to keep up a very brave front until I’d finished healing from the last op to be safer.

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– I struggled with sex for a few different reasons. Part of it was suddenly questioning if I was still a top or if resolution of dysphoria came with becoming versatile or a bottom. This was challenging but generally a good experience, pleasant to find I had comfort in exploring something in ways I hadn’t been able to previously. The greater challenge was with having genitals no one had experience being intimate with before. I would disclose I’d had lower surgeries and suddenly people wanted a “101” on my surgeries or “how to” handle, and both killed my mood. And that was among the people who didn’t run for the hill from the stigma alone.

There were those who during the years I didn’t have a penile implant demanded I penetrate them. I tried a few external stiffening devices, some of them even did their job in the stiffening department. But they didn’t anchor my penis to my pubis region so the skin at the base would over stretch and that was painful. I quickly made peace with that reality, and remembered that my hands and mouth were as available to get someone off as they were prior to surgery (and since penile implant, of course.) I never forgot that sex is primarily suppose to be fun. But so many people tore into me for not having a penile implant already. It wasn’t enough I’d suffered through multiple surgeries, dealt with post-op depression and stigma, I had to be sorry for not being done already, apologise for my body. Totally gutting. This is probably more an issue for those of us who are single/non-monogamous.

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In conclusion…

There was a lot of post-op depression to get through. Some reasons for it were probably tied to GA and trauma to my body brought on by invasive procedures. Others I think quite rational given the social context in which many of us recover and the total impact these procedures have on our bodies, wallet, social and professional lives.

One more time, the link to the page on post-op depression resilience.

Nota Bene: some guys experience post-op depression following chest reconstruction, hysterectomy and other procedures because post-op depression is not unique to lower surgeries in the least.

[Header image description: a fire truck on a hill, with none of its wheels on the road because it is suspended on stabilizers coming out of the sides of the truck to keep it leveled with flat ground.]