Standard disclaimer: my experience may not be yours; we are all unique for a myriad of reasons. Yay if some/all of this resonates with you. Your experience is totally valid if none of this matches up with your truth./

Generally speaking, my dysphoria got worse over time. Stuff that initially didn’t bother me much and was managed via one coping strategy gradually became intolerable and required new and combined strategies to manage. In some instances there was little else to do but disassociate in some fashion or another. More on this in a moment.

Researching and consulting for surgeries ironically made things exponentially worse. It was as though my subconscious knowing I was getting closer to resolving a trigger needed to find out just how bad the trigger could get in the home stretch of its existence. Once a surgery date was set, the elation of knowing it would soon be over was short lived before my dysphoria doubled down to crush my belief that I could surely make it until a little longer after having managed for years already. Following stage 1, I experienced a lot of post-op depression, here’s some of what I did to address that.

Things that may help while waiting for or in between surgeries:

Find/create language that works for you

Don’t beat yourself up – Validate

Plan and execute the mountain of things to do before

Hang out with people to whom you don’t disclose

Nurture a hobby

Hang out with trans people in a similar situation

Find links with non-trans dis/ability stuff

Listen to music that validates and encourages

Mindfulness Breathing

Stone/ace and disassociation

Manage boredom

Spend time in a sauna

Get your glans tattooed (for those who get phalloplasty)

Find language that works for you

I couldn’t always use male gendered words for myself pre-op, for example, I could not use scrotum to refer to the skin that now makes it up. I could use dick and cock no issue. Your mileage may vary. But more often I favoured gender neutral language, e.g. chest , torso, gonads, crotch, genitals, junk.

If you are surrounded with well meaning/cisnormative messages of “love your body as it is” that probably stem from body/fat positive rhetoric (which in and of itself, is wonderful, no one get me wrong), you may struggle with not having a positive or neutral relationship to a body part or two. I did. This prompted me at one point to find one thing about my former junk I genuinely appreciated. I finally came up with one and turned it into another way of naming my junk: personal lube dispenser. It was practical not to have to go far to get free, non yeast causing lube for hand jobs. It wasn’t much to go on, but some times it helped to remind myself of the one thing I liked about my then junk.



[Picture by Erica Nilsson on Unsplash. Description: a warning sign outside that reads” DANGER thin ice keep off.”]

Don’t beat yourself up if what used to work doesn’t anymore – validate that it’s an indication of how long you’ve been managing/enduring

At one point binding and packing silicone may help alleviate dysphoria. But in time both may come to cause it. You may find quasi-effective work arounds, though don’t be surprise if each new approach works less long than the last. If your mind starts down a version of “how can this not work anymore?!? I’m doomed, DOOMED if my tried, tested and true solution has become a BUST!!” road, do your best to nurture kindness for yourself. Validate the crap out of how hard it is to manage dysphoria and all the more so the longer it’s been going on. Validate that you’re experiencing dysphoria because you’re already a guy. You don’t need surgery to be male, but it’s understandable (not universal!) for a man to struggle as hard as you are because you are however you are at the moment.



[Picture by Braden Collum on Unsplash. Description: relay sprinter at a starting block.]

Plan and execute the mountain of things to do before the next op

Maybe you have a pet, maybe you are volunteer commitments, kids, whatever. You probably have many things to put on pause beyond your occupation while you heal. Some of that stuff can take a while to get covered or postponed. Maybe you need to book travel, out of hospital accommodation, sort out meals, etc most of the time it’s cheaper if you book stuff in advance. Generally, flights are at their cheapest roughly 47 days prior to take off. Not all surgeons will give you that must notice, or not consistently, but point is, the sooner you book it, probably the cheaper.

If you’re going for urethraplasty, expect to take at least one year to clear the hair over the area being used for your urethra. You might take less long, you might take longer if you’re on the furrier end of things. Ideally the area is clear of hair for 2 growth cycles (approx 6 months) prior to surgery to be sure it’s actually hairless but any amount of time before hand is better than none. That translates to ideally starting the process of permanent hair removal roughly 18 months prior to surgery. Hopefully that helps to put a bit of a positive spin if you’ve been quoted a wait time to surgery of 18 or more months.

You can do the area on the outside of the dick afterwards, but it’s harder to come by an electrologist willing to work on genitals than wherever the skin is before surgery. I also recommend doing it before surgery because treatment will take less long without scar tissue, which slows the process when done post-op.

Bonus:

If you have the time, ability and resources, building up core muscles (esp lower back and abs) ahead of time. Once one or two of your limbs are compromised, those core muscles can make the difference between smoother and less painful getting in and out of bed, shower, etc.

Regardless, value how everything you need to do legitimately gets you closer to the surgery and a smoother recovery.



[Picture by mauro Mora on Unsplash. Description: people out of focus crossing an intersection.]

Hang out with people who don’t know your medical history

Pre-amble/context:

My medical transition started with T, and was among the lucky (for those who aspire to this) for whom it didn’t take long before I became consistently recognised as male. It enabled one of the most effective way I had to manage dysphoria both before and in between surgeries./

Left alone or around trans guys too often, dysphoria sometimes became the central, overwhelming thing on my mind. Hanging out with those who don’t know my medical history forced me to put a cork on the topic. Unknowingly/effortlessly they reminded me of everything else that makes me who I am besides my medical history. Time spent with those friends, for the most part**, was time going by without my mind ripping me apart. ** will be covered below, because “1 size doesn’t fit all” scenarios. Sometimes, such as planning trips together with expectation we’d share a room, pee by the side of a road/in a bush, etc I became anxious, and I mostly excused myself from such plans.

I’ve lived most of my life in places where I’m not from the locally dominant cultural group. Thus, hanging out with trans people and accessing care was all done “in [cultural if not literal] translation.” The majority of people who “know my medical history” frame it within their understanding of gender, transition, so on. Those who don’t know my medical history more often recognise (in positive ways) the parts that make up my cultural background, instead of erasing them. It does me good to speak in my mother tongue, watch films that touch on history of personal importance, etc.

Take away message: distraction can be good. You are a whole person, nurture all of your dimensions.



[Picture by Marius Masalar on Unsplash. Description a sheet of music with aid notes scribbled around.]

Nurture a hobby or two

Having a hobby on which to focus is another great distraction. It leads to pride in accomplishing whatever to do with it, a nice counter narrative when your mind may try convincing yourself you only worry about your body or the medical stuff ahead. I wish I’d been better at this. It was hard following stage 1 to reflect on the last few years and feel I’d done little else before dysphoria was resolved than spend so much energy battling dysphoria. I really nurtured my main hobby after that and my mental health was exponentially better for it. It can be a bit of a double edge sword if you are trying to prep towards something that has a deadline (could be presenting at a conference, competing in a tournament, whatever) and you don’t know when your (next) op will be, or if you’ll heal fast enough. But for the most part, you’ll be glad you can point to something besides your occupation and surviving your demons in the lead up to whatever procedure(s) you get.

** Hang out with fellow trans folks that share similar politics and struggles as you.

As mentioned above, validation is your friend some of the time. Too much can lead to an echo chamber of overwhelming/depressing thoughts. But mix hang outs with friends who distract you from your thoughts and those who validate that you’re amidst a significant struggle.

If you’re involved, virtually and/or IRL in trans spaces, I don’t need to tell you we are a diverse bunch with complex and ever evolving experiences. You won’t get along with everyone but if you can’t find any that share some of your struggles, good news: the virtual world is not a zero sum space! Create a FB page, forum, subreddit, tumblr, what have you, to focus on whatever you want to focus on. Others looking for just that will join. Or perhaps there’s a space that in theory is about what you were looking for but you and the moderator got off on the wrong foot, or your ex is in it too making is less than safe, whatever. Create another one. It can be a great way to meet/find people geographically closer.



[SomeEcards that reads “Dear whatever doesn’t kill me, I’m strong enough now. Thanks.]

Find links with non-trans dis/ability stuff

It’s easy to think no cis person can relate to your struggle. Perhaps it’s true when it comes to specifics. But a fair bit of art and blogs broadly about chronic illness, anxiety and depression offer validation, can help put words to tidbits or another of feelings towards components of your experience. You may find content on the spoon theory useful to explain why you can do relatively little in the months following surgeries or when dysphoria has you in its grips, leaving you with less mental health to adult.

You may find amazing people, safe(r) to go into some of your more personal stuff that cannot, by virtue of their cisness, have horizontal hostility towards your decisions. They may put into perspective that some of the systemic barriers you encounter in the medical system isn’t unique to trans people/isn’t transphobia. I unexpectedly related to many cis people, and they could relate to me even if we were dealing with quite different health stuff. Plus, some had awesome, new to me, ways of considering things like scars, extended periods of healing, knowing it’s a matter of when not if I was returning to the OR, etc

In case this doesn’t go without saying, this isn’t about pathologising/medicalising yourself. Many of my dis/abled friends have helped me expand my understanding of the social model (vs the medical one), and tweaked/expanded my understanding of chosen family in the best ways. One of my dearest friend is a cis woman whose dis/abilities have her visiting the ER semi-frequently. We’ve become “doctor buddies”, so that I’m the person she calls if she needs to go (whether to wait with her or pick her up afterwards, depending on circumstances) and she’s been right there, as in by my side inside the consultation room, the time I needed to go to the ER, and validated that it was pretty obnoxious how many times I had to disclose to the medical staff (since I was there for my dick, it was relevant) only to have them somehow understand I was a trans woman instead. I also wanted my friend there to validate if a request for me to drop my pants was warranted (I’ve had a history of medical staff wanting to see my genitals or other body parts when not relevant. It hasn’t happened when someone else is there in a room with me.)



[Picture by Namroud Gorguis on Unsplash. Description: a cassette tape against a solid background.]

Listen to music that validates and encourages

You may lose interest in listening to some of your favourite tunes. Especially in the early days of recovery, you may not have the emotional capacity or patience to listen to songs with themes that feel so far removed from the thick of recovery. Create a playlist with songs validating whatever feelings you have and those promoting resilience. Our musical taste probably differ, but here are some examples from mine:

A Letter to Remind Myself Who I am – Shane Koyczan

Fun – Carry On

Tiziano Ferro – Il Bimbo Dentro

Grand Corps Malade – J’attends

Goo Goo Dolls – Name

Finger Eleven – One Thing

Emmanuel Moire – Beau Malheur

Matt Nathanson – Small Victories

Fauve – De ceux

Classified – All About You

RJD2 – Work It Out

Gym Class Heroes – The Fighter

Fort Minor – Slip Out the Back

Rudimental feat Emili Sandé – Free

Vinnie Paz – Is Happiness Just a Word?

Staind – So Far Away

NB: I know some of these favs are problematic. I’m not excusing or defending any of that.



[Picture by Lesly Juarez on Unsplash. Description: a folded piece of paper on a window ledge that reads “Mindfullness”.]

Mindfulness breathing

Preamble: there are people for whom mindfulness will make things worse. Check in with yourself before trying if you haven’t done it before. If slowing down and shutting the world out for a moment to focus on your breathing will make you more aware of chronic pain, tinnitus, or other causes of discomfort, mindfulness is not for you. None of the strategies I propose will universally work for everyone, never mind at all times./

If you can find a cheap or free class to go to, start that way. You can find videos and gifs online that can get you going on your own. It’s not about the exact number of seconds you spend inhaling, holding and exhaling your breathe, it’s about focusing on and controlling it for a while. This can be especially useful when struggling to fall asleep. My default is to inhale for 4 seconds, hold for 7, exhale over 8. Controlling something that you typically do without thinking centres your attention to the present and calms. There are ways of adding to mindfulness such as going from top to bottom of your body, slowly contracting, holding and releasing all your muscles one after the other or doing other things. There are many examples online or attend a guided session.

Stone/ace and disassociation

Stone in this context means not having anyone touch your genitals, nothing to do with drugs. I went stone in the months leading up to phallo. I basically disassociated from that part of my body, which is another double edge sword. As long as it’s working, great. But the times I was jolted out of it (e.g. at the pre-op appointment) were rough on the mind.



[Photo by meredith hunter on Unsplash. Description: a bulldog laying down looking bored.]

Manage boredom

In between surgeries, especially right after them, boredom can be a huge factor. When you’re on painkillers, antibiotics wrecking havoc on your gut, probiotics and laxatives (because you love yourself), anti-inflammatory meds, had one or more limbs’ movement compromised, there’s not a lot you can do, even once your mind is up for it. Cabin fever is common. I downloaded one of those time wasting game apps on my phone and played it like it was my day job. It’s all about finding things to do that don’t require you get out of bed or leave the place you’re staying in after the hospital. Grocery shopping may well be the highlight of your week. Emailing friends, family, or colleagues may be of limited value because either they don’t know you’re getting surgery, or all too often they’ll ask the same question as everyone else. Nothing wrong with canned responses. Many won’t answer your sincere questions to them about what’s new with them, because they know what you’re doing, and you’ll run out of ways to wax poetic about not doing a whole heck of a lot. There’s only so many ways you can write that you’re in moderate amount of pain and it’s not far along healing to know your outcome.

If you’re a loved one of someone recovering: please answer our questions about you. Your words are a window into what the rest of the world is up to and contribute to a few minutes relief from boredom.

Spend some time in a sauna

If you’re struggling with feeling more like an operating site than a human, and feel comfortable enough wearing a towel around your waist or less in semi-public, spend some time in a sauna. This can help with re-establishing a non-medicalised/pathologised relationship to your body. Taking time to slow down and treat your body can also do wonders for reducing anxiety.



[Photo by Andrej Lišakov on Unsplash. Description: a tattoo gun against a blue circle on a pink background.]

Get your glans tattooed (for those who get phalloplasty)

You need to wait until all your wounds have closed and swelling has come down (check with your surgeon for a recommended wait time), but if you want to modify the monochromatic nature of phalloplasty, get the ink done prior to your penile implant. It might take more than one trip to the tattoo shop to achieve sufficient ink absorption because of the underlying scar tissue. But if you get it done sooner rather than later (again while being careful not to go too early in your healing) you will feel less if anything at all!

This can help make a glans more pronounced (not usually an issue the first year or so but with time) and it’s something you can do locally, without all the paperwork and waiting that comes with surgery.

Kuddos if you got to the end. Hopefully some of it was useful, gave you new ideas. Cheers!

[Header image description: Edinburgh Castle.]