Preparing for and recovering from gender-affirming surgery

Recovery fails when logistics fail. Before surgery day, confirm these:

Housing for recovery: Where will you be for 2 to 6 weeks after surgery? Is it safe, clean, and affirming? If your current housing isn't suitable, talk to your navigator or call WERQ TOGETHER, we can help coordinate temporary placement in some circumstances.

Caregiver: Who is physically present with you for the first 72 hours? A partner, friend, or chosen family member who can drive, get food, and watch for complications. This is not optional for most surgeries, you will not be able to safely be alone.

Transport home from surgery: Not rideshare, not TriMet. A personal vehicle or NEMT. For OHP members, Ride to Care covers NEMT to and from surgical appointments, call 503-416-3955 at least 48 hours ahead.

Food in advance: Easy-to-prepare meals for 1 to 2 weeks, ready before surgery. Post-op fatigue makes cooking impossible in the first week. Food 4 QTs (WERQ TOGETHER's monthly grocery delivery for trans community members) can help if you're connected to our network.

Medications on hand: pain meds, anti-nausea, stool softeners (post-op constipation is real), and any antibiotics your surgeon prescribed, all filled before surgery day.

Surgeon's on-call line saved in your phone. You will need it.

Your surgeon's discharge packet has the procedure-specific warning signs. Read it before you leave the hospital, not after. These universal red flags require calling the on-call line or going to the ER:

• Fever above 101°F
• Heavy bleeding through dressings
• Severe pain not controlled by your prescribed medication
• Signs of infection, redness spreading, warmth, pus, or worsening pain after day 3
• Shortness of breath or chest pain
• Leg swelling or calf pain (possible blood clot)
• Inability to urinate for 12+ hours
• Inability to have a bowel movement for 48+ hours

First call: your surgeon's on-call line. If you can't reach them within 30 minutes for a serious symptom: 911 or nearest ER.

⚠️ Unity Center for Behavioral Health (503-944-8000) is the 24/7 psychiatric emergency center if emotional crisis occurs during recovery, separate from physical complications.

Post-surgical bodywork speeds recovery and reduces complications. This is real medicine, not optional.

Trans Bodycare is mobile, trans-owned, and specializes in post-top surgery and post-GCS manual lymphatic drainage and scar work. Book early, they fill up. For top surgery, lymphatic drainage can reduce seroma risk, dog-ear swelling, and scar thickness. Usually starts 1 to 2 weeks post-op.

For bottom surgery (vaginoplasty, phalloplasty, metoidioplasty): follow your surgeon's protocol exactly for dilation or wound care. This isn't the place to improvise or slow down.

Scar care (when your surgeon clears you): silicone sheets, sun protection, and gentle scar massage per their instructions. Most surgeons want you to start around 6 to 8 weeks post-op.

Post-surgery mental health surprises people who waited years for this. What you might experience, and what's normal:

• Post-op depression: hormonal shifts, physical exhaustion, and the "now what" of finally arriving at something you worked so hard for. Very common. Usually resolves.
• Body image shifts: your body is swollen, bruised, and not yet what it will look like at 6 or 12 months. Be patient. The results at week 2 are not the final results.
• Regret fears: these almost always resolve with time and support. They're worth talking about, not suppressing.
• Isolation: recovery is often solitary. Plan for how you'll stay connected.

Portland resources for this:

• Quest Center for Integrative Health (503-238-5203), LGBTQIA2S+ affirming therapy
• Trans Lifeline (1-877-565-8860), peer support by trans people, 24/7
• David Romprey Warmline (1-800-698-2392), non-crisis peer support, any time you need to talk

The emotional ride is part of healing. You don't have to manage it alone.

You need protein and calories to heal. Plan for this before surgery, post-op fatigue makes cooking impossible in the first week.

Options during recovery:

• Food 4 QTs (WERQ TOGETHER): monthly grocery delivery for trans community members in our network
• Meals on Wheels People: if you're 60+, home-delivered meals through recovery
• Store to Door Oregon: grocery shopping and delivery; recovering from major surgery qualifies as a qualifying condition
• SNAP (Oregon Trail Card): if you're not already enrolled, apply as soon as you can. Oregon Food Bank pantries (1,200+ sites) are also available while SNAP processes

Ask your caregiver to batch-cook before your surgery date.

Most gender-affirming surgeries require 2 to 6 weeks off work. File paperwork before surgery, not after:

Oregon Paid Leave: up to 12 weeks of paid leave for medical reasons. Apply before surgery at paidleave.oregon.gov.

FMLA: 12 weeks unpaid job protection if your employer has 50+ employees. Gender-affirming surgery qualifies. Submit paperwork 30+ days before surgery if possible.

Short-term disability: if you have private insurance with this benefit, surgery usually qualifies, check your plan.

If income runs out: WERQ TOGETHER has limited stabilization funds for gap income during recovery for trans community members in our network, reach out at werqt.org.

Surgery is not a single event, it's a year-long healing process. Here's what to expect:

The results at week 2 are not the final results. Most surgeries look dramatically different at 3 months vs. 12 months. Swelling, bruising, and scar redness are all temporary.

Follow-up appointments: your surgeon will set a schedule. Keep them. Bring your questions written down.

Revisions: minor revisions are normal and are usually covered by insurance. Most surgeons discuss them at 6 to 12 months when healing is complete. Needing a revision doesn't mean something went wrong.

Hormone adjustment: some surgeries shift the way hormones work in your body. Labs at 3 months post-op catch this, make sure your prescribing provider knows you had surgery.

Mental health check-ins: 3, 6, and 12 months. Integration takes time. Many people find 6 months post-op to be unexpectedly emotional, not bad, just real.

🏳️‍⚧️ You did a huge thing. Celebrate the milestones, even the small ones.