• Elijah Castle

how to plan for gender affirming surgery

Depending on the type of surgery you’re getting, the need for planning may not be too extensive, or it may be quite an undertaking. We’ll go through some things that you’ll need to think about when going through the process.

-where will you stay?

This may be a non-issue for people who are seeing a local surgeon and have stable housing. However, for gender-affirming surgeries, many people have to travel far enough that they won’t be able to go back home immediately after surgery. Surgeons often want to see you at least 1-2 times after surgery for post-op follow-up appointments, and you’ll need to be local to be able to attend those appointments. It’s also a good idea to stay close for at least the first week or two, in case you experience any complications.

Some people are lucky enough to have a relative or friend they can stay with. It can also help to find people who may be willing to house you for a short time. Often these can be other trans people who have gone through the same or similar procedures. Or, there may be a local post-op housing spot.

Another option is staying in a hotel or Air BnB. Though hotels especially can be costly for prolonged stays, getting a hotel credit card and building up points can be helpful, especially if planning for a staged surgery, where you’ll have to travel multiple times to the same surgeon until you’re finished with your process.

The most important thing to consider when you’re planning for housing after your surgery is having somewhere you can safely and comfortably recover. A high-stress situation will not be conducive to healing well.

-who will take care of you?

Getting through surgery on your own is not the best idea. Not only is surgery physically exhausting, but mentally, and you need to be able to put your energy toward healing. Having someone who can help do household chores, get groceries, do laundry, make food, etc. is imperative. Depending on your surgery, you may even need help moving around and getting dressed.

Similar to what I stated above, you should be in a low-stress situation when recovering. That also includes your caregiver. If you can avoid it, don’t have someone taking care of you who is not a positive person in your life. Your caregiver should be someone you can trust, who will not make you feel badly for needing their help.

If your caregiver is squeamish, or if you absolutely cannot find anyone to take care of you, then a visiting nurse service might be a good option. A nurse may be able to visit you daily to check your wounds, change your dressings if needed, make sure you’re healing properly, etc. Make sure your insurance covers this, and also be aware that the nurses who are employed to do this work may not necessarily be trans-friendly. But it’s definitely a good last resort if you have no other options.

Your surgeon should discuss with you at your consult or pre-op appointment your plans for your caregiver. It is also helpful to have your caregiver attend a consult or pre-op appointment so they can ask their own questions as well.

-do you have travel accommodations?

How are you planning on getting to your surgeon’s office? To the hospital? Home from the hospital?

Various options include driving yourself, taking public transportation, getting a taxi or a ride service (Uber, Lyft). If taking public transportation in an unfamiliar city, try to talk to a local about how the public transportation works, how reliable it is, the cost, and any other considerations.

Check to see if your health insurance reimburses for travel and accommodations. This is not a common benefit, but it does exist for some plans, and it can save you a lot of money.

Just like the hotel credit cards, if you will be flying a lot, then consider looking into an airline credit card. Building up points is a great way to lower the cost of multiple flights.

Also take into consideration not only how you will get to the hospital, but how you will get home, and how you will get to your pre-op appointments. Public transportation may be an option when you are still pre-op, but post-op, it can be difficult navigating public transportation. You may not have full mobility, and you may be jostled or bumped, which could be uncomfortable in the best case scenario, and cause complications with wounds re-opening or stitches popping in the worst. Better to be safe than sorry, even if it means spending a bit extra on travel.

-how long will you be out of school/work?

Give your place of employment a heads-up about your surgery about a month in advance. That way they can plan for your absence. They will also know how long you will be out — this is a question you can have answered by your surgeon. There is no one answer, as it depends not only on your job, but the procedure you’re going through, and your surgeon’s discretion. Some people are able to go back sooner with restrictions — for example, being able to go back to desk work but not necessarily being able to lift anything.

If you are concerned about job stability while on medical leave from work, check to see if you are protected by FMLA leave:

-what will you do about your finances?

In addition to figuring out how long you will be out of work, it is important to consider your finances while not working. Certain states offer short-term disability coverage (New Jersey, New York, Rhode Island, California, Puerto Rico, Hawaii), and various employers offer it as well. This means a percentage of your salary will be given to you while you are out of work, though it may not be as much as you would make when regularly working. There are also insurance companies that you can take out short term disability insurance through (Aflac, Metlife, etc.).

Saving up in preparation for surgery is always a good idea, but may not be feasible. Those who are able to save have a certain amount of privilege, and they should not be the only ones with access to surgery. Some people have luck raising money through crowd-funding services.

The point is — though financial means should not be the be-all-end-all of access to surgery, often times it is. It is important to take finances into consideration to figure out if you are comfortably able to be out of work for the amount of time you will be recovering.

-do you need any supplies?

Some surgeons and/or hospitals will provide you with the supplies you’ll need for recovery. Other surgeons will not give you the supplies, but will provide a list of what you’ll need. For example, for top surgery, you may wake up wearing the required compression binder. Other surgeons may have you purchase this in advance. Other necessary supplies, depending on your surgery, may be gauze, antibacterial ointment, tape, etc.

Your health insurance may or may not cover the costs of your supplies. If you have an HSA, you can use it to pay for your supplies.

-who can you rely on for psychological support?

Having a caretaker to make sure you are physically taken care of is important, but beyond that, surgery is an arduous process not only for your body, but for your mind. For a length of time, you will be unable to go about your normal activities, and you will be limited in what you can do. You may be in physical discomfort, and your body may feel unfamiliar as you heal and get used to the effects of your surgery. This is not a bad thing, and change can be difficult to get used to. But it is important to have someone who can support you so you don’t feel like you are on your own.

I did previously write on the topic of post-op depression, which you can read here:

But to touch on the potential psychological impact of surgery here again, briefly — a therapist can be a great ally to have during your healing. They are an objective sounding board you can relay your thoughts to, and hopefully they will have constructive advice.

It can also be very helpful to reach out to people who have already gone through the same or a similar surgery. They can talk about their own recoveries and how they coped.

While you may be inclined to want to be alone, try to schedule time with friends or family, if only for an hour or so. It can bring a sense of normalcy back into your life, to be around people who care about you.

-what if you have complications?

It can be a good idea to discuss potential complications with your surgeon prior to surgery so you are prepared for what may happen. But being prepared for the potential of complications is different than actually going through them. It can be difficult mentally, as well as financially if you are expecting to only be out of work for a certain amount of time, and then it turns out you have to take more time off. This is why it can be helpful to save financially pre-surgery. But if this is not feasible for you, then it is important to just keep in mind what you can do in the event that you have complications to keep your head above water, financially. Maybe you can do some work from home, or work part-time.

In addition to the financial aspect, be sure to know what to look out for that could be a potential sign of a complication. Generally, complications with gender-affirming surgeries are not severe and will not drastically prolong your healing time. But it is important to be aware of the fact that a complication may occur, and to have a plan in place if it does happen.

-what can you do beforehand to make your recovery easier?

For example, prior to top surgery, you may want to move everything you use on a daily basis down to chest-level or below, so you do not have to reach up and potentially stretch your incisions.

Another way to prepare in advance is to make and freeze meals that can be easily re-heated. Post-op nutrition is important, and after surgery you may be too tired to make a meal for yourself. Hopefully you will have someone to take care of you, but if not, preparing meals in bulk and storing them for later will be a great asset.

You can also make sure you have paid your bills, or automated their payments while you are healing, so you don’t have to worry about keeping on top of due dates. If you’re in school, maybe try to get your work done in advance as much as you can, so you can spend your time recovering resting, and not worried about doing work.

There are many layers to planning for and recovering from surgery. These are just a few things to keep in mind. Your individual plan may vary, but as long as you have some semblance of a plan in place, your surgery and the aftermath should go smoothly.

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