FREQUENTLY ASKED QUESTIONS about all things Transgender: Depression after Surgery
Answers to your questions about the medical and emotional aspects of transgender life by Sidhbh Gallagher, MD and Michele O’Mara, PhD
Why is it common to get the post surgery blues?
Depression after surgery is a common experience for patients of most major surgical procedures. However, when the surgery is designed to positively impacts your social presentation and gender identity, and you have spent most of your life waiting for this day to arrive, it can be very surprising to then experience post surgery depression.
According to Dr. Sidhbh Gallagher, many of her patients experience sadness and anxiety after any surgery. When asked why, she said, “There are many reasons for this, and it is completely normal.”
- CHANGE IN ROUTINE. One of the most basic reasons for post-surgery depression and anxiety is the basic change in your normal routine. When you are admitted to the hospital, you become temporarily displaced and while you may have the support of friends and family, it is unlikely that you have the same kind or quality of contact with them during this time. Routines provide comfort, structure, and predictability to our day. Whether you turn to a morning cup of joe, a hearty workout or yoga class, or a Mc-breakfast to start your day, your body will notice this change in routine.
- PERMANENCE ANXIETY. In the weeks following surgery, it is very typical for a transgender patient to think, “What have I done to myself?!” Not only is it common to feel depression after surgery, feeling anxiety is also common. Even when you know that you have taken the right step in aligning your body with your true gender, it is common to question yourself. When you progress through a gender transition, it is common to forget the pain that drove you to make the choices to start HRT, to pursue surgeries, and to transition in the first place. Each step you take toward a gender transition brings relief. From this place of feeling better, it is easy to question if you really needed to make these changes at all. Think about the messages you have received throughout your life about who and how you “should” be. It is a monumental task to counter everything you were told and taught that you are supposed to be, that you were born a boy/girl, and that your body is that of a boy/girl, and you are expected to behave, dress, think, and socialize as a boy/girl.
- HORMONAL CHANGES: Adding insult to this already complicated surgical scenario, is the fact that many transgender patients will need to stop taking their hormones for a period of time before and through the surgery process, to reduce medical risks for blood clotting and other concerns. This, alone, contributes to a low mood and lack of energy.
- GRIEF. It’s a bit counter-intuitive to think we would grieve something that we’ve desired for so long. However, from an emotional perspective, surgery is often the last item on your list of “todo’s” as you journey toward your truest self and authentic gender expression. Consider the time, energy and resources that you invest throughout your gender transition. It is all-consuming. For many, transitioning is the most dominate focus in life. When you complete this list of todo’s there is a feeling of “now what?” To feel depression after surgery is natural. The process of transitioning involves a roller-coaster of emotions. From the lows of fearing the loss of (and sometimes not just fearing, but actually losing) relationships, supports, jobs, and more – to the highs of feeling aligned with your true self, is an exhilarating ride. After surgery, the roller coaster begins to slow and you are faced with having to adjust to a new normal.
- WHAT IF’S? Gender-related surgeries invite a lot of “firsts.” While for many this is a wonderful adventure, it can also be very anxiety provoking. Whenever we do not know what to expect, it is natural to feel anxious. When you go through a gender surgery, there are a lot of “what if” questions. What if I don’t like how my _____looks? What if I never orgasm again? What if my swelling never goes down? What if I still don’t feel happy even after having surgery? What if this does not take away my dysphoria? And, on and on….
Some Helpful Tips To Deal with Depression after Surgery:
- Focus on the here and now. If you are seeking information about how to deal with your post surgery blues, know that in this moment, as you are reading these words, all is well. Focus on right now; not what used to be, not what you are afraid will be, but what is. When you stay grounded in this moment, you can also stay connected to the reality that you are okay, that all is well.
- Remember the pain will go, the wounds will heal, and the numbness or itching all gets better! Your body knows what its doing just give it time. Put down the mirror! Many patients will not see their final results for up to a year.
- Surround yourself with supportive folks as much as possible and talk it through.
- Be aware that bad habits like smoking can be very hard to avoid after going through the stress of surgery. Have a plan for when temptation sneaks up on you.
- Remember to ask for help if you need it. Some patients experience real episodes of anxiety and depression after their surgery. Your mental health professional is available to you and can be incredibly helpful during these times reach out if you need help.