Post-Op Depression Resilience

11 Things that may help:

Find Validation
Post-lower-op Guys
Virtual Post-lower-op Spaces
Take Things One Moment at a Time
Create Art/Write About the Struggle
Sexology Sessions
Spend Time With Friends who Don’t Know Your Medical History
Creating Familiarity with Your Genitals
Resexualise Your Genitals
Taking a break from surgeries

Find Validation

Dis/ability, chronic illness  and mental health themed blogs and articles can provide much validation. For example: this article about post-op depression written by a cis woman. The specifics are different but you might relate to the spirit of such pieces. It helps to remember post-op depression is a widespread phenomena, not unique to trans people. Some of us with a history of depression may experience it differently if we wonder whether it’s post-transition regret. I put an emphasis on lower-surgeries/phalloplasty on this blog but here’s a piece about post-op depression following chest reconstruction.

(Re-)reading The First Man-Made ManHung Jury and Below The Belt can also be healing.

Post-lower-op guys in person

Selectivity is key because not all guys struggle with POD or are able to share vulnerability, especially in person. There are post-lower-op only spaces (see below). Another way is to help guys in the early days of their healing. You have to put yourself out there, forum lurkers seldom ask for help but most will really appreciate it. Some guys are delighted to run into fellow post-op guys in the surgeon’s wait room, others will be uncomfortable.
Examples of formal in person spaces in North America:
– The post-lower-op workshop at the Philadelphia Trans Wellness Conference
– Attending an in person peer support group.

Virtual post-lower-op spaces

The Bottom’s Up listserv
Life Beyond Lower Surgery on FB (closed group)

Coming soon: Meat of the Matter over Zoom.

Take things one moment at a time, then one day at a time

Everything that happens following surgeries cumulatively can be overwhelming. It’s one thing to accept as individual things:

  • significant pain for any amount of time
  • reduced use of a limb or two
  • inability to sit too long
  • reduced energy level
  • struggling to pass a bowel movement
  • constant feeling of a need to pee from having a catheter
  • followed by the inability to pee without making a mess
    (if sitting doesn’t solve it or is too uncomfortable, I hope you have a shower)
  • for those who have a sexual drive, inability to have sex or masturbate
  • ongoing craptastic communication with surgical administrative people
    (anecdotally this is a wide spread problem)

But disruption and loss of control to all facets of your life is brutal however temporary. The knowledge of its temporary nature may prove less of a comfort as time goes by, especially the stuff that was suppose to only take a few days or weeks and turns into months. Some times, it’s about taking it one breath at a time. Tell yourself you just had to make it to the next exhalation, however many times it takes.
Bonus: sometimes the repetition acts as a sort of mindfulness breathing exercise and can help to fall asleep. Once you can take it one day at a time, it becomes about boredom management and staving off cabin fever. That may look like spending way too much time playing video games, some of it is about other points below.

Create art/write about your struggles

Make Good Art (not trans specific, but really good)
To Trans Men Considering Phalloplasty
Challenging the lens through which trans men lower surgery is framed
Managing Dysphoria – While waiting or in between surgeries


A phenomenal trans affirming therapist makes a heck of a difference. That’s almost certainly not going to look like what little is available for free, unless you have amazing mental health coverage. But if you can afford it, have insurance or benefits that pick up the cost, a therapist can help keep enough of you together until you have other sources of support, and then along side of it if need be.
Ask local guys about trans affirming therapists in your region, or inquire with your primary care team.

A few sessions with a trans knowledgeable sexologist

Whether you’re in a committed monogamous relationship, single, non-monogamous, poly or something else, even if (all) your intimate partner(s) are supportive, surgeries can throw you for a total loop. A sexologist can provide exercises and reading material to help re-sexualise your body and re-capture intimate ownership of it. Having everyone around refer to your genitals as a surgeon’s work, spending so long doing wound dressing changes, battling insurance, lazy/overworked administrative staff to get your next surgery scheduled, etc desexualises genitals. Also having genitals that aren’t what they’ve always been but aren’t yet done healing from the last surgery either can be distressing.

Your sex drive may have been non-existent in the lead up to surgery but suddenly, with your dysphoria resolving or resolved, your libido may return but you’re waiting to heal, or struggling with finding a way to have penetrative sex prior to having a penile implant (if you find a way that works for you) and/or working out what sex looks like for you with your reconstructed junk.

Also, similarly to how it isn’t uncommon for trans people to revisit their sexual orientation after starting medical transition, during or following lower surgeries, you may find myself wondering if you’re still a top/bottom/vers/whatever. A sexologist can help navigate uncertain terrain.

For those who play (kink), a sexologist can help if you find your relationship to kink shifting. Following the restoration of a healthier relationship to fear (discussed below for those who experience this), and improvement in body image, you might resume playing but differently then before.

To find a registered sexologist near you (not just in the US), try:
The American  Association of Sexuality Educators, Counselors and Therapists
The American College of Sexologists International
Remember to inquire if they are trans knowledgeable/affirming.

Spend time with friends who don’t know your medical history.

Not in contradiction to spending time with trans men who share similar experience, this can compliment that. Spending time with friends who don’t know your medical history forces your head space to go beyond recovery, coordinating communication between surgical and local clinicians or whatever is eating away at you when your mind is left to its own device. Nurturing a few hobbies is great to ground in the present, ensure you have something else going on in your life than surgeries and to discuss with those with whom you’d rather not chat about genitals.

Demedicalise your genitals / create familiarity with them

This could mean spending time in saunas, showering at the gym. At home, gently explore your genitals without a sexual end in mind. Take pictures of your junk from different angles so you don’t only know them from looking down or straight on in a mirror. You don’t have to share them; it’s about better knowing the new configuration of your genitals.

Resexualise your genitals

Especially if you’re single but even  if you’re not, between the nurses and doctors medically handling your junk, all the post-op care, not being able to masturbate or have sex for a while, your genitals may feel more pathological than sexual. Sex after lower surgeries can be tremendously psychologically healing as well as erotically fun.

For queer and/or non-monogamous guys, something that may be especially healing is having sex with, or in the same room as, another guy who’s had lower surgeries. Even if there are differences between your surgeries and outcome, it can be incredible. It can help normalise your junk.

For those who don’t head into surgeries in a monogamously committed relationship, another experience that may heal is having sex without disclosing*. Many people insist post-phalloplasty dicks in particular, though post-meta dicks get slack too, are awful/fake/scarred/slurs I won’t repeat here. Maybe you pick apart your own over what seem to you as “give aways” of its surgical reconstruction history. Maybe you prefer to disclose to intimate partners. But if someone is digging you, you dig them, there’s enthusiastic ongoing consent, and you find yourself with someone’s hands/mouth/junk on yours without disclosing nor them noticing any peculiarities, consider going along with the moment. You might begin to believe it too: you have a penis, not a surgery. You aren’t your surgeon’s work in need of a wound dressing change. You’re a sexual person. It seems self-evident and facile when put that way but it might take a lot of unpacking to get there.

* If you live in the UK, this carries a unique potential risk. Thus far there’s been no ruling by the courts on “sex by deception” for post-lower surgery guys. But given the Delacruz ruling set the precedent that legal status doesn’t matter to the courts, and other guys were convicted for doing the sex act agreed upon that didn’t include the use of their genitals (e.g. digit-sex, oral sex), it’s shaky legal grounds at best. I’m not a legal expert, I’m not giving you advice. I’m putting it out there that there’s things to consider for those living in the UK.

Taking a Break from Surgeries

This one is definitely not for everyone and not always an option. But if you’re reasonably confident your insurance coverage isn’t liable to suddenly evaporate for one reason or another, your surgeon to stop practicing, etc it might do wonders for your mental health, romantic relationship(s) (for those in one/them), or other components of your life to take a breather. It can provide a chance to focus on something else for a while, possibly improving the mind/body relationship if it’s gotten strained. It comes with the potential of improving future surgeries as it gives more time for scar tissue in the area to become softer, which makes future surgical interventions easier to perform.


With all of that cobbled together, you hopefully feel part of a giant group hug. But the road there can be long and rough.

5 thoughts on “Post-Op Depression Resilience

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