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Post-Opt Depression

depressionThis is a ‘second’ transition – a transition to living a normal life – and this is not talked about or at least not mentioned to the degree that it should be.  In some ways this was expected but perhaps none of us that have gone through SRS really understood the full ramifications of.  That is post-op depression. For some it’s huge.  For me it’s a slight sidelight hardly worth mentioning, but yet, very important to mention…

We have spent an inordinate amount of time and energy planning, researching, questioning ourselves and preparing for transition – taking almost every second of our day and occupying our dreams at night.  Suddenly all that planning etc. is over, done, accomplished – even the dreams stop.  And here we are – marvelously and finally our true selves, whole at last – but all that action is gone, finished, leaving us somewhat devoid and that sends some into a depression or just feeling down.

I use the word ‘we’ as I’m mostly talking about others in the sisterhood (I use ‘sisterhood’ to mean all those that I went through SRS with plus many others that are post-op).

I’m quite active in a number of areas, so for me I was able to simply ease into a relaxed life.  The greatest effect for me was being physically handicapped and unable to do a lot of the outdoor activities I enjoy (hiking, climbing, swimming, kayaking etc.).  But I’m also creative, love learning and do a lot with computers.  So I have many ways that I find rewarding and fulfilling.  I also had spent a lot of time pre-op getting my psychological self in order.

In addition to this sudden lack of intense activity, there is a low level pain that is pretty constant for 4 to 6 months as down there is swollen and still healing. I can see the progress, but it is very slow, measured by the week – not the day.  This has a couple of effects for me.  First it either prevents me from doing activities I love or at best it makes me think twice if I should do something or not.  But the thought is constantly present.

When I was researching SRS, as I was initially looking into the possibility that I wanted to go that far.  I read about the maintenance that is required and was taken back by how much there was.  Dilation for the rest of your life is a big one especially when you understand what and how and how often it must be done.  Add to that the normal but new (for us) activities a woman has to routinely do:  cleanliness, pads/liners, checking yourself/making sure all is ok and how to use the restroom – how to sit, clean, even how to urinate.

All these take additional time that before we never had to even think about.  And now, the time to do all these duties constrains our ability to get into the things that bring us joy and keep us (anyone actually) happy and away from depression.

At times we feel so good, but then something else happens and back we go.  The pain will sometimes abate, only later to come back in a different form.  Just when we think things are getting better something else starts in.  This is a long journey – it’s takes a year to recover from an operation this massively huge.  But relapsing after feeling so good can be very difficult to take mentally.

So we have this seven pronged threat:

  • Intensive mental activity leading up to surgery
  • Physical handicap keeping us pent up and unable to do activities we enjoy
  • Constant low grade pain
  • Things taking so much longer to heal than expected
  • The new duties
  • Maintenance required with our new parts and the lack of time to do enjoyable activities that keep us out of depression
  • Relapses after things were going so good

In a way, it’s equivalent to soldiers coming back from a war.  It’s suddenly over but perhaps too suddenly.  Everything keeps going around in our heads.  It’s hard to let all of that go and settle down.  It happens just too fast.  And the ‘way of life’ is completely different.  Whereas there was so much to do before, now there is a lot to do, but it is totally different.

For my sisters:  this is much larger than you think or possibly can imagine.  This is more than a change of your physical sex.  It’s more than just living as the opposite gender.  It’s also more than how society views you or more importantly, your own insecurities and fears. In addition to all of that, this is a profound life style change – right down to how you ‘wipe’ yourself in the restroom!

My advice for those that are contemplating SRS:  Do your due diligence in researching this.  Join online groups and social media that are targeted for pre-op’s.  Once you settle on a surgeon – ask that clinic what pre-op and post-op social media they have and get invited to those (these are almost always private).  Once connected – read back one year to get a good clear idea of what you are going to face.  You will read about complications, about troubles and issues, but also about marvelous achievements and proud moments.  A word of caution:  everyone is different both in what they experience and the timing for various healings to take place.  Take it all with a grain of salt as they say.  But at least you will have a better idea of the full spectrum of possibilities and outcomes.

A bit of a soapbox moment:  I saw so many sisters that carried high sexual expectations once they completed surgery.  It bears mentioning that around 50% of women (gender) born female (birth sex) ever have an orgasm.  A transsexual after completing SRS is no different and has the same statistics!  We are all sensate (feelings and able to have an orgasm) – but the big ‘O’ is more than just being sensate.  It requires a heavy mental aspect as well.  What it requires is an opening up, being in tune with your body and being calm mentally and letting go.  All of which are completely opposite of what is required of a man and is therefore even more difficult for a transsexual.  My soapbox is this – do NOT go into this for sexual reasons.  You really should only be doing this because you have a deep down need to have your life be congruent, to be whole, to embody the essence of who you are.  Let the rest come – it will.

For most males (birth sex) under the ‘influence’ of testosterone, they have an almost daily urge.  For me this was confusing and at odds to the woman (gender) that I am.  Those urges caused a conflict in me as the male influence of testosterone had it’s way.  This is part of what I called the testosterone poisoning.  Getting on HRT and now completing SRS solved this and got that poison out of my system along with all of it’s effects.  Mind you, if you are a cis male (meaning your birth sex and gender match), testosterone is perfect and wonderful and I appreciate that in others.  However, for me, a transsexual, that was an awful burden that caused great disphoria and conflict.  Of course for some this is a concern – will they still have sexual urges after HRT and SRS?  And for a lot of sisters going through SRS this translated to worries about size/depth (again think testosterone – how many males do you know that are concerned with ‘size’ …) and orgasmic potential (especially after being able to, on demand).  Granted, for those that are young and have or will have a male partner, these things are important – I’m not saying otherwise.  I’m saying these should not be the top priority nor the reason for coming this far.

You are changing into a female (you are already a woman). Your body is now going to act and respond as one.  This includes the much more subtle urges, the relaxed sexual tension (compared to before) and a completely different way that we orgasm.  Many worry (I did) about how will we be satisfied if perhaps we can not orgasm or as often and ‘easily’ as we could before.  When you come out of the ‘testosterone fog’ and into femaleness, the urges change too.  In other words, you are now a female and your urges and abilities will match a female’s as well – do not fret over this, let it happen.  Let me put this yet another way:  your new body and self will match … perfectly!

And for those that have had surgery:  This is HUGE!  You had a major surgery – it does things to your body that take a long long time to heal.  You might feel ok at the moment – but is it not finished.  We need to take this one day and one thing at a time.  Conquer it and it alone, then focus on the next.  Don’t get overwhelmed – it’s so easy to do.  This is going to take up to a year – all the adjustments, all the issues that come up – both physical and mental.  So many times, the clinic has told us – recovery is 90% mental and it’s very true.  I remember the first time I saw blood on my dilator – omg I went crazy worried.  I reread the ‘manual’ the clinic sent me a dozen times.  Did what they said – and no problem.  But the mental anguish was difficult.  Of course now I just put pressure on the spot (always a granulation) and it’s gone and done – not a biggie.  And that is how most of recovery has to be dealt with.  One day at a time, one thing at a time and put-in the time!

For some, this is a difficult period and an unexpected complication.  I have a feeling that this may have been the reason two people I know of that committed suicide. So this is serious.  If this is you – please, there is so much help out here – reach out – please ….  There are a lot of us that have been through this – we made it, it’s more than possible – it’s just more hard work.

With so much Aloha



About sifankahale

I retired from an astronomical observatory and now live on the Oregon coast where I teach astronomy and give talks and presentations. I am enjoying astrophotography, kayaking and hiking in beautify Oregon.

15 responses »

  1. Forwarding this post to my spouse, who is looking at SRS down the road. Thanks, Sifan!

  2. Excellent post with lots to think about, Sifan. I’m sure it will be helpful to others.
    Coming up on 15 years postop, let me just add a few of my own thoughts.

    Pain. Pain comes in different sizes for different people. Not all will experience a sense of pain for months after surgery. Within a few weeks, I was pain free except for the discomfort of moving to the next larger dilation stent.

    Healing time. Yes, it is major surgery, and you will be tired for quite awhile. Don’t push yourself too hard.

    Dilation. Yes, it is forever. After 15 years, I still dilate for 20 minutes twie a week. I consider it ‘protecting my investment.’ It is neither a pleasure or Pin; it is a necessity that one can do while reading, watching TV, or even meditating. Lube yourself and the stent an

    Emotional stress. Well, we still have to live life. Rarely will Prince Charming carry us off to the castle and a life of bon bons and servants.

    Happiness. It is within us. We don’t need someone else to make us happy, but we can certainly be happy with someone else. I cite myself and my husband as Exhibit A. I find much happiness in just realizing that I have been true to myself. Old cliche, but I am happy in my own skin.

    Me ke aloha pumehana.

  3. Thank you so much for being so open and sharing, Sifan. You give some of us hope.

  4. Pingback: 4 Months Post-Opt | Sifan's Journey

  5. i crashed _hard_ post op. i am a suporn gal. Late Jan 2014. All was well. magic and pixie dust, i felt valid and it felt (i don’t know how to describe it other than) not like a caved up c**k. Then i examined myself and recognised a mole from my donor tissue that was now on my inner labia.

    Magic evaporated. Invalidity once again reigned and in all honesty (and it might sound stupid to you) but i was close to jumping off the choninter roof a couple times. i was on floor 7, it was 1 flight up and a jump.

    i intentionally didn’t research methodology too much, i just always knew Suporn was the doc for me due to his reputation, reviews i had read and feeling his way of performing the procedure made the most sense. To look in the mirror and see precisely what had been done was devastating. All because of a stupid mole.

    i went back to thailand two weeks ago for revision. He cut me up pretty good and now the magic is back and thus far it has remained.

    This story may sound childish and foolish and fuelled chiefly by my own naivety but nevertheless it is the reality i experienced.

    Suporn is top notch, he really is. His team are amazing. Aey, Jib, Bow, Minda (now) Fon too. And all the nurses. i love every single one of them.

    i’ve heard tell of people feeling that Suporn’s practice has turned in to something of a production line, and if you view how well organised and skilled they all are in a negative light i can kind of see why.

    But the bottom line is this: once you’ve done something so many times, so regularly and get so good at something it DOES become like a production line. Because there’s a care path for every eventuality, every need you could have, before, during and after the operation. Every complication you could possibly imagine has been experienced by someone prior to you and thus they know just how to deal with it in the unlikely event it occurs again.

    Production line? No… Very very well oiled machine. Absolutely yes.

    • Mahalo Annabel. I couldn’t agree with you more regarding Dr. Suporn: a well oiled machine that has been tuned precisely. Total care.

      I’m glad you were able to have that revision and more importantly that your magic is back!

      You are right – it doesn’t take much to lose that magic – even though we know what and how it was done. But I think we all have a period we go through where anything that reminds us that we were not born with it causes us anguish. I’m not sure that ever goes away, I think we just learn to cope with and accept who we are.

      I look at the surgery this way: almost all the parts and pieces were there, but just in the wrong configuration. Dr. Suporn is skilled enough to ‘see’ that and put them where they are supposed to be. That minimizes that facts that ‘this’ used to be ‘that’. Ya, it was, however, it was always supposed to be ‘this’ and now it is!


  6. Wow. This post was…*awesome* Girl, *you* are awesome.

    I’m sitting in Chonburi right now about 10 days after my surgery and looking up post op sexual is bugging me a little, I mean, I do have sensation, just nothing like I had before.

    While I have all the time in the world to sit here and contemplate every aspect of everything, its inevitable that this would enter my mind. Patience patience..

    Thanks again for your post 🙂

    • Congratulations Jessica. Please say hi to everyone at the clinic for me! They are so awesome. You are in the best hands there!

      You will hear this over and over – everyone is different and that is one thing I witnessed first hand. So take my next statement with that in mind….

      I had some sensation there, but like you are saying, it’s not the same nor the same intensity. This changes over time as things heal. For me, 6 months was the magical time frame. Right now, everything down there has a long way to go. In month 2 and 3, nerves will start to reconnect – they will tell you about this in your training and the manual they give you. After that period is when I had a lot more feeling. However, things were still sore until 6 months.

      Also, you are a woman – things occur differently – both in where sensations are located and in how we now react. By now you know that urinating is completely different – you can not ‘force’ it like you did before, you have relax and wait for it. Sorry to draw this similarity, but climaxing now is sort of the same – you can not force it, that shuts it down.

      The best advice I received (from a number of our sisters that went before us) is 1) be patient 2) when healed enough (you do ‘not’ want to get stitches there….) explore all the different places you now have, see where you have sensations (and remember, as nerves reconnect, this changes) 3) relax and tune into your body, feel your entire body.

      There are a lot of posts and articles for women on how to climax – those are applicable to us too. Most of our sisters that have had orgasms have had those after month 4.

      I hope that helps. I know it’s hard to wait – but trust me, you do not want to do something that will cause additional pain or worse – corrections. The first couple of weeks after surgery are remarkably pain free. It gets harder in month 2 and 3, but then at about 6 months it’s great.


      • i came 73 days post op with a genuine hitachi, there was a bit if blood on the head of it but it needed doing lol

    • i believe i left my french press with Jessica lol what a small world!

      She’s ossum :]

  7. Hi Sifan. Thank you for writing this post. I am currently going through some post op depression and it’s comforting to know I’m not alone in this. I thought everything would be magical rainbows after surgery, and at times it has been, but at 4 months post op I’m going through a lot of regret, anxiety, confusion, and worry about whether or not I made the right choice.

    Granted, I would absolutely never want to I back to my previous equipment, but there’s still this nagging urge that what I have now isn’t full on woman. I’m discounting myself and thinking even after all the money, stress, pain, heartache, and hours of dilating, I don’t quite feel completely female. My new bits have become a new, focused source of this developing body dysphoria that jut won’t quit.

    How did you, or others, overcome feelings like this? Getting back to normal life has certainly helped, but in the wake of so much change so quickly, there’s still a lot to deal with.

    • Aloha Nikki ! Well, you have heard this before I’m sure and you probably know this already, but sometimes it’s helpful to have it said again: we always were women. True, what you are going through is on top of that, however, it’s good to remember this and have this fact as our ‘basement’ foundation. And also that with today’s social environment most women also suffer trying to live up to what they were lead to believe a ‘women’ is! Perhaps there is no such thing. I had a lot of trouble up until month 6. Down there suddenly – almost overnight – got better. And I was being accepted as a woman everywhere – however – that I believe was because of my confidence not looks: a lot had to do with my accepting that I ‘AM’ a woman – regardless of the path that was taken to get here or how I look or anything else.

      Feeling female comes in waves of intensity. I had many talks with my beloved spouse (she passed away last April ….) and she has these same ups and downs feeling more or less feminine. The trick is not to let that ‘get’ to you – to have confidence of who you are.

      Time and gaining experience and comfort dealing with outside life was one thing that helped me. My spouse was an immense support for me as well as a role model, confident and mentor. I have lost so much when she passed away. Right now every minute of my life is focused on how to continue with this huge loss and grief.

      I have found a number of similarities between loss/grief and post-op depression. Both require that we develop a confidence in ourselves and both require … time … (unfortunately). That is probably the hardest part of this – time – we have to go through it. I think this is where faith comes in – in the form of trusting yourself and having confidence in yourself, both in your decisions and in the fact that you will be able to handle the future. It is just going to take this time to sort it out and get back on your feet.

      One other thing – we have a history of who we were. Having surgery does not erase that, our previous feelings, thoughts, etc. Those all carry forward. We need to accept that these are part of our life and continue with us. We need to separate those from whether or not that means we are male or female.

      Hope this had helped ….

      With much aloha,

  8. Hi, Sifan. It was nice to read your well thought out piece. I’m kind of an antique; Biber girl, 32 years post op. My post operative experience, while not pleasant, was not terribly frought with bad experiences. Mostly, after a 5 year transition period, was a sense of loss of direction. Kind of like a tether-ball loose from its rope. I had the advantage of some phsycological awareness due to having started out my working life as a military nurse. Yes, it’s somewhat akin to a slight case ptsd. Everything felt slightly askew for a while. I think mental preparation played a big part in a relatively fast emotional recovery. Having no social media back then, I had to rely on the few friends I had for comparative analysis. As an “old timer” I am somewhat jealous of the resources available to the trans community today, and would urge all my sisters to take full advantage of it!

  9. It gets better as you settle into your new life. Your feelings are perfectly normal. Find a man!

  10. Beautiful story. And it’s so good to hear a woman’s side of things.


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