How to Care For Your Friend Having Gender Affirming Surgery

A loved one has a gender affirming surgery coming up, wonderful!

There are many surgery prep documents out there that focus on the physical and material aspects of the surgery itself and recovery. The ones from the Gender Confirmation Center by Dr. Scott Mosser may be a good place to start. Their language is on the medical side, but it still offers a helpful roadmap — they have one for what they call breast augmentation top surgery, and one for what they call chest reconstruction top surgery. Check them out, and ask your network for more — there’s a treasure trove out there, and that prep is certainly important.

However, it’s not the only prep that matters. This piece will cover some of the more emotional, intangible parts of surgery recovery support, like how we relate to one another and care for our recovering loved ones. Remember that surgery is a temporary disabling event. If your loved one is already disabled, post-surgery care specific to their disability/disabilities must be considered in addition to our guide below.

I myself just underwent surgery two months ago and can tell you first hand: it takes a village. It also seems to be a near universal trans experience to have friendships and relationships be strained throughout the process. There’s no use in pretending otherwise: surgeries take a toll on the person undergoing them and everyone around it will feel it. Some relationships will flourish, and some relationships will sadly reach their breaking point. I say this not as a way to scare you or anyone against surgery or participating in support, but as a way to best equip you for what is to come.

While I still recover, I can tell you with confidence: it was absolutely worth it. Arriving to this depth of gender euphoria and sharing it with my people is worth it all. There were aggressively choppy waters at times for me, but as I feel more myself and continue to take stock of my recovery process I see all the love that carried me through the whole time. This guide is intended to help you provide that love and care to your loved one.

If You Are One of the Primary Caregivers:

Congratulations! Your loved one loves you and trusts you to be part of their most intimate circle of care.

First: make sure you have the time and capacity to show up in the ways you hope and/or have signed up to show up. All of us want the best and only the very best for our friends, and tied up in that hope is the damn honor to have been asked to show up for them in what is sure to be a life-changing experience. It can be such a rush to know that your friend trusts and loves you in that way, it’s hard to see past it. I’m here to tell you to take a pause. See past it.

Questions to Ask Yourself Before You Say Yes to Being a Primary Caregiver:

  • Is their surgery taking place during a particularly busy time for you at school, work, or family? Pass.
  • Does thinking about caring for them feel exciting but deeply anxiety-inducing in ways you don’t feel equipped to handle? Pass.
  • Are you avoiding thinking about their surgery at all? Pass.
  • Do you notice you haven’t been able (or maybe willing) to prioritize connecting with your loved one in meaningful ways before surgery day gets here? Pass.
  • Do you feel secretly resentful that you have to make space for this? Pass, pass, pass.

Providing meaningful care means not only caring for your friend (completing tasks, making meals) but it is also caring about your friend. It necessitates your emotional presence and attention. It is a promise that you’ll center your recovering loved one for the days you signed up, and show up with curiosity, bravery, and grace. If you know you can’t wholly show up no matter how badly you want to, pass.

If you pass, whether 100 days before their surgery or the day before, you are doing exactly what your loved one asked you to do: you are caring for them and your relationship. Caring for chosen family works best for all involved when you do it out of love and ease, not guilt or a deep fear of disappointing them. It will be hard to say no, but it will be harder to run yourself and your friendship to the ground if you agree to do something you actually have no capacity to do right now, no matter your wishes and intentions.

What You Can Do Even If You Can’t Be a Primary Caregiver:

If you pass on being a primary caregiver you are giving your friend the chance to find someone else who will better fit the role. It’s possible this will shift your closeness, or that your friendship will never be exactly the same, even as time goes on — but this is still kinder (to yourself and them!) and a healthier way of relating than committing to help someone in ways you can’t properly follow through on. It also doesn’t have to be all or nothing; you can pass on the original ask and still offer to help them brainstorm other options, reach out to those folks, feed your friend while they continue to navigate logistics, or even chip in for a hired aid — whatever is within your capacity will work. Bare minimum, hold steady to your capacity and remind them of your love for them, (either through communication or by giving them space if they ask) and with time they will be able to draw up a new plan.

Okay, but maybe you are the friend who does have the capacity. ¡Buenísimo! On to the next steps.

Things a Primary Caregiver Should Do Before Surgery:

1. Check in with your friend! Post-surgery care requires pre-surgery planning. Your friend may be deep in the weeds of logistics, fears, excitement, or whatever rollercoaster is happening internally for them — your support starts the moment you decide to say yes to being a primary carer, and that requires checking in. Here are some suggestions about how you can schedule check ins:

  • Ask them to save half an hour once a week to talk on the phone through logistics, concerns or just to stay in touch.
  • Ask them to meet for a meal once a month to iron out details before the big day.
  • Drop by their place whenever you can to touch base, have a moment to connect and confirm you are both on the same page so far.

It’s important that you make the time to check in with your loved one before surgery. These check-ins can be quick and casual or long and detail-oriented, as either way will help you get a sense of where your loved one is at before surgery. Intentionally showing up before surgery will strengthen your bond, help you address or prepare for any potential challenges you notice simmering during prep-time, and also help minimize potential surprises once surgery has happened.

2. Check in with yourself! What do you need to feel prepared? Are you clear on what you have to offer, or what is expected of you? What will you need to feel cared for yourself? Offering care can be a lot of work! Identify what you’ll need if at any point you feel depleted, need a break, or just general pampering after taking care of your loved one. Identify friends who are not as involved in care-taking to support you when you need it. Consider blocking time off on your calendar after you take care of your loved one so you can focus on yourself, as well.

3. Make an intentional plan that takes both of your needs into account! Whenever a major event happens in a relationship, it’s a good idea to talk explicitly about how to show up — this goes double when you actively volunteer to care for someone getting life-changing surgery! Here’s a guide to some questions you and your friend can consider and investigate together to set yourselves up for success:

On a regular day, what helps your friend feel loved and cared for? Here are some examples: touch, quality time, a home-cooked meal, inquiring about their day… the options are endless. I personally like physical closeness and also have a friend who loves to be hyper-independent: our care needs are drastically different. They need to feel spaciousness, and I need to feel like my people are basically on top of me. Ask your friend, even if you already know the answer — it’ll be good to review it, and can help you each feel certain you can give and get the emotional care you desire.

What is your availability? Are you taking time off work or will you be in virtual meetings. Are those meetings interruptible? Communicate this to your friend. They may immediately forget it, communicate it again.

If you are sleeping in the same house or room: do you have specific sleeping needs, does your friend? Is your friend a light sleeper? Sleep deprivation will ruin even the most stoic of queers, make sure you and your loved one have what you need for restful nights.

Things a Primary Caregiver Should Do Day of Surgery:

  • Follow their lead. If your friend looks like a nervous wreck, comfort them. If they can barely contain their joy, celebrate them! Pictures and videos may be a nice way to commemorate the day.
  • Stay at the clinic. The day is here! Your friend may need things from you, something may come up. Stay close by and ready to greet them when they wake up.
  • Listen closely to surgeon instructions. Your loved one will probably get started on painkillers and antibiotics at the hospital, and might be too out of it to remember when they’re supposed to take which pills — set your alarms.
  • Prioritize your loved one. Now is the time to put into practice the “ring theory.” This is basically a framework that visualizes care as a group of concentric circles: the most inner circle is your loved one recovering from surgery, and every circle further out represents different levels of support pouring in. The main point of ring theory is that comfort and support moves inwards, and venting/complaining/generally coping moves outwards. That means your loved one is at the center of care while they recover, and that you as a phenomenal person also have outer circles pouring love into you — they are also able to hold any complaints and annoyances that may come up as you support your friend.

Things a Primary Caregiver Should Do During the Immediate Surgery Recovery Period:

Remember: your recovering friend is the center of it all. Not to the detriment of your own needs, but as a principle.

Your friend will, most likely, be needy at times and maybe even annoying! Painkillers and anesthesia impact us differently, and navigating a temporarily disabling event while also celebrating gender euphoria is a lot to do for one single body. That’s why they asked you to be there: they’ll need love, support, and compassion to have a smooth recovery. That’s why I’m asking you to identify other people to support you: you’ll need the places to vent and circle back to compassion and humor, if possible.

There will be moments of fun and euphoria, but also there may be moments of pain and grief. Let your friend feel their feelings and refer back to your pre-surgery conversations: What will make them feel supported in the moment? Give them space if that’s what they need, distract them if they’d rather space out, or hold them tight if that’s what they want.
You know your friend best: are they acting in ways that are out of character? Are they quieter than usual? Lead with curiosity. Check in with them gently, explore whether they have needs they haven’t been able to identify on their own under the fog of painkillers / after anesthesia.

Patience patience patience: your friend may be totally out of sorts, disoriented or having a hard time regulating feelings.

Check in with them and with yourself. Identify someone that can be there FOR YOU if anything goes sideways or becomes activating and you need to be set back on course. You cannot expect your surgery recovering friend to be the person to co-regulate with you right now.

Be available when you said you’d be. If something changes, communicate it to your friend and help them find backup support if needed.

Loop back to the things you know help your friend feel loved and cared for: are they food oriented? Ask them if they have a craving. Do they like physical touch? Offer to play with their hair before you head out for the day / your shift with them is over.

Here’s What You Can Do If You’re Part of the Support Network:

The support network is a vital part of the recovery team! Here is a task list I put together for my team: Surgery Support Template. Consider adapting it for your own needs. Here are things to consider when offering help as a member of the support network.

1. Find the tasks that make you the happiest and/or bother you the least. If there are no tasks that do either of these things for you, reach out to your friend with offers: do you need to have someone on call? Would you like quiet company? Yes or no questions are golden because they make it easier for your friend to a) have some sense of autonomy and control while they recover, and b) make decisions without having to fabricate solutions out of thin air.

2. Look into the tasks and find the ones unaccounted for. Great questions to ask: Who is helping you vacuum? Does your pet have enough food? Would coming in to tidy around the house help?

3. Check in with them even after the timeline listed in the sign up sheet. I had friends offer to complete tasks for weeks after I had asked for help and it made a world of difference. Even if I said no, because I didn’t need that specific kind of help anymore, it helped me feel connected and loved while I navigated the world in my brand new body.

4. If you are seeing your loved one in person at all, make sure to check-in about COVID protocols. Offer to test before seeing them and/or ask if they would like you to be masked while you visit them. Basically, anything that takes the onus off of them to ask will be helpful.

How to Provide Care If You Are Far Away?

Send your friend things. You can make them something physical (I got cards that are still on my fridge and make my day everyday), you can make them something virtual (like a little video wishing them a speedy recovery), or you can order take-out and groceries for them. If they are the talkative type, then giving them a call once in a while will go a long way. If they are your quiet friend, sending them a voice memo with no expectation of reply may hit the spot.

What If You Have No Capacity?

Send them love. If you are not trans, read about trans lives and stories — it’ll make a difference, even if they don’t know it.

Question Your Own Internalized Transphobia:

It’s helpful to remember to interrogate your own internalized transphobia no matter the kind of support you are able to offer. Notice if you find yourself questioning why your friend is choosing this procedure or when it is happening or how it is happening. These questions may come from genuine concern, but if there is judgment attached to them then that concern may be very well rooted in transphobia — the belief we (trans people) don’t know what is best for us, cannot choose for ourselves. Support your loved one through the inevitable stress of surgery by reminding them they know what is best for themself -and if they are in doubt, you can be there to troubleshoot.

What If After All This Preparation, Conflict Still Occurs:

Give it time. I didn’t feel like myself fully until about a month or so after surgery. If there are things that are time-sensitive, you can try to discuss them, just remember your loved one will still be in recovery mode and most likely lost in a haze of feelings. Their best self may be shaky, to say the least. If it can wait, give them time, a month or longer. Odds are that your friend will be as invested as you in addressing any conflict that may have come up, but won’t have full capacity to do so until the deepest part of recovery is behind them. Give them grace while they re-orient themselves to the world, their new body, and sense of self. If your goal is repair, set both of yourselves up for success by waiting.

Ultimately, communication, humor, and compassion will be key. I was lucky to be showered in care via intentional check-ins, texts, drop-bys, and calls. Most of my people (and new to being my people) showed up. Some others had things come up, plans changed, availability changed, and I still felt loved by how they communicated it to me and helped me troubleshoot (when possible). You don’t have to be perfect, but you will have to be brave and kind. Be brave in naming your limits, be kind in tolerating your friend when they are on your last nerve asking for just one more cup of jell-o, pleeeeease. I think you can do it. I think you’ll do great.


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Araguaney R. Da Silva

Araguaney R. Da Silva is a Venezuelan writer, interpreter, translator and facilitator living with their small dog and about fifty-seven houseplants in Portland, OR.

Araguaney has written 1 article for us.

23 Comments

  1. Thanks for writing this super extensive overview! I love how much room and attention there is for people deciding NOT to help, because doing things you don’t want to do doesn’t really help anyone in the long run.

  2. Thanks for this thorough and thoughtful article! I definitely didn’t think enough about the emotional dynamics of the people I asked to care for me after surgery, and it made the whole experience pretty stressful for everyone.

    • Thank you for reading it! And your experience is v relatable. I was honestly shocked by how many of us have found ourselves in that situation, but at the same time it makes sense? There are just SO many things for us to keep track of before surgery -it’s hard to take care of it all on your own. Here’s to more guides of all kinds <3

  3. I really love this article, thank you for writing it! The only sticking point for me is that of course realizing you don’t have the capacity to help is totally ok, but pulling out the day (or week, honestly) before surgery because of that realization (rather than a change of circumstances outside your control) doesn’t feel ok. Before deciding to be a caregiver for a procedure, a chosen family member needs to check in with themself about their emotional capacity to do so well in advance, since these procedures + insurance approvals need to be planned months in advance. I agree that we do need to care for ourselves first and foremost, but I think it’s also important to be mindful enough about our capacities when we make these agreements to begin with so we can honor our commitments to our loved from when they are in need.

    • Thank you, Andy! I also I’m in complete agreement with you. I think pulling out last minute would ideally never happen, and I also think that given the choice some of us would prefer have friends pull out last minute than provide care reluctantly / out of obligation. That kind of care doesn’t feel good or like care at all, to me.

      Your comment makes me think of another option, though: perhaps giving people a timeline would be helpful. Like, I communicated and named that people on my care team could pull out literally up to the second we boarded the plane (I had to travel for my surgery) but maybe you draw the line at a week before surgery, and maybe others draw it earlier. Maybe adding that to the pre-surgery check-ins would help.

      • I think communicating a timeline of when people can opt out is a really great idea and is customizable to the situation. And that’s something that definitely depends on the type of surgery/whether travel is involved/etc.

  4. Thank you so much for this! This is a vision of the kind of community care I’d like to cultivate in my life, too. It’s all the more important because I just booked a surgery consult and I’m looking forward to a very interesting 2023!

    Wishing you continued healing, recovery, and much care from your people!

  5. Yessss I love this. Especially the questions to consider before opting in.
    Surgery recovery support has been doable but intense for my husband and I – what has helped both of us a lot is to try to rest together and eat together as much as possible so that I don’t burn myself out, and he doesn’t stress about whether I’m burnt out.

  6. Wait, what? PASS on making time for an intimate loved one when they’re going through a once-in-a-lifetime surgery? You are not a burden! Your people love you and are excited to support you. If this article doesn’t resonate with you, it’s okay. This is clearly one specific person’s experience.

    If you’re looking for a detailed, compassionate, informative, and thoughtful guide to top surgery for caregivers, I recommend “Like a barrier lifted:the top surgery caregivers support zine” by Quinn Rivenburgh. https://drive.google.com/file/d/1gAaEo1c1u0XitzjxCiqVtdfPp8vC7NvA/view

    • Thank you for linking this zine! I just read it and thought it was very helpful. It also included a section on “consenting to be a caregiver” as well as a section on “caregiver burnout”, which I thought both addressed similar things to this guide’s “PASS” section – namely the need to really check in with yourself before you make a commitment to help, to take care of yourself and not take on more than you can chew.

      I understand why one might have a strong negative reaction to this section but I would like to offer my perspective on why I really appreciated it. In my life, due to difficult family situations and then a lot of death, I have often been put in positions of needing care. I’m also the person in my relationship who gets sick more often. In the past, sometimes people have “felt like they had to” do a lot of things, and it led to resentment, burnout, and me feeling like a massive burden! Nowadays we are all older and wiser and we make sure to check in with ourselves and each other about what things we are actually willing to do, and I don’t feel like a burden anymore even if I am going through cycle 16362738 of grief or yet another cold that knocks me on my ass, causing me to need a lot of grace, patience, and care.

      Reading the “PASS” section did not, to me, raise worries that people might feel like a burden, but rather made me happy, as I know how awful it feels (and how much of a strain it puts on relationships) to be cared for reluctantly, or at the expense of the caregiver’s wellbeing. I just wanted to offer this perspective in case it was helpful.

  7. This article is great!! I supported my gf through 3(!!) surgeries of different intensities a couple of years ago, and while I did most of what’s suggested in this article, having it laid out and written down would have been really helpful.

    One small fun thing we did during recovery for the biggest surgery was, we watched all the Marvel movies over the course of like a week. I had never seen them before and they’re fun and not that complicated so kinda perfect for this scenario, imo.

  8. Hm. This amount of conflict hypervigilance is really not the norm and positioning this as a “how to” guide instead of what feels pretty transparently like experience processing is a weird approach and might even be potentially harmful to our community seeking resources. I did appreciate the references to other guides.
    Autostraddle, do you have other guides to supplement this take, or do you have editing powers to clarify about how this is just one approach among many?

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