Diet After Sex Change Surgery
Few people understand just how important diet and nutrition are in conjunction with sex-change surgery and hormone replacement therapy. The transgender community often experiences reduced nutrition compared to other communities, and the reason for this is still somewhat unclear. Nonetheless, for transgender individuals who are on hormone therapy and will receive sex reassignment surgery, nutrition is actually essential.
While we mainly use the term « sex change surgery » in this article, these instructions can also apply to any kind of gender affirmation surgery. Even things like facial feminization surgery or plastic surgery unrelated to gender identity can benefit from these suggestions. Also, remember that a sex change operation does not only mean female to male or male to female surgery. It also includes procedures that enhance gender non-binary attributes.
Post Op Care
Post-operative care instructions are often provided by a surgeon but not always followed by a patient. This can lead to increased pain and complications that can result in patients having to return to the hospital. Part of post-operative care might involve the help of a family member as movement can be restricted, like in the case of top surgery.
Other post-operative care might involve how often a dressing needs to be changed, substituting a shower for a need to sponge bathe the patient instead. In most cases, the initial recovery is the hardest, and great improvement is noted by the end of the first week. Within two weeks after the procedure, most patients will be able to resume their own care without help.
Overall Health and Healing From Surgery
Before we look specifically at transgender health issues, we have to cover general health and healing. The underpinning of gender reassignment surgery is that it is major surgery. Any major surgery holds risks. There are some of these risks that are pretty standard for everyone.
A body that is in homeostasis (balance) will naturally heal faster and more effectively than one that is not. Therefore, a healthy weight, stable hormone levels, a good diet, healthy habits, etc., will count in your favor when healing from major surgery.
An overweight patient is at greater risk of hormone and insulin instability. There is also diminished blood flow to the skin and extremities and greater pressure on blood vessels. All of this means an increased risk of post operative infection.
This is another reason why patients are advised to quit smoking before major surgery. It increases blood pressure and decreases blood flow which increases the risk for infection and increases the time it takes to heal.
Alcohol contains a lot of sugar, on top of being overall unhealthy. It thins the blood and destabilizes insulin and cortisol levels. Any surgical plan will involve decreased smoking and alcohol intake. In rare cases, a surgeon’s instructions might include losing weight. In such an incidence, it is not about how you your physical appearance but rather that weight loss will decrease the risks involved in major surgery.
A few weeks prior to a procedure, it is good to check in with your insurance company to make sure what kind of treatments your insurance will cover. Include recovery options and durations of hospital stay in your discussion with them in case you require additional treatments unexpectedly during your recovery. Knowing beforehand what your insurance covers and what it does not will reduce your stress levels should complications arise.
Gender Reassignment Surgery and Body Mass Index
Now that we have discussed general health risks associated with major surgery, we need to break away into transgender health specifically. Sex reassignment surgery often goes hand in hand with hormone therapy, which can impact a person’s weight. Any changes in hormone levels will have temporary effects on weight.
Most surgeons require a patient to have been on hormone therapy for at least one year prior to the surgery date, even if the World Professional Association for Transgender Health does not specify. This is simply to ensure the best possible outcome for your sex change operation because of how long it takes for your system to adjust entirely to the hormone changes. Attempting surgery too soon can result in unexpected post-operative changes, and it might also interfere with weight around the time of the surgery date.
Sex change surgery, like other major surgeries, can be quite a shock on the body, so it is important to allow your body the space and time it needs to adjust to procedures like facial feminization surgery or breast augmentation, or other kinds of gender reassignment surgeries. While these will certainly help you to feel comfortable in your body, it is a major change and can, in some cases, have unforeseen difficulties. While this should not deter you from pursuing sex-change surgery, it should encourage you to be more conscientious about possible adverse outcomes.
Food Intake and Nutrition
A balanced diet consists of protein, fats, and carbohydrates at varying levels; things like salt should be limited.
Protein is commonly found in things like tofu, eggs, seeds, fish, and meat. While the protein recommendation for transgender individuals is the same as cisgender individuals (for example, a transman should eat the same way a cisman would if they have standard testosterone levels), if you are trying to build muscle or lose fat, you could benefit from a diet slightly higher in protein. Healthy protein levels also help to sustain weight.
Extensive consumption of protein often leads to kidney problems, so if you are using protein shakes and other supplements, you should adjust your protein intake accordingly. All things in moderation are good advice for a higher protein diet.
Fat is also essential to a healthy diet. Generally speaking, we have good fats and bad fats. Bad fats are things like animal fats and oils; good fats can be found in fish, nuts, seeds, and avocados or pure olive oils.
Interestingly hormones are made of fats, so control of the fats that you consume can have an extremely positive effect on hormone balances. A healthy intake of good fats also helps with stress because it coats your neurons and controls cortisol levels.
In any circumstance, it is best to look for food that is closest to its natural form. Highly processed foods lose their nutritional value. While good fats are necessary for your diet, bad fats (saturated fats) lead to health conditions like cholesterol and high triglycerides in the blood.
Carbohydrates are basically starches and sugars that the body can break down into glucose. Things like pasta, rice, potatoes, sugars, and certain grains are carbohydrates. Diets that are high in carbohydrates make it harder to lose fat because your metabolism will use these foods for energy before it will start using fat.
Carbs will raise your blood sugar as well, and this will encourage your body to store fat rather than burning it. Furthermore, a rise in insulin causes a rise in cortisol which increases stress and anxiety. Such processes also lower testosterone levels.
That being said, carbs are still an essential part of a balanced diet. Try to stick to healthier versions, whole grains, and starchy vegetables rather than sugars and highly refined grains.
Other considerations would include choosing unprocessed foods above processed options. Fresh fruits and veg are very important as well. Refined sugars are also not ideal for a balanced diet. Fiber is extremely important in a balanced diet. What we eat can have a major impact on our skin and the rest of our body, so a nutritious and healthy diet is far more important in the recovery from sex-change surgery than most people realize.
Controlling Hormone levels through diet
To lower testosterone:
Try to get protein from plant-based products like seeds or nuts, and things like eggs, while avoiding too much meat. It is not necessary to cut meat out completely, but lowering meat intake will help.
Reduce intake of saturated fats, deep-frying, and highly processed things. Try to increase your soy intake and try to eat natural and organic food.
To lower Estrogen:
Higher intake of vegetables high in fiber. Eat more flaxseed. Focus on organic food, reduce caffeine and stay away from processed food. A higher intake of sulfur in food like seeds, fish, nuts, and eggs can also be beneficial.
Hormone changes and imbalances while you are adjusting to hormone treatments can cause weight fluctuation and skin issues. This should level out once your body adjusts to the new hormone levels.
Breakdown of Diet after undergoing sex-change surgery
Your first two or three meals following surgery should preferably be liquid.
The first few weeks after surgery should include lots of high-fiber vegetables, fruits, and grains. Meat can be consumed, but as far as possible, cheese should be excluded.
Furthermore, a low sodium diet is advised following surgery because sodium leads to water retention. Patients should preferably also cut out alcohol intake completely, or at least limit it extremely following surgery.
If you are taking medications, then you should try to take your prescriptions with things like apple cause or yogurt. Such things coat your stomach and help to protect your stomach lining from harsh medicine.
Fresh fruits and veggies can be great. Some fruits can even help reduce swelling, like papaya or pineapple. High-fiber fruits like prunes are also a good snack option. Colder meals can help to reduce inflammation, so snack on things like frozen dessert bars (preferably fruity ones as opposed to ice cream-based). Low sodium soups can also help with swelling and pain.
It is important to maintain good hydration, so drink fruit and veggie juices and lots of water.
These should be consumed moderately. While they are good for healing and consumption can be increased slightly during the healing period, consuming anything in excess can be quite bad for you.
A Note on Medications and Supplements
Some medications can thin the blood, which increases bleeding and should thus be avoided from at least two weeks before surgery: aspirin and ibuprofen. Also, wait for at least one to two weeks after surgery before resuming these medications.
Things like ginger and ginkgo Biloba or things like turmeric can be great to fight inflammation and increase overall health. Be careful with things like St John’s Wart, which is often included on this list. It can interfere catastrophically with certain antidepressant medications.
Bring it to your doctor’s attention if you are taking any medicine specifically designed for period pain or arthritis, as these can be dangerous in surgical situations. There are also some vitamins, for example, fish oil, garlic, and vitamin E, that should be stopped at least two weeks before surgery and a week after surgery. Also, things like medication for cholesterol need to be stopped.
It is absolutely essential that you notify your doctor of every last medication and supplement that you take, even if you only take them occasionally. They will be able to give you detailed information on what you can take and what you cannot. They might even give you a list of all medications that should be avoided.
Food to avoid as far as possible
Canned food that is not marked as « low sodium », also canned fruits in syrup. Processed cheese, meats, and grains need to be avoided in general, not only for the few weeks following sex-change surgery. Ready-made meals are often not as healthy as home-cooked meals, but there are some healthy options in some parts of the world. Some types of salad dressing can be high in animal fats and other unhealthy fats or even sodium. Pickled meats and veggies are high in sodium. White breads and pastas are high in carbohydrates. Alcohol and sugary foods also have dire consequences for blood flow, sugar levels, insulin, etc.
Frequently Asked Questions about Sex Change Surgery
How long does it take to heal from sex-change surgery?
There are various times specific to the type of sex-change surgery you will have. However, generally speaking, the first few days after surgery are the hardest. They are most painful, and there can be movement restrictions. Dressing must be changed regularly, and wounds are still fresh.
Within a week, surgical drains are removed, which greatly improves pain levels and makes it easier for the patient to move around. Within two weeks after a procedure, a patient will likely feel fine for the most part and should be back at work and resuming light exercise.
Some unexpected surgical side effects like infection can delay recovery, might result in a patient having to return to the hospital, or, in extreme cases, can lead to another procedure, but such severe side effects are rare.
There are considerations to be made related to some forms of sex-change surgery. For example, trans women who want to receive breast augmentation for their gender identity affirmation might be required to take hormones for at least a year prior to surgery in order to allow HRT-related changes to settle.
Any sex change operation that is done on a part of the body that was often bound is slightly riskier because binding has a negative impact on the integrity of the skin in that area, which can result in longer recovery times or even greater scarring.
Must I have sex-change surgery to treat gender dysphoria?
Sex change surgery is a common treatment for gender dysphoria, but it is not compulsory. There are so many steps that you take to help your gender identity that some trans people never feel the need to go as far as undergoing a sex change operation.
Transgender health demands that gender identity be treated on a case-by-case basis to ensure that each patient receives the care that they need. It also stipulates that procedures that can be seen as plastic surgery for cisgender individuals can actually be a medically necessary procedure for trans people.
Is facial feminization surgery painful?
Surprisingly it is considered a less painful procedure than most people expect. Any sex change operation will involve some post-operative pain, as will be the case with any surgery. It is important to discuss pain management with your surgeon. You need to know what medications you can take and what other steps you can take to manage discomfort. Your surgeon will be able to help you with this.
How long will I stay in hospital after a sex change surgery?
The length of your hospital stay will depend on the type of surgery that you will be undergoing. Highly complex surgery or something that cuts through bone might involve a longer hospital stay than a smaller procedure that involves only soft tissue.
Your hospital might have different rules about the length of your hospital stay than another hospital might. And furthermore, your insurance company might have limits on the length of hospital stay according to different surgeries.
Depending on how your surgery goes, your surgeon might recommend a longer hospital stay than you initially expected. This might also be the case if your skin is somehow compromised, maybe due to extensive binding, etc.
Hospital care means that the surgeon can closely monitor your progress and can deal with any side effects of the surgery much quicker, but overall the goal will be to get you released from the hospital sooner rather than later to free up a bed for another patient and to get you mobilized and adjusting to your new life as soon as possible. As with all things, balance is important.