Post-Op MtF Depression, You’re Not Alone

If you are an MtF patient with postoperative depression after facial feminization surgery, you are not alone. Fortunately, you can find resources and assistance on the topic easily nowadays. 

More professionals are now trained in trauma-informed care to help facial feminization patients manage the postoperative depression phase after FFS surgery. Similar to postpartum depression, postoperative depression subsides in time. 

The good news is that the depressive feelings are usually replaced with an improved quality of life, as shown in scientific literature conducted by our team and other researchers. Your quality of life is even more important given the elevated incidence of depression for trans people. 

For this reason, we will also offer tips to prevent gender dysphoria and navigate those low feelings during the facial feminization healing process. But first, let’s define what postoperative depression is and differentiate it from the typical post-op blues in this post. 

What is a Post FFS Depression?

It’s easy to forget about your mental health quality when facing life-changing experiences such as FFS surgery. Fluctuations in emotions are a normal part of the process of facial feminization surgery. 

However, postoperative depression involves a deep feeling of sadness, apathy, lack of energy, social isolation, loss of appetite, and difficulty in enjoying things you used to love. For transgender patients assigned male at birth, developing depression may occur after the mtf surgery for no apparent reason. However, triggers such as stress and chronic pain are prevalent.

These types of depressed feelings affect people with a history of risk factors, like emotional difficulty or gender identity-related anxiety or depression.  Consequently, the majority of trans people are susceptible during the recovery process. The postoperative period is an emotionally vulnerable time when you are more prone to feeling down or as if you’re not capable of handling the situation. 

Although it is not normally required to suspend HRT, some patients are asked to change the gender affirming hormone therapy routine, which also may cause a temporary flux in levels that affects mental health and quality of life for a period. 

Post-Op Depression vs. Postop Blues

We should also distinguish between postoperative depression and a low mood. 

Marked depressive symptoms are not so common and may require some professional guidance by a mental health professional. Yet postop blues are quite frequent in the days after surgery given the disruptions in the body’s rhythms due to jet lag, fasting, not to mention medications and anesthesia.

Patients usually feel particularly low during two specific moments: when they are discharged from the hospital and the “anti-climax” when they return home after the healing retreat in Marbella.

Hospital Discharge Blues

When discharged from the hospital after FFS surgery, you’ll probably feel exhausted, still be swollen, probably be hungry but can’t eat properly, and might be dealing with irregular bodily functions as well as a series of other physical factors. That’s enough to make anyone irritable!

The sum of these temporary symptoms boils down to feeling tired physically and, therefore, emotionally down. But this usually dissipates after a few days when you begin to get over the medication “hangover” and regain strength.

Back-to-Work Blues

You’ll likely experience another lowering of spirits, which is not depression, at the time of returning home. Heading back is a sign that this whole process, that’s consumed your life up to now, has suddenly come to a close. It has all finished, and now, having to focus on cultivating patience and healing is a bit of an anti-climax. 

It can be a bit frustrating during these early days, when you inevitably seek the final results of the surgery at a time when they cannot yet be seen. At this moment a void may appear in your life because you have been focused on the surgery for months, organizing a million details, imagining how everything would be. 

When your FFS visit is practically over, you’re likely having a lovely time, and the postop euphoria dissipates as reality and responsibilities near.  If you do not have pre-scheduled activities or a plan to occupy your mind before going back home and to work, it is easy for negative thoughts to take over. 

Prevent a Post FFS Surgery Depression 

We believe it is beneficial to plan a few activities you enjoy after surgery. Something you look forward to with enthusiasm which you may focus on once the objective of FFS surgery is complete. For example, think about how you will spend each day, perhaps a new book you’ve been wanting to start, small trips, a course or beginning an exciting project at work. 

We advise spending your time on as many things that make you feel good as you can.

Try thinking about this in the month before the surgery. Jot down on small notes all those activities that make you feel good. Be it going to the movies, setting up a virtual tea time with friends, making a call to a special someone, learning a new drawing technique, or listening to a favorite music or podcast, give one a go already to get in the habit. 

Keep those notes of paper in a jar that you can call “emotional vitamins.” If one day, after returning home from the operation, you don’t feel like thinking about what to do, just grab a random piece of paper and let yourself be surprised by your own ideas.

Also, feeling part of a larger tribe is really more important than we realize. You may not want to socialize at first perhaps, but joining face-to-face support groups helps people feel solidarity with others, an important element of mental health.

Manage your Mental Health Around a Surgery Experience

We hope these tips help you learn more about potential anxiety before FFS surgery as well as manage depression after facial feminization. Also, we hope to help friends and family understand more about the facial feminization process and how to keep an eye out for what may be a sign of depression.

Mindfulness and relaxation services, such as acupuncture, lymphatic massage, or yoga-style physical therapy have been medically reviewed to help relieve emotions after your ffs surgery. Also, a healthy diet and lifestyle is important in the long term as the base for caring for your mental health.

These recommendations are for informational purposes only. Please ask your family doctor for medical advice and your health insurance coverage if any resources are available in this area of healthcare. Finally, patients report how being positive affects their emotional wellbeing, so it is well worth the investment of time for a little self-care and body positivity.

Statistics of depression among trans identities

Depression is a mood disorder marked by intense feelings of sadness, apathy and a lack of interest in anything. A 2021 Study in Australia emphasizes how factors such as barriers to care, victimization, and cis-sexism place undue stress on trans people that can lead to depression.

In the Trevor Project’s U.S. -based survey of over 34,000 respondents, more than half of transgender and non-binary youth have seriously considered suicide. Furthermore, 29% of these have actually made at least one attempt.

Other science explains the how and why depression is so common among trans people:

  • 2015 study reported that transgender youth are two to three times more at risk of mental health needs,.
  • 2018 paper found that transgender people were 4 times more likely to suffer depression.
  • The 2019 Trevor Project National Survey adds that more than 2 in 3 transgender and nonbinary youth report symptoms of major depressive disorder.
  • In 2020, Transgender youth face further health disparities, as they are twice as likely to experience depressive symptoms, seriously consider suicide, and attempt suicide compared to cisgender lesbian, gay, bisexual, queer, and questioning youth.

Depression rates among LGBTIQA+ people is higher than average and in some cases coincides with drug dependency issues. This article is not meant to replace expert medical attention. Please seek help from the appropriate professionals if struggling with mental health or substance abuse.

Patient Relations Manager Lilia Koss, presentator of Lilia's Livestreams
About the author

Hello world! I’m Lilia Koss and I use she, her, and they pronouns. What are yours? With a background in humanities and diverse professional experiences, I have been working with the Facialteam founders and directors since 2008. Involved from the ground up, so I’ve had hands in many pots: patient coordination, orientation events on 3 continents, social media, written and audiovisual content about our gender-affirming healthcare...but now life is more defined. Lately, I focus my energies on Public Relations, community management and live streaming to help raise the visibility of trans health. Life is pretty complete.