How Undergoing Gender-Affirming Surgery Changed the Way I Approach Standalone Sessions for Surgery Letter Writing

Before I underwent my own gender-affirming surgery, I felt pretty resolute in the way I approached standalone sessions for letters of support. My framework was grounded in informed consent, clinical ethics, and the World Professional Association for Transgender Health (WPATH) standards of care. I took that responsibility seriously, as I still do.

 At the time, though, my focus was largely on readiness for surgery itself: whether someone had the capacity to make an informed decision, whether their gender dysphoria was consistent and persistent, and whether any co-occurring mental health concerns were being managed well enough that they wouldn’t interfere with surgical outcomes. I assessed understanding of risks, benefits, and expectations, and we talked about how surgery might help alleviate distress that other interventions hadn’t meaningfully resolved.

What I didn’t fully understand yet was how much the recovery process itself can shape someone’s experience emotionally, psychologically, and relationally.

What Surgery Recovery Taught Me

Undergoing top surgery and recovery changed my clinical lens in ways I couldn’t have fully anticipated beforehand.

Recovery is not just a waiting period between surgery and relief. It’s a time of intense bodily awareness, vulnerability, dependence, uncertainty, and emotional fluctuation. Even when surgery is unquestionably affirming (it was, and is), recovery can be physically uncomfortable, sensorily overwhelming, and psychologically destabilizing at times.

I learned firsthand that body image can temporarily feel worse before it feels better. Unfamiliar sensations can trigger many types of anxiety. Relying on, and needing others.. especially others who have gone through the process, can be surprisingly hard. The whole gamut of emotions shows up: excitement, anticipation, grief, fear, doubt, relief, all coexist sometimes within the same day.

What became clear to me was this: I had been evaluating readiness for surgery, but not always readiness for recovery.

How This Shifted My Standalone Sessions

As a result, my approach to standalone sessions for gender-affirming care has become more holistic and recovery-informed, not more restrictive.

I strongly believe that trans people deserve access to the care they need. This shift is not about being more “gatekeepy,” more cautious about writing letters, or raising the bar in ways that block access. It is about making sure people are supported through the entire arc of the experience, not just the end result.

In sessions now, I still assess informed consent and decision-making capacity. But I also spend more time exploring how surgery recovery may intersect with a person’s broader mental health history, nervous system, and lived experience. I would suggest other clinicians who understand this work do as well.

Some of the areas I pay closer attention to include:

·       History of eating disorders or body-based coping strategies

·       Past or current substance use concerns

·       Experiences with severe or recurrent depression

·       Neurodivergence, particularly autism and sensory sensitivity

·       OCD, health anxiety, or compulsive body checking

·       Medical trauma or fear related to bodily uncertainty

·       How someone typically responds when their body feels unfamiliar or out of control

To be clear, none of these automatically disqualify someone from surgery. They are not red flags in and of themselves. Instead, they provide important context for understanding how recovery might feel and what kinds of support could make it more manageable.

Recovery Is a Mental Health Experience, Too

Another shift for me has been how I think about aftercare planning.

In the past, aftercare discussions often centered on logistics: stable housing, time off work, and basic physical support. Those things matter but they’re not the whole picture.

Now, I also want to know:

·       Who will you talk to when emotions spike or doubts creep in?

·       What support do you have if old patterns resurface under stress?

·       How do you usually cope with pain, limitation, or dependence on others?

·       Do you have access to ongoing mental health support during recovery?

·       What would help you feel less alone if recovery feels harder than expected?

A Clarification About Access and Autonomy

To drive the point home: this evolution in my practice has not made me more hesitant to write letters of support, even in just one session. I remain deeply committed to gender-affirming care and to respecting clients’ autonomy. What has changed is my belief that informed consent should include honest, compassionate conversations about recovery not just outcomes. Supporting access also means supporting sustainability, resilience, and care beyond the operating room.

Standalone sessions can still be brief. They can still be focused. But they can also hold space for nuance, preparation, and care planning that acknowledges the reality of recovery not just the hope of relief. To me, that’s informed care.

By the way, if you are a clinician who wants to become more knowledgeable in this area, let’s chat.