What is PREhab for Transgender Surgery? PT Expert Explains

Thanks to Dr. Sarah Ecker, pelvic health physical therapist, for contributing this article on the importance of preparing – physically and mentally – for gender-affirming surgery. This article is the first of two parts.

Usually, when we think of having a surgery, we think about what it will mean to recover from it. How long will it take? How will I feel? Will there be a lot of pain? When can I get back to my normal activities?

Less often, we think about how can we prepare for the surgery. Sure, we plan to take some time off work, maybe re-arrange our living space to be more accommodating, schedule help from friends or family to help with meals and errands, and stock up on any supplies we may need for recovery (ice packs, bandages, medications, etc.).

But what about preparing our body for surgery? What does our body need prior to surgery?

The answer: PREhab! a.k.a. rehabilitation prior to undergoing a planned surgical event.

What we know about PREhab

Research shows that prehab can enhance general health and wellbeing, improve mindset, and even optimize surgical outcomes. By specifically training our bodies for surgery – both physically and mentally – we can anticipate an improved post-surgical recovery.

Think of it like this: You want to run a marathon. Do you sign up for the one happening next week? Yeah, sure, no problem … I’ll go ahead and put down the ice cream, get off the couch, and demand 26.2 miles of RUNNING from my couch potato bod in just a few days. I don’t think so. Many marathoners train for A YEAR prior to a race. Why? Because you need to make sure that you have the proper strength and endurance … that any previous injuries have healed and you’re able to easily address minor aches and pains that come up during training … that your diet and fluid intake are right … your sleep is solid … your stress is managed … and you’ve gotta train your brain to not throw in the towel on mile 24 … because guess what? You’re nearly there! You’ve trained for this!

The same is true for preparing for gender-affirming surgery. Whether you are having a top or bottom surgery, these are physically demanding procedures. Being in tune with your body prior to these surgeries can also be incredibly mentally demanding because of stress, anxiety, depression, and body dysphoria. However, if you can take some time (ideally 3 to 6 months prior to your surgery) to work with a physical therapist who specializes in pelvic health/LGBTQ+ health, you can feel beyond confident that you are well-prepared (“trained up!”) for your surgery.

What would a physical therapist have me do for PREhab?

First, your PT will listen to you. Before assessing your posture or strength or even talking about your pecs (top surgery) or pelvic floor (bottom surgery), it’s important for your therapist to know about your general health history and activity level. Anything you want your PT to know about your body, your health history, or your personal goals is important. Don’t leave anything out!

Then, your PT will explain how the examination will go, give you options according to your comfort level, and talk you through different movement, strength, and tissue assessments (tissue could mean skin, muscles, or joints). Any deficits will be noted, and you and your PT will come up with a plan together to address them.