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Page 12 of 20 Kant et al. Plast Aesthet Res. 2026;13:4

paradoxical responses to common medications can trigger a range of surprising reactions. As medication is
typically the front-line treatment for psychosis, all clinical staff should be aware of any existing as-needed
(PRN) prescriptions for anti-psychotics.

The same is true for anxiolytics, which may also be indicated for syncopal reactions mediated by stress .
[89]
Discussing PRN medications ahead of surgery appears to anecdotally increase patient willingness to take them when
indicated, especially if conversations are led by a behavioral health provider with whom the patient is already
familiar. Syncopal reactions may impact a patient’s ability to participate in necessary postoperative care, such
as dilation or wound care. Patients who have used avoidance strategies previously should be counseled that
this mechanism for anxiety avoidance is likely not possible through the entire perioperative course.
Alternative strategies should be provided, such as gradual desensitization or exposure, if possible.

PREPARING PATIENTS FOR THE HOSPITAL
While not universal, individuals seeking gender-affirming surgery may be in early adulthood and may have
never undergone a surgical procedure before. It may be their first experience with anesthesia or an overnight
hospital stay. Although much attention in both lay and clinical literature focuses on either approving a
patient for surgery or caring for them longitudinally post-operative, for many, the most challenging period
is often the immediate week(s) following the procedure, during which they are partially immobilized and
experience substantial discomfort .
[15]

Helping patients anticipate the environment in which they will be recovering, including challenges reported
by others, can help future patients prepare to manage their experiences and communicate specific needs they
may have during recovery. For example, research indicates that the sensory experience of being surrounded
by the sounds of hospital machines can have a deleterious effect on patients’ mental health, blood pressure,
and sleep quality, and by extension, surgical recovery [90,91] . Patients who are sensitive to sound (e.g.,
misophonia, autism spectrum disorders, certain anxiety disorders) may wish to consider bringing sensory
tools such as noise-canceling headphones or earplugs. The same is true for patients with textural or olfactory
needs. These can be used to form the basis of grounding exercises for patients who experience significant
anxiety or overstimulation while inpatient, and are easy to communicate to other providers beyond the
behavioral health team.

COMPLEX EMOTIONS IN THE PERIOPERATIVE PERIOD
Patients who have undergone a gender affirming surgery commonly experience contradictory emotions.
They may feel simultaneously thrilled about having undergone the surgery that they have been waiting for
and disconcerted as they realize both that this has not fixed everything in their lives and that they may have
completed all the “steps” they were planning in their transition. Patients may struggle to navigate this
dialectic and become concerned that they are not only excited and happy about having undergone surgery.

While ideally, the reality and normality of complex emotions after surgery are discussed with patients prior
to the procedure, these are areas that a behavioral health provider is well-suited to address. Genital
affirmation is, for many transgender and gender diverse people, the final formal step in their transition, and
they may feel lost without having a plan for what is next. It can be helpful to strategize about other areas of
life that patients want to work on. It is also important to discuss how a person’s gender journey, exploration,
and growth can continue throughout life as they learn how to live and be in their affirmed body - both alone
and in relationship to others.