Caregiver Guide

By Nick Peplow·Gender-affirming surgery coordinator

Last reviewed 27 September 2026· How this site is researched

This page is for the person doing the looking after: partner, parent, friend, housemate. You do not need medical training. You need to be there, be practical, and know when to pick up the phone. Of the carers I have worked alongside, the ones who cope best write things down: doses, times, drain output, questions for the next call.

What you are signing up for

The clinic will give you its own expectations. Roughly, what I see:

• Top surgery. Heavy help for 3–5 days, useful help for two weeks. They cannot lift or reach above shoulder height, so you dress them, wash their hair, and get things off high shelves. With double incision there are usually drains for about a week.
• Hysterectomy. Often home the same day or after one night. A few days of real help, then lighter support for two or three weeks. No heavy lifting for several weeks, which means you do the shopping and the laundry.
• Metoidioplasty. One to three nights in hospital, then two to three weeks of significant help. With urethral lengthening they come home with a catheter and leg bag for two to four weeks, and you will be emptying it.
• Phalloplasty. The big one. Stage one usually means five to seven nights in hospital, then weeks of heavy help, with a catheter for three to four weeks if the urethra was lengthened and a donor site, often a splinted forearm or a stiff thigh, that makes them partly one-handed or slow on their feet.
• Facial surgery. About a week of help with swelling, soft food and sleeping propped up. After forehead work the swelling can close the eyes for a few days, so they may need guiding around the house.

Talk beforehand about what they expect and what you can give. If you cannot take two weeks off, say so now. Arranging a second person for the second week is easier before surgery than halfway through the first.

Before surgery

• Read the surgeon's post-op instructions yourself. On day one they will be foggy from anaesthetic and you will be the one remembering.
• Save the clinic's daytime and out-of-hours numbers in your phone, and write them on paper by the bed.
• Go through the pre-op checklist and packing list together and agree which jobs are yours: usually the recovery spot (a bed or recliner they can get out of without using their arms), the food shopping and the lift home. They will not be allowed to leave hospital alone.

If you are going with them to a surgeon in another city or country, the trip adds its own jobs; travelling for surgery covers them.

At discharge

This is the most useful half-hour you will spend. Ask the nurse to show you, not only tell you, the jobs you will be doing: emptying a drain, changing a dressing, emptying a catheter bag. Then ask:

• Which medication, what dose, how often, and for how many days?
• What should the wound look like tomorrow, and at a week?
• When may they shower?
• When is the first follow-up appointment, and who removes stitches or drains?
• Which number do we call at 2am, and does someone answer?

The carers I have watched do best at home asked to try the drain or catheter job once under the nurse's eye before leaving.

The first 48 hours

• Expect them to be groggy, sore and possibly nauseous.
• Keep a written log: medication name, dose and time. Set alarms. Neither of you will remember reliably.
• Give pain relief on the schedule the clinic set, before the last dose wears off rather than after. Pain management explains why.
• Help with the first trips to the toilet. They are wobbly.
• Short walks around the room from day one, unless told otherwise. Walking lowers clot risk and gets the bowels moving.
• Fluids in small amounts, often.
• If there are drains, you empty, measure and log them. Drains walks through it, and it is less grim than it sounds.
• Sleep in the same room, or within earshot, for the first night or two.

The first two weeks

• Food and drink ready to hand. Open packets, cut things up, fill the water bottle before it is empty.
• Help with washing: hair over a sink, sponge baths, then standing by during the first showers once allowed.
• All the lifting: shopping, laundry, bins, pets, children.
• Drive to follow-up appointments.
• Photograph the wounds at each dressing change, in the same light and from the same angle. A change is much easier to spot across a series than from memory.
• Watch their mood. A dip somewhere between day three and day seven is common, from anaesthesia, opioids, pain and boredom together. Mental health covers what is normal and what is not.
• Keep visits short. They will want company, enjoy it for an hour, then crash.

Procedure-specific jobs

Catheter. A leg bag by day, a larger bag overnight. Keep the bag below bladder level, keep the tubing free of kinks, and empty it before it is more than about two-thirds full. Wash your hands before and after. If nothing drains for a couple of hours and they feel full or crampy, call.

Phalloplasty flap. In hospital the nurses check the flap's colour and warmth often, hourly at first. Some teams ask carers to keep an eye on it at home and will show you what normal looks like. A flap turning pale, dusky blue or cold is an immediate call.

Facial surgery. Cold compresses in the first two or three days if the surgeon allows them, head up on pillows, soft food they can manage without opening wide.

When to call the clinic

Call the clinic, or go to emergency care, for:

• A fever at or above the clinic's threshold; 38°C / 100.4°F is the usual one
• Spreading redness, heat or a bad smell from a wound
• Sudden swelling on one side of the chest or at a wound site, which can be a hematoma
• Bleeding that soaks through a dressing
• Drain output that jumps or turns bright red after it had been falling
• Chest pain, breathlessness, or a swollen, painful calf. These can be clots. Do not wait for the clinic to call back; go to emergency care
• Vomiting that stops them keeping fluids or medication down
• Pain that is getting worse instead of better after day three
• After bottom surgery, no urine passing, or urine leaking from somewhere it should not

If you are unsure, call. Clinics expect these calls and would rather have one at 2am than a problem left overnight. This page is not medical advice and does not replace their instructions. Complications describes what each of these looks like.

Looking after yourself

• Sleep when they sleep in the first days.
• Let other people take shifts. You do not have to be the only one.
• Get out of the house for an hour a day once they are stable.
• If it is hard for you, emotionally or physically, that is allowed. You can be fully supportive and still find it exhausting.

Small things that help

• Doing up their buttons without being asked
• Holding the phone at eye level so they can see it lying down
• Not asking how they feel every twenty minutes
• Being pleased for them

For what the weeks after look like, the recovery timeline is written for the patient but is just as useful to you.