Pre-Op Checklist

By Nick Peplow·Gender-affirming surgery coordinator

Last reviewed 27 September 2026· How this site is researched

Once you have a date, the weeks before surgery fill up fast. This is the list I have ended up rebuilding for patient after patient, ordered by how far ahead each job needs to start. What to buy is on the packing list; what your carer does is in the caregiver guide. Your surgeon's own pre-op instructions override anything here; if the two disagree, theirs win.

Three months or more out

Most of this applies to bottom surgery, where the lead times are longest. For top, facial or body surgery, the nicotine, letters, insurance and passport lines are the ones likely to apply.

• Donor-site hair removal. For phalloplasty with urethral lengthening, book the first electrolysis or laser session as soon as the flap is chosen. Clearing the strip of skin that will become the urethra takes many sessions, commonly six to twelve months, and the surgery date waits for it
• Nicotine. For top surgery most surgeons want four to six weeks nicotine-free either side. For phalloplasty it is commonly six weeks to three months before and three months or more after, and some surgeons test for it. See smoking and nicotine
• Letters. Check how many the surgeon and any insurer need, and that they name the exact procedure. Some insurers want them dated within the last year; see letters of support
• Insurance pre-authorisation. In the US this can take weeks and sometimes an appeal. Do not book flights or time off on the assumption it will come through; see insurance
• Fertility. If you are having a hysterectomy with the ovaries removed, or an oophorectomy, and might want biological children, fertility preservation needs a clinic appointment, blood tests and a stimulation cycle. Clinic waits can run to months
• BMI. If the surgeon has a cut-off and you are near it, you need the time now, not in the last fortnight; see BMI requirements
• Passport and visa, if you are travelling. Check expiry dates against the whole trip, including a possible extended stay

8–12 weeks out

• Confirm the date, deposit, refund terms and payment schedule in writing
• Book time off; see time off work for how long by procedure
• If travelling, book flights and accommodation near the hospital; see travelling for surgery
• Decide who is looking after you, for how long, and share the caregiver guide with them
• Ask the surgeon and your prescriber whether to pause testosterone and, if so, when to stop and when to restart. See testosterone and surgery

4–6 weeks out

• Pre-op tests, as the clinic arranges. Commonly a full blood count and clotting screen, sometimes kidney function, hormone levels or an ECG. If you are on T, the blood count shows your haematocrit, and a high reading is one of the few things that can move a date
• Medication list. Send every medication and supplement to the surgical team, with doses. Blood thinners, high-dose fish oil, vitamin E, St John's wort and some herbal supplements are commonly stopped, but let the team tell you which and when rather than stopping anything yourself
• Order what you need from the packing list: button-up shirts, a wedge pillow, and compression garments if the clinic does not supply them
• Transport home. You will not be allowed to drive after a general anaesthetic, and many hospitals will not discharge you to a taxi alone
• Food. Batch-cook and freeze meals if you live alone or your carer cannot cook
• Work. Tell your employer about any restrictions on your return, in writing if possible

2 weeks out

• Ask about anti-inflammatories. Many teams stop ibuprofen, naproxen and aspirin at some point before surgery and leave paracetamol in place. If you take any of them for a reason, speak to whoever prescribed it
• Cut alcohol right down or stop
• Move what you use daily to waist height, so you are not reaching up after top surgery or bending after bottom surgery
• Pick up any post-op prescriptions the clinic issues in advance
• Confirm your follow-up appointments and how they happen if you live far away
• Read the surgeon's post-op instructions properly now, while you can concentrate

The week before

• Call or email the clinic to confirm arrival time, fasting instructions and exactly where to go
• Ask whether you need bowel preparation. Some teams ask for it before vaginectomy or phalloplasty, and it needs a clear day
• Wash the sheets, clean the bathroom, do the laundry
• Stock easy, high-fibre food and a stool softener. Opioids and anaesthesia constipate almost everyone
• Charge everything, download entertainment, and give anyone handling things for you the passwords they need
• Take "before" photos if you want them

The night before

• Follow the fasting instructions exactly. Many units allow food until about six hours before and clear fluids until about two hours before, but others still say nothing after midnight. The times are theirs, and getting them wrong cancels operations
• Shower with the antibacterial wash if you were given one
• Do not shave the surgical area yourself. Small nicks raise infection risk, and the team will clip hair if it needs to go
• Take off nail polish and jewellery, including piercings. No moisturiser or deodorant on the morning
• Pack the hospital bag and set two alarms

Morning of surgery

• Wear loose clothes that open at the front
• Bring ID, paperwork, your medication list and a long phone charger
• Take only the medications the anaesthetist told you to take, with a sip of water
• If you have a uterus, expect a pregnancy test on admission whatever you have told them. It is routine and not a judgement
• Arrive on time. The anaesthetist and surgeon will usually see you before you go in; this is the moment for any last question

Ready at home for when you get back

• Bed set up to sleep propped up
• Water, snacks and medications within reach of where you will be lying
• A written medication schedule with times, so your carer can track doses
• The clinic's numbers, including out of hours, somewhere your carer can find them
• Drain supplies and a log sheet if you will have drains; see drains

Two things I see go wrong more than anything else. People leave the hair removal or the insurance paperwork too late and the date moves. And people leave the house jobs to the last two days, then spend their first week back hunting for a clean towel with their arms pinned to their sides. For what those first weeks look like, read the recovery timeline.