Transgender-affirming physiotherapy

Quality of life physiotherapy

Your identity is not defined by your anatomy or by any surgery you may or may not opt into, but the day-to-day practices you use to feel like you're in the best body for you can add to the work your body does, and may need some tweaks in technique or some exercises to help it accommodate the changes those practices create.

• Binding - chest binders and wraps apply constant pressure to the chest muscles and soft tissue, ribcage, and shoulder blade areas, which can alter breathing, chest muscle (like the pectorals), and shoulder and shoulder blade muscle (the lats, traps and rhomboids, and rotator cuff) mechanics. Physiotherapy aims to support and optimise these mechanics and postures, and to both mobilise and strengthen these areas with and without the binding supports in place, so you can build up to longer pain-free periods in your supports or garments.
• Chest packing - while lightweight non-adhesive packing materials may not affect upper-body mechanics, larger silicone breast/chest plates and "chicken fillets" add weight to the front of the body and call for compensatory use of the upper back and shoulder blade muscles to keep you upright. There's no one perfect posture, but you should be able to hold your typical positions while packed or wearing a plate, so physiotherapy here involves mobilising and strengthening the upper and mid-back to reduce the pain or fatigue that can come with the extra weight on the front.
• Pant packing - depending on the inserts used for packing (or stuffing), they can be wrapped around the hip or stuck onto the body at the pelvis, which increases pressure on the pelvis and can alter how the pelvic floor muscles work at rest and their ability to contract and relax. This can also include stand-to-pee (STP) packers, which can make starting and controlling the urine flow (and holding on) more difficult.
• Tucking - this can involve duct tape, silicone wraps, tucking pants, and tucking tape that compress the external genitals into the perineum, which can irritate or tighten the pelvic floor muscles and cause tension or irritation to the skin of the genitals and perineum. Physiotherapy for those who tuck involves normalising pelvic floor activity while tucked, and optimising tucking technique to minimise irritation and changes to pelvic floor activity when not tucked.

Beyond these specific practices, there are other changes you might notice: a sense of pelvic floor tension or tightness from bracing or holding onto your bladder for long periods (if you avoid public bathrooms or feel dysphoric toileting outside your usual environments), various musculoskeletal aches and pains from holding postures and positions that aren't typical for you (most often the neck and mid-back, shoulders, lower back, and hips), and changes to sexual function and comfort, particularly when you're new to transitioning or coming to terms with your preferences.

Transfeminine* pre- and post-op care

Support before and after facial, top, and bottom feminising surgeries, with a particular focus on preparing and rehabilitating the pelvic region for the significant changes that come with bottom surgery.

What I help with

• Chest augmentation / feminisation (top) surgery - strengthening the upper back and shoulder blade muscles before surgery can prepare you for the extra weight on the chest and help you keep your usual posture rather than defaulting to a prawn-like position (which some people find uncomfortable), then scar management and a gradual return to activity (shoulder and mid-back mobility and flexibility, then strengthening as needed) and the gym or sport.
• Oestrogen-related changes - oestrogen can change the skin, organs, and muscles, most commonly developing breast tissue, depositing fat around the hips and thighs, and changing overall muscle size and strength. Oestrogen has a small perk of lubricating the joints, so mobility may improve through your transition, but some strength and conditioning alongside it helps you adapt, as you may lose some muscle mass and strength moving from naturally producing testosterone (a muscle-building hormone) to a higher oestrogen concentration.
• Prostatectomy - some transfeminine folk don't opt for bottom surgery but still remove the prostate as part of their transition to eliminate the risk of prostate issues as they age. A full breakdown of what a prostatectomy and its rehabilitation involve is on the before and after prostate surgery page.
• Phallectomy, orchiectomy, and vaginoplasty (bottom) surgeries - vaginoplasty is invariably the most complex of the gender-affirming surgeries, needing pre-operative pelvic floor co-ordination, strength, and regulation, and extensive post-operative physiotherapy to train the muscles around the neovagina and the modified urethral length and position, and to regain continence (it goes both ways, there will be a period of wetness as everything recovers). Beyond the initial phase, physiotherapy introduces dilators, which need regular use to stretch and maintain the "patency" (openness) of the neovagina, since it isn't made of the same tissue as a native vagina and needs to be trained to stretch (a bit like an ear piercing, except instead of leaving the piercing in while it heals, you repeatedly expose the neovagina to gradual, progressive stretch). There's also scar management and, in some cases, pain management, since it's a complex series of procedures that can come with discomfort in the healing phase.

How I support your recovery