October 19th, I had the honor of presenting physical therapy topics to the Transgender Information and Empowerment Summit (TIES) in Richmond, Virginia, and I had a great time! The audience was wonderful, and my hope is they learned a few things in the brief hour we had together. I want to share with you some of the ways in which physical therapy can help you during and after your transition whether it involves hormone replacement therapy (HRT) or gender-confirming surgeries.

Carpal tunnel syndrome can either flare up if you already have it or you can develop it once on HRT testosterone. The carpal tunnel is a series of bones in the wrist that create an archway for the tendons, ligaments, nerves, and blood vessels. Some of the changes that occurs on testosterone HRT are denser bones, increased muscles mass, but also thickening of the tendons and ligaments, which can make an already narrow space tighter. This then can cause numbness, tingling, or even pain in the wrists and hands. If this is happening to you, then try some ice to reduce any swelling in the area and massage the wrist in a hand-to-forearm direction. If this doesn’t help, then seek your local trans-friendly physical therapist.

Binding is a common practice with trans men who have not had top surgery yet, but this, too, can come at a cost. Binders can give you the contour you are looking for but because it is a stiff elastic material, it can restrict how the joints of ribs and the spine move, creating some back pain or even rib pain called “costrochondritis.” It is our movement that helps lubricate these joints. It is recommended that when you are able, remove the binder, take deep chest breaths in order to get the numerous joints in the rib-cage area moving again … motion is lotion!

Peyronies – abnormal curvature of the penis when erect – can occur for a couple reasons. Trans women who are tucking can stretch the top of the penile tissue while allowing the bottom portion to shorten over time. While I was at the Philadelphia Trans Wellness Conference, I heard of another cause – estrogen HRT! This was new to me but apparently estrogen HRT can cause shortening of the penile tissue, but not uniformly, therefore the person ends up with a curve to their erect penis. Believe it or not there is physical therapy for Peyronies!

Phaloplasty is an extensive surgery with at least a year’s prep work. There is going to be a donor site either on the forearm or the thigh for the new phallus and it has to be hair-free, which takes the diligent effort of a year, from what I understand. Scar and edema management are critical in the beginning after the surgery, not just of the phallus but also of the donor site.

Vaginoplasty is an extensive procedure, too, but not quite as extensive as the phalloplasty. The neovagina does need to be maintained through dilation on at least a daily basis, if not twice a day. A common encounter is the depth is not compatible with your partner. OhNut is a series of silicone rings for your partner to wear which will allow proper penetration without overshooting the mark!

I’ve mentioned this in previous articles about scar tissue after any surgery and how it can impact the body, but I am going to say it again: Scars (from injury or surgery) shrink over time, causing kinks or abnormal tension in the fascial network that “Saran-wraps” us from head to toe in a criss-cross fashion. These kinks and areas of localized tightness can (and often do) restrict how the body moves, which can then cause pain in odd locations. I have seen people with knee and ankle pain as a result of mastectomies, not to mention odd sensations.

Keep in mind that top surgery is only one of the many gender-confirming surgeries available to people today, and they all have the same risk with scar tissue. This will also apply to people getting phalloplasty or vaginoplasty, breast implants, and facial contouring. If you have had one or more of these surgeries and a new pain seemed to “pop up” out of nowhere a year later, the pain may be related to your surgeries! If this is the case, then I urge you to see your local trans-friendly physical therapist 😉 

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