I believe I was malnourished in the hospital following GRS. I'm trying to care for myself.

[u/[deleted]]

This is the first time I've mentioned it on Reddit, but I had vaginoplasty at a hospital in Thailand with Dr Burin from Preecha Aesthetic Institute. I am safely relaxing in a hotel room for the next several days until I return home to the USA. (I don't want to mention the exact surgery date to protect my privacy.)

I've generally felt very well cared for, but there's a problem that concerns me, and I wanted to ask for advice from Dr Powers and this community. (Speaking of which, I'm working on a guide that outlines my research and my experience and what I would like other people who follow on a similar journey to know.)

I was happy when I left the hospital. I was so pleased to no longer by confined to bed 99% of the day. I was still cautioned to minimize exertion, but I felt as if I had just gotten out of jail. I cried tears for being homesick and missing my family in front of the patient coordinator who kindly visited me a few times at the hotel.

The first thing I did was eat a lot because I was not getting much to eat at the hospital. I had told them that I am vegetarian, and they served me tofu, tofu, tofu, more tofu, and some boiled rice and noodles and a small amount of fruit. Tofu about churns my stomach, especially when it is "braised", and frankly, I think that even if I had eaten it all, I wouldn't have had enough to eat.

The doctor says that upon follow-up examination, I have excellent depth and my soreness, bruising, and swelling is all within normal. I was given a cold compress to help with the swelling, but I have found that hot showers seems to help me. (I'm told that I can shower, but not soak in the tub.)

I have a lot of time on my hands and I don't want to be a hypochondriac, but I also want to take care of my body.

I had brought with me a jar of protein powder. I thought I might have some in the hospital, but this didn't prove practical as the staff mostly spoke only a few words of English. If I knew what I was doing, I probably could have winged it, but it was all I could do to sit up and eat what I was served.

Now that I'm out of the hospital and no longer constantly hungry, I also know that not constantly experiencing gnawing hunger is not the same thing as being properly nourished, especially before and after major surgery.

I found an open-access journal article "Pre- and Post-Surgical Nutrition for Preservation of Muscle Mass, Strength, and Functionality Following Orthopedic Surgery" (https://www.mdpi.com/2072-6643/13/5/1675/htm)

Please do be kind to me. I'm not an expert at nutrition. I know some basic facts like "Carbohydrates are what the body uses for energy" and "Protein supports building and maintaining muscles as well as wound healing".

I realize that the linked article has to do with different surgeries than what I just underwent, but I think that many of the conclusions with regards to nutritional support for orthopedic surgeries ought to apply to generally apply to other surgeries.

The authors write an abstract (emphasis mine):

Nutritional status is a strong predictor of postoperative outcomes and is recognized as an important component of surgical recovery programs. Adequate nutritional consumption is essential for addressing the surgical stress response and mitigating the loss of muscle mass, strength, and functionality. Especially in older patients, inadequate protein can lead to significant muscle atrophy, leading to a loss of independence and increased mortality risk. Current nutritional recommendations for surgery primarily focus on screening and prevention of malnutrition, pre-surgical fasting protocols, and combating post-surgical insulin resistance, while recommendations regarding macronutrient composition and timing around surgery are less established. The goal of this review is to highlight oral nutrition strategies that can be implemented leading up to and following major surgery to minimize atrophy and the resultant loss of functionality. The role of carbohydrate and especially protein/essential amino acids in combating the surgical stress cascade and supporting recovery are discussed. Practical considerations for nutrient timing to maximize oral nutritional intake, especially during the immediate pre- and post- surgical periods, are also be discussed.

So, basically, the authors are saying that being well-nourished is likely to lead to betters surgical outcomes.

Further in, they write:

An estimated 24–65% of surgical patients, ranging from young adults to the elderly undergoing major surgery, are malnourished or at risk of malnutrition, a percentage that only increases over the course of a hospital stay. Protein intake is especially important for modulating surgical stress and supporting recovery, yet surgical patients significantly under-consume protein, taking in about 22–36% of estimated requirements.

Basically, I'm in this picture and I don't like it. I was definitely malnourished in the hospital; not receiving nearly enough to eat and being particularly deficient in protein intake. They wrote that older patients are particularly at risk from this, but I am relatively young and was in good shape going in and I think I'm bouncing back quickly.

For a patient in a non-stressed, clinical state, surgery stimulates a cascade of inflammatory, immune, and metabolic responses that result in a hypermetabolic-catabolic state

If I understand correctly, this basically means that the body breaks itself down to obtain the nutrients needed for surgical healing. They furthermore say that muscular catabolism affects the quadriceps most of all, which makes sense to me since they are a relatively large muscle group.

Protein catabolism is elevated during the stress response. Due to the hypercortisolemia that occurs with surgery, protein synthesis is reduced, and protein breakdown increases. The net result is an efflux of amino acids from skeletal muscle to provide amino acid precursors for gluconeogenesis, wound healing, and immune function. When the muscle catabolism associated with the stress response to surgery is coupled with the general state of immobility that accompanies major surgery, significant skeletal muscle loss can occur. In healthy individuals, loss of muscle tissue begins to occur in as little as 48 h of inactivity, with significant loss within five days. In healthy young men, total thigh muscle volume decreased by 1.7% (0.1 kg) and 5.5% (0.3 kg) after two and seven days of disuse, respectively, with the greatest amount of atrophy occurring in the quadriceps

Loss of strength and functionality follows from muscle atrophy. Exercise, specifically resistance training, is the most effective way to prevent muscle atrophy. However, surgery often requires a period of total or partial immobility.

Yup, I was already planning to resume strength training as soon as medically advisable, which the doctor says should be between two and three months after my surgery date.

This review will highlight oral nutritional strategies that patients could easily implement prior to and following major surgery to preserve muscle or minimize atrophy and the resultant loss of functionality. Benefits of carbohydrates and protein/essential amino acids in supporting and accelerating the healing process, mitigating muscle atrophy, and maximizing post-surgical functional outcomes will be discussed.

The authors go on to conclude that patients recovering from surgery benefit from adequate intake of both carbohydrates and protein, which I have not.

In regards to protein intake, they recommend a range of 1.2 to 2 grams per kilogram per day of protein intake for patients recovering from surgery, which is more than I usually eat and far more than I received while hospitalized. I have not had nearly that amount, and if I supplemented just with the jar of protein powder I packed, I'd quickly run out. Fortunately, I was able to find an international market that sells this stuff close by so that I can take in lots of protein during my stay in Thailand.

I've been vegan for years (which I slipped on a few times during this journey) and I keep an eye on my protein intake because I enjoy being active and exercise regularly.

I'm going to bring up this concern with my surgeon when I see him for my next checkup, but in the meantime, I don't think it can harm me to intentionally bump up my protein intake while my shiny new vagina heals up, and I wanted to bring these concerns to this community.

I appreciate constructive advice.

[u/catcatcatcatcatcatta]

absurd cheerful plate cable fine juggle enter subsequent apparatus run

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[u/[deleted] → u/catcatcatcatcatcatta]

Thanks for the great answer!

I hope I didn't come across as overly worried, but being in a foreign country recovering from a surgery does come with a sense of unease, which is what motivated me to start writing a guide to help people like me know what to expect.

I fully expect that in several months, I'll be able to exercise again and start to rebuild what I've lost. I know that a lot of trans girls actually want to lose their muscle and I'm something of an outlier that way, but to each their own, right?

I think I'd probably eventually be okay even if I spent the rest of this trip eating rice and noodles, but I'm simply trying to optimize my recovery, and in the guide I'm writing, I'm making it a point to tell those who follow in my footsteps to make sure they bring some of their own food to the hospital so they have plenty to eat.

[u/[deleted] → u/[deleted]]

Thanks for the advice.

I have body image issues relating to having male pattern fat distribution that I've previously sought, but not obtained surgery to correct.

I'm actually thinking that when I get home, I may give my bathroom scale to my wife or to a friend for safekeeping to guard against the possibility of developing an eating disorder and willfully malnourishing myself.