Pre-Op Checklist

By Nick Peplow·Gender-affirming surgery coordinator

Last reviewed 12 October 2026· How this site is researched

Once you have a date, the weeks before surgery fill up fast. This is the list I have rebuilt for patient after patient over ten years of coordinating surgery in Bangkok. It is ordered by how far ahead each job needs to start. 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 vaginoplasty, where the lead times are longest. For facial, breast or voice surgery, the nicotine, letters, insurance and passport lines are the ones that matter.

• Hair removal. For penile inversion, the skin that becomes the lining has to be cleared permanently before surgery. That usually means many months of electrolysis, often a year or more for dense hair. It has to be finished, not just started, and the surgery date waits for it. Ask your surgeon for the exact area and keep a signed log. See hair removal
• Nicotine. Most surgeons want you nicotine-free for several weeks before and after, and some test for it. See smoking and nicotine
• Letters. Check how many the surgeon and any insurer need, and that they name the exact procedure. See letters of support
• Insurance pre-authorisation. In the US this can take weeks, sometimes with an appeal. Hold off on flights until it is confirmed. See insurance
• Fertility. Vaginoplasty and orchiectomy end sperm production for good. If you might want biological children, sperm banking needs planning, and oestrogen may need pausing first. See fertility preservation
• BMI. If the surgeon has a cut-off and you are close to it, you need the time now. See BMI requirements
• Passport and visa, if you are travelling. Check the expiry date covers the whole trip, including a longer stay if needed

8–12 weeks out

• Confirm the date, deposit, refund terms and payment schedule in writing
• Book time off. Vaginoplasty usually means six to eight weeks away from a desk job, often longer for physical work
• If travelling, book flights and somewhere to stay near the hospital. Plan roughly three to four weeks in Bangkok for vaginoplasty, two to three for FFS, about two for breasts and about a week for orchiectomy. See travelling for surgery
• Decide who is looking after you, for how long, and share the caregiver guide with them
• Ask about oestrogen. Oestrogen raises the risk of blood clots, and major surgery raises it again. Many surgeons ask you to pause or lower oestrogen for a few weeks around a long operation like vaginoplasty or FFS. Others keep you on it, especially on patches or gel, and rely on clot prevention in hospital. Practice varies between surgeons, so ask your surgeon and your prescriber together, get the plan in writing, and follow it. Do not stop or change anything on your own. See hormone requirements
• If you take an anti-androgen, ask what happens to it too. Many people stop it after vaginoplasty or orchiectomy, but your prescriber should confirm when

4–6 weeks out

• Pre-op tests, as the clinic arranges. Commonly a full blood count, clotting screen and kidney function, sometimes hormone levels or an ECG
• 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 often stopped. Let the team tell you which and when
• Dilators and supplies, for vaginoplasty. Ask whether the clinic supplies dilators, and in which sizes. Most do. Then stock up on what they do not include: water-based lubricant, a mirror, absorbent pads, unscented panty liners, gloves, and a douche if your surgeon recommends one. See dilation
• Compression garments, for breast augmentation, FFS or liposuction, if the clinic does not supply them
• Clothes. Loose, front-opening tops for breast or facial work. Soft, loose bottoms and a doughnut cushion for vaginoplasty
• Transport home. You cannot drive after a general anaesthetic, and many hospitals will not discharge you alone
• Food. Batch-cook and freeze meals if you live alone

2 weeks out

• Ask about anti-inflammatories. Many teams stop ibuprofen, naproxen and aspirin before surgery and keep paracetamol. If you take any of these 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 bending after vaginoplasty or reaching up after breast surgery
• Pick up any post-op prescriptions issued in advance
• Confirm your follow-up appointments, and how they work once you are home
• Read the surgeon's post-op instructions properly now, while you can concentrate. For vaginoplasty, read the dilation schedule twice

The week before

• Confirm arrival time, fasting instructions and exactly where to go
• Bowel preparation. Some surgeons ask for it before vaginoplasty, and it is standard before an intestinal vaginoplasty. It may mean a low-residue diet for a few days, then a laxative drink the day before. Only do it if your surgeon asks, and follow their timings exactly. It needs a clear day near a toilet
• Check your hair removal area one last time. Most surgeons want the last session some weeks before, so the skin is calm on the day
• Wash the sheets, clean the bathroom, do the laundry
• Stock easy, high-fibre food and a stool softener. Painkillers and anaesthesia constipate almost everyone, and straining hurts after bottom surgery
• Charge everything and download entertainment. After vaginoplasty you may spend several days lying flat

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. 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 what needs to go
• Remove nail polish, make-up and jewellery, including piercings. No moisturiser or deodorant in the morning
• Pack the hospital bag and set two alarms

Morning of surgery

• Wear loose clothes that are easy to get on
• 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
• Arrive on time. The surgeon and anaesthetist will usually see you before you go in. This is the moment for any last question

Ready at home for when you get back

• A bed you can get in and out of easily, with pillows to prop yourself up
• Water, snacks and medications within reach
• A written medication schedule with times, so your carer can track doses
• For vaginoplasty, a clean dilation station: dilators, lubricant, pads, a towel and a mirror, all in one place
• The clinic's numbers, including out of hours, where your carer can find them

Two things go wrong more than anything else. Hair removal or insurance paperwork is left too late, and the date moves. And the house jobs are left to the last two days, so the first week home is spent hunting for clean towels. Get both done early and you can give your recovery your full attention. For what the first weeks look like, read the recovery timeline.

This is information, not medical advice. Your surgeon knows your body and your operation, so their instructions come first.