Gender-Affirming Physiotherapy: Supporting Transgender and Gender Diverse Individuals Through Transition and Surgery

Gender-affirming healthcare is deeply personal, individual, and life-changing. For transgender and gender diverse individuals accessing safe, respectful, and affirming healthcare can make an enormous difference to both physical and emotional wellbeing.

As awareness and access to gender-affirming healthcare continues to grow, many people are seeking multidisciplinary support throughout hormonal transition and gender-affirming surgery journeys. Pelvic floor and musculoskeletal physiotherapy can play an important role in supporting transgender and gender diverse individuals before and after gender-affirming treatment and surgery with compassionate, evidence-informed care.

What Is Gender-Affirming Care?

Gender-affirming care refers to healthcare that supports a person’s gender identity and overall wellbeing.

This may include:

• hormonal transitioning

• social transition support

• voice and communication support

• mental health care

• pelvic health support

• surgical care

• rehabilitation and recovery support

  
  

Hormonal Transitioning and Physical Changes

Hormone therapy can create significant changes throughout the body over time.

For trans women (male-to-female / M2F individuals), oestrogen and anti-androgen therapy may influence:

• muscle mass and strength

• connective tissue flexibility

• pelvic floor function

• body composition

• exercise tolerance

• posture and movement patterns

  
  

For trans men (female-to-male / F2M individuals), testosterone therapy may contribute to:

• muscle development

• strength changes

• altered pelvic floor tension patterns

• changes in body mechanics

• chest and upper body changes

The Role of Physiotherapy During Hormonal Transition

Physiotherapy can support transgender and gender diverse individuals through:

• exercise guidance

• strength and conditioning

• pelvic floor rehabilitation

• scar management

• posture and movement retraining

• breathing and core rehabilitation

• pain management

• return-to-exercise planning

  
  

A personalised approach is important, as every body responds differently to hormonal transition. Physiotherapy may also help individuals experiencing:

• pelvic pain

• bladder or bowel symptoms

• pelvic floor tension

• discomfort during intimacy

• chest or upper body tightness

• postural strain

Physiotherapy and M2F Gender-Affirming Surgery

For trans women undergoing male-to-female (M2F) gender-affirming surgery, physiotherapy can play an important role both before and after surgery. This may include support surrounding:

• vaginoplasty recovery

• pelvic floor relaxation

• vaginal dilator therapy

• scar tissue management

• return to movement and exercise

• pelvic pain management

• bladder and bowel function

• breathing and nervous system regulation

  
  

Physiotherapy and F2M Gender-Affirming Surgery

For trans men undergoing female-to-male (F2M) gender-affirming surgery, physiotherapy can also provide valuable support during recovery. This may include rehabilitation following:

• chest masculinisation surgery (“top surgery”)

• hysterectomy

• phalloplasty

• metoidioplasty

  
  

Physiotherapy may assist with:

• scar management

• shoulder and chest mobility

• posture retraining

• breathing mechanics

• pain management

• pelvic floor support

• return to exercise and strength training

  
  

Pelvic Floor Physiotherapy and Gender Diversity

Pelvic floor physiotherapy is not only for cisgender women or postpartum care. Transgender and gender diverse individuals may benefit from pelvic floor physiotherapy support for:

• pelvic pain

• bladder or bowel symptoms

• constipation

• pelvic floor tension

• dilator therapy

• surgical recovery

• intimacy-related pain

• exercise rehabilitation

  
  

Importantly, affirming pelvic floor care prioritises:

• consent

• inclusive communication

• trauma-informed care

• patient comfort

• individual goals

  
  

Many people delay seeking care due to fear of judgement or previous negative healthcare experiences.

Creating a safe and supportive environment is an essential part of gender-affirming physiotherapy care.

Supporting Gender-Affirming Care Across South East Melbourne

Samara Nanayakkara is passionate about providing compassionate, inclusive, and evidence-informed physiotherapy care for transgender and gender diverse individuals throughout South East Melbourne. People across Rowville, Mulgrave, Glen Waverley, Mount Waverley, Wheelers Hill, Oakleigh, Scoresby, Knox, Surrey Hills, Burwood, and Notting Hill are increasingly seeking healthcare that feels safe, collaborative, and affirming throughout their transition journey. Everyone deserves healthcare that respects identity, supports wellbeing, and empowers people to feel more comfortable and confident in their bodies.