The Opera, Camus & Post-op Depression

Female-To-MaleHolden Madagame
Picture of Holden

Picture of Holden

By Holden Madagame

Before I decided to get top-surgery, I was miserable. Truly miserable. And before I decided to go on testosterone, I was even more miserable. The fork in the road, as I saw it, was that I was either choosing to give up on my career as an opera singer (as T would affect my voice)—or giving up my chance at happiness.

Looking back on my life before I decided to medically transition in 2014, I was depressed most of the time—though I didn't quite realize it. I constantly stayed indoors, which went unnoticed because before I came out as trans, it was winter in Berlin. It’s freezing and dark. Nobody really comes out, everyone drinks a bit too much Glühwein and Bier, and depression usually takes a very cold, gray turn. I was no different, except that I didn't have the self-awareness to realize something was really very bad.

It took my ex-girlfriend and the Weltmeistershaft to make me realize that I was killing myself with my chest-binder by wearing up to 10 hours every day. My body couldn't function, and it got to the point where I couldn't breathe or stay out too long. Of course, my mind wasn’t quite functioning either.

"Something has to change," she said to me three years ago. "This isn't sustainable."

I don't know specifically what it was about the statement “This isn’t sustainable” that flipped a switch in my brain. I think it was the fact that the word “this” was referring to my entire life; in other words, my life as I knew it wasn’t sustainable.

When I contemplated possible solutions to the pain I felt in response to her comment, the first things that came to mind were testosterone and top-surgery. It sounds surprising, but that’s what my instinct gave me as a potential answer.  It's hard to explain in just a few sentences (and I’m sure I’ll save that piece for another time), but I also felt acute fear about the impending sense of freedom I would potentially be getting from hormone therapy and surgery. Suddenly, I would be different—my body would be different, and most importantly, my voice would be different. Because I’m an opera singer and had, thus far, devoted my whole life to singing, I thought taking testosterone would ruin my chances of a career. And while I feared that outcome, I also knew that I needed it to keep myself alive. And once I decided that I was going to go through with a transition, it didn't take long for me to choose a name (I'd already made a babynames account to plan for this), and come out on Facebook.

Fast-forward a year and a few months to August 2015. I had been on testosterone for about a year, and my girlfriend and I had gotten to Bangkok to have my top-surgery. It was one of the most painful and most exciting things I've ever experienced. I woke up with no memory of what had happened, but with a throbbing pain where my breasts had been, and a medical binder on.

Here's what people don't want to hear: it was a fucking painful and horrible week. I couldn't sleep, I cried myself to sleep every night while my girlfriend read me Camus' L'étranger. I was in pain and the excitement of anticipation was gone. When I finally got my medical binder off to be able to look at my chest for the first time, I was, quite frankly, disappointed. My body had bloated and gone soft from having to be off testosterone for almost two months at this point (to prep for surgery), the muscle that I had meticulously built up on my chest had been disturbed from the surgery, and the scars weren't how I had imagined them at all. They curved around my small chest. Not like all the videos and the pictures I'd seen of other trans guys. Their chests were so masculine and clean and boxy.

I thought, "Maybe I made a mistake. Maybe I only wanted a beautiful chest."

That thought quickly was banished though, because the feeling of absolute joy when standing up, and being able to put my hands on my new, flat chest, was like arriving at a new sense of home. This was MY chest. No one could take it away from me, no matter what.

That said, my newfound feeling of connection with my body didn't stop me from getting depressed soon after.

Something that people don't tell you is that dysphoria and depression can get a lot worse before they get better. Post-op depression is very much a thing, even for non-"gender confirming surgeries." When you go under general anesthetic, your body and brain shut down in such a way that you become physiologically depressed—on a neurological level. And for each hour you are under anesthetic, the longer your post-op depression lasts.

Luckily, I had read an article about this right before the surgery, so I was at least somewhat prepared. But my adjusted expectations didn't diminish the fact that I was in a physical state of depression, and incapable of doing anything for myself. I had to have people bathe me, make food for me, clean for me, dress me. I constantly felt like a burden—not only to my friends helping me, but to the world, for even existing in such a state of confusion. I couldn't work out, and it even took a long time before I could even even open doors comfortably on my own.

Ultimately, it took about 8 weeks for me to recover physically, but recovering mentally was a whole other story. I hated my body, I hated my very existence. Top surgery didn’t necessarily exacerbate or add to these feelings of shame and self-loathing, but it made me realize that everything I was working out was internal. I wanted to be authentic, to be myself, and I was investing too much in something external to solve my problems.

One thought that I relied on to keep me going during my recovery process was, "I'll be able to work out in [x amount of time]. Then I'll be happy." A word of advice though, whenever you say the phrase, "I will be happy when...," you’re setting yourself up to fail. By putting off your own happiness, and tethering it to a specific outcome, know that you will not be happy when you expect to. You may have the capacity and the facilities to pursue happiness, but no event in your life will ever make you magically happy. You will still have to dig into yourself and find happiness, despite or because of your environment.

When I was able to work out again, I realized that I had lost all of the strength that I had built up over the past year. I could barely lift the lightest of my dumbbells. I tried going to the gym with my girlfriend, but that was just a recipe for dysphoria and feelings of inferiority to watch my girlfriend and the beefy Turkish guys lifting dozens of kilos more than me (not to even mention locker room anxiety).

I was back at square one, and realized that simply working out, or getting outside, or being productive with work, wouldn't make me happy. I was still going to feel what I was feeling, and I needed to sit with the discomfort, to show up for it—and then let it pass. The horrible truth that I didn't want to admit to myself was that top-surgery definitely hadn't instantly fixed my problems, something I’d been expecting for so long.

"Wait wait wait, Holden, are you saying you're not happier after having top-surgery? Why did you do it at all?"

No, you misunderstood: it didn't INSTANTLY fix my problems. I am without a doubt happier than I have ever been, and a large part of that is having had top-surgery. Now, I can go swimming or can bike for long distances without worrying about my binder strangling me. I can have sex without having to bind or have massive conversations about what is OK to touch and what's not OK to touch. My life is definitely easier, but it wasn't magic, and I suppose that’s the point I want to make.

This wisdom holds true, I think, for any kind of life transition. If you’re at a job you don’t like, it’s probably true that switching jobs—or at least taking specific actions to learn more about what’s available or to “put yourself out there”—will improve your mental and physical state. But any time we think happiness exists outside of ourselves, we avoid the real lesson life is presenting us with. No matter what, there will always be discomfort, frustration, disappointment, misaligned expectations. Being able to recognize that, figuring out the practical changes to make, and then going along for the ride, is an essential part of growth—for anyone. I know that I’m still processing my transition and generally just getting to know myself more.

Discomfort is part of it all. That doesn’t mean we should all passively watch our lives go by, but it does mean we can practice letting go of “extra” bad feelings like guilt and self-blame. So no, top surgery didn’t solve my problems. But the real lesson is that nothing can—we can only learn to acknowledge them with kindness, and then deal with them in our own way.


Holden Madagame is a trans American opera singer, activist, and writer based in Berlin, Germany. He finds it vital to share his experiences as an openly out trans, queer opera singer, and to educate people on the wonders of feminism. When he isn't singing in an opera or chatting about feminism, he enjoys writing short fiction, and making a damn good cup of coffee. You can find him on Twitter @HMadagame and on Instgram @holden.mad. His website is: