FTM (female-to-male) bottom surgery, also known as masculinizing genital surgery, refers to procedures that modify female genitalia to have a more typically male appearance and function. There are a few primary surgical options, and the choice depends on the individual’s goals, including desires for aesthetics, sexual sensation, and the ability to urinate while standing.

Here are the primary procedures:

1. Metoidioplasty:
   • This procedure takes advantage of the clitoral growth caused by testosterone therapy, which many trans men take as part of their transition. After being on testosterone for a while, the clitoris enlarges.
   • During metoidioplasty, the enlarged clitoris is released from its ligaments to extend it further outward, creating a small phallus or neophallus.
   • Benefits: Retains natural sensation and, in some cases, the ability for erectile function.
   • Considerations: The resulting phallus is often not large enough for penetrative intercourse.
2. Phalloplasty:
   • This procedure involves constructing a larger phallus using skin grafts taken from other parts of the body, such as the forearm, thigh, or back.
   • The neophallus is more extensive than the one resulting from metoidioplasty and looks more like a typical penis.
   • An implant can be added later to allow for erections.
   • Benefits: Results in a larger phallus, which may be more aesthetically satisfying for some and allows for penetrative intercourse with an implant.
   • Considerations: It often requires multiple surgeries, has a higher risk of complications, and may result in less sexual sensation than metoidioplasty.
3. Urethral Lengthening:
   • This procedure can be done in conjunction with both metoidioplasty and phalloplasty. It extends the urethra through the new phallus, allowing the individual to urinate while standing.
   • It’s a complex procedure and can carry risks like fistulas (an opening or hole) and strictures (a narrowing).
4. Scrotoplasty:
   • This involves creating a scrotum using labial tissue. It can be done as part of both metoidioplasty and phalloplasty.
   • Silicone testicular implants can be inserted in a separate procedure to give the scrotum a more typical male appearance.
5. Vaginectomy:
   • This involves the removal of the vaginal tissue. It might be done in conjunction with other procedures.
   • This surgery prevents vaginal secretions, which some trans men find bothersome.
6. Hysterectomy and Bilateral Salpingo-Oophorectomy:
   • Hysterectomy is the removal of the uterus.
   • Bilateral salpingo-oophorectomy involves removing both ovaries and fallopian tubes.
   • These procedures prevent menstruation and reduce the levels of estrogen produced by the body.

The choice of procedures and surgical techniques is highly individual and depends on the person’s goals and anatomy. Potential candidates for these surgeries should consult with experienced surgeons and understand the risks, benefits, and potential outcomes of each option.