Surgery for gender transition from female to male (FTM) is commonly referred to as “top” and “bottom” surgery. Here’s a breakdown of the procedures:

  1. Top Surgery (Chest Masculinization):
    • Bilateral Mastectomy: This is the removal of both breasts. After the breast tissue is removed, the chest is contoured to create a masculine appearance.
    • Nipple Grafts or Resizing: Often, the nipples and areolas are resized and repositioned to achieve a more masculine appearance. This can be done using a variety of techniques, depending on factors such as chest size and desired results.
  2. Bottom Surgery:
    • Hysterectomy: Removal of the uterus. This can be performed through various methods, including vaginally, laparoscopically, or through an abdominal incision.
    • Bilateral Salpingo-Oophorectomy: Removal of both ovaries and fallopian tubes.
    • Vaginectomy: Removal of the vaginal tissue.
    • Metoidioplasty: This procedure uses the testosterone-enlarged clitoris to create a neophallus (new penis). It often results in a smaller phallus than phalloplasty but retains sensation and sometimes allows for standing urination.
    • Phalloplasty: Creation of a neophallus (new penis) typically using grafts from other parts of the body, such as the forearm or thigh. Urethral lengthening can be done if the individual wishes to urinate while standing. This procedure often requires multiple stages and can include the addition of implants to facilitate sexual intercourse.
    • Scrotoplasty: Creation of a scrotum using labial tissue. This can be done as part of other bottom surgeries and can later be filled with testicular implants for a more typical male appearance.
  3. Other Surgeries and Procedures:
    • Some individuals might opt for additional procedures for more masculine facial features or body contouring.
    • Hair transplants, especially for the creation or enhancement of facial hair, might be sought after by some transgender men.
  4. Hormone Replacement Therapy (HRT):
    • Though not a surgical procedure, many transgender men choose to take testosterone. This therapy induces physical changes such as voice deepening, increased muscle mass, growth of facial and body hair, and the cessation of menstrual periods.

Remember, the decision to undergo any or all of these surgeries is deeply personal. Not every transgender man will want, need, or have access to all of these surgical options. Furthermore, surgeries can be expensive and might not be covered by insurance in all regions or under all policies. Each individual will have their own unique journey, and it’s crucial to make decisions that align with one’s own comfort, health, and goals.