FtM Medical Transition: A Guide
There are many steps that can be taken to medically transition from female to male. Not every person who transitioning chooses to take all, or any of these steps. It is important to note that this information is just an overview of the steps that can be taken, and further research should always be done before taking any of these steps.
Hormone Replacement Therapy
- Hormones Blockers:
Hormones blockers are generally used for people who have not undergone the puberty of their birth sex, or have not completed the puberty of their birth sex. Hormones blockers stop the birth sex puberty from happening.
Hormone blockers are given in the form of injections.
Testosterone is given to people transitioning who want to undergo male puberty and gain male characteristics. These can be taken after taking hormone blockers or after going through female puberty. Generally, testosterone is taken for a life time. Testosterone will essentially put the person through male puberty. For a complete list of what testosterone does and does not do, see here.
Testosterone can be given in the form of injections, gel, or skin patches.
Top surgery is the process of removing the breast tissue and constructing the chest as a male chest. This can be done with or without nipple re-sizing. There are different procedures.
This procedure it used for people with small breast size (A or small B cup) and good skin elasticity. The incision is along the bottom of the areola and the nipple isn’t generally re-sized or re-positioned.
This procedure is done on people with B or C cup breasts with good skin elasticity. The incision is around the areola where the breast tissue is removed through, then a ring of skin is removed in a wider circle around the areola. The skin is pulled toward the center of the opening and stitched to the edge of the areola. The areola may or may not be trimmed and the nipple may or may not be re-positioned.
- Double Incision Mastectomy:
This procedure is usually done on people with a breast size over a C cup or with breasts that do not have good skin elasticity. There are two incisions, a u-shaped incision under each breast. The skin is then pulled back, breast tissues is removed, the extra skin is removed, and the incisions then closed. Usually the nipples are re-sized and re-positioned.
Removal of Reproductive Organs
There are a few procedures, often done at the same time, that remove the internal female reproductive hormones.
The removal of the uterus. A total hysterectomy includes removing the cervix as well.
The removal of the ovaries. Often at the same time the fallopian tubes are removed; this is known as a salpingo-oophorectomy.
Genital Surgery/Bottom Surgery
Genital surgery/bottom surgery is the process of reconstructing the female genitalia into genitalia closer to that of a biological male.
This procedure is done after the person has been on testosterone (generally for over 2 years) and the clitoris has grown. The ligament that connects the clitoris under the pubic bone so more of the clitoris is visible. Depending on each patient and surgeon fat from around the pubic mound can be pulled up to make even more of the clitoris visible. Flaps from the inner labia can also be added to make the clitoris/new penis thicker.
The removal of the vagina is optional, unless the patient is getting a urethral lengthening, then it is almost always removed.
Another option is getting a scrotoplasty, which is the creation of a scrotum.
Phalloplasty is done in stages.
Stage 1: Formation of a Phallus
This is the removal of skin, blood vessels, and nerves (usually from the forearm but not always) and created into a phallus. The phallus is then attached to the pubic area, over top of the clitoris.
Stage 2: Formation of a Neourthera
This is the creation of a urthera so the person can stand to pee.
Stage 3: Testicular implants & glands sculpting
A scrotoplasty, the creation of a scrotum is done at this time. As is sculpting to add detail to the phallus.
Stage 4: Penile Prosthesis
There are two penile prosthesis that allow the phallus to get hard for penetrative sex.
There is malleable/semi-rigid is made of a silicone rod with a flexible steel core.
The other type is the inflatable which has three parts; cylinders, pumps, and reservoir.
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