Information collection made by and for the trans community.
FTM Transition
This page contains information on hormones, surgeries, and more for trans men and trans masculine individuals. Content warning: Talk about and images of prosthetic genitalia and medical procedures.
Beginning Your Transition
Binding
Binding is the use of a special top, or tape, to hide breast tissue, creating the appearance of a flat chest.
Safety
A main source of dysphoria for trans men and trans masculine people is the chest. Going through female puberty as someone who isn't a girl is troubling; trust me, I know. An irreversible consequence of AFAB development is the development of breast tissue. The solution to this is top surgery, but that's a big and lengthy process, in the meantime, you're likely looking into or already binding your chest. Chest binding is great for relieving dysphoria, but it is not always good for your body. There are a few safety precautions that you'll hear every time but I still need to share:
1. Do not bind with ace bandages, belts, duct tape, or anything not designed to be used for binding. Binding in these ways can cause damage to your ribs, you back, your lungs, and your skin. Overall, it's just very bad for you.
2. Do not bind while exercising, swimming, showering, or sleeping.
3. Binders should not be worn for longer than 8-10 hours a day
4. You should aim to take breaks from binding every few days.
5. Only wear binders that are your size, do not wear a size smaller, it will cause damage. In the same vein, only wear one binder at a time.
Cease binding if you feel any discomfort or pain. Remember that as tempting as it can be to not abide by these rules, prolonged unhealthy binding habits can lead to permanent bodily damage, and can jeopardize your top surgery results later on, or may even prevent you from getting it at all.
Alternatives
If you aren't in a position to buy a binder, whether for monetary reasons or an unsupportive family, there are some alternatives to traditional binding tops.
SPORTS BRAS
Wearing one sports bra alone does have a slight binding effect. Another way to use sports bras is by layering them, only layer using 2 at the most. Some guys also have good results by wearing one properly, and the other backwards. If using this method, keep safety in mind. Use sports bras that are your size. The brand tomboyx has sports bras designed for compression, they aren't as good as a normal binder, but they do the job.
KT TAPE/TRANS TAPE
Kinesiology tape can be used to bind the chest if you can't get a binder. This method works best for those with a smaller chest. The brand TransTape has thicker cut tapes that require less tape than normal tape. They are essentially the same product however. Before using the tape, do a skin test to make sure you do not have an allergy or sensitivity to the adhesive. To use KT tape for binding, you must begin by putting bandaids, or another cover, on your nipples. If you skip this step you might find yourself in a painful situation later down the road. Once you've done this, use one hand to flatten your chest tissue, with the other hand apply the tape to the inner most part of the chest. Rub it down to create a solid hold, stretch it out and apply with pressure to the rest of the tissues, moving out, anchor the end of the tape to your side/back. You will likely need more than one strip of tape. Tape can stay on for a few days at a time, can be slept, exercised, and showered in. When removing the tape, first soak or apply oil to breakdown some adhesive. Go slowly, taking caution not to rip at your skin.
Binders
To use a binder, you simply pull it over your head like putting on a tank top, a really tight tank top, it can be difficult at first, and it isn't uncommon to get a bit stuck the first time, but after a while, it gets easier. For a while, there were only a few companies that produced safe binders, but recently many more have become more popular.
SPECTRUM
Spectrum has quickly become a favourite. They are a UK based company. Reviews all praise the flattening ability and comfort of their binders. But, they can be costly ($65), especially with shipping fees.
UNDERWORKS
While Underworks is not a trans business, they do have rave reviews on their chest compression tops. Their binders are known for being great at binding at a reasonable price, they can however be a bit uncomfortable for some people.
GC2B
Ahh gc2b, the original binder. Before my top surgery, I only wore gc2b. I found them effective and budget friendly. However, in recent years customers have reported a reduction in quality. They have responded by releasing 2 new improved lines.
FLAVNT
Flavnt Streetwear has been a name brought up frequently when discussing good binders. Reviews have said they are very comfortable and don't inhibit movement. That being said, they may not bind as well as a gc2b binder, and at $70, they are the most expensive on our list. I've never used their binders BUT they do have kick-ass T-shirts that I absolutely adore!
*For comparison, I have used the black half-tank binder from each brand, but they all have other colours available, and all except Flavnt have full-tank cuts
Packing
Alright, what we've all been waiting for, let's talk about dicks. Packers can serve many purposes, creating the appearance of a bulge, standing to pee, having penetrative sex, and masturbation.
There are many many MANY packers on the market, coming it at all kinds of price points.
Soft Packers
My favourite "packer" in this category is socks. A common trope in the trans community, but hey it's a trope for a reason. My biggest struggle with packers is making sure I don't look like I'm walking around with a boner, socks are perfect at avoiding this. I take an ankle sock, roll it from the toes to the opening then turning it inside out to keep the roll secure. This creates the perfect subtle bulge. I appreciate that the socks don't chafe the way some silicon packers do, but when the bottom dysphoria is rough, I want to look down and see a penis not a sock.This brings me to the tried and true -- Mr. Limpy. Mr. Limpy comes in multiple sizes, but I recommend starting small, for the same boner concern I brought up before. Mr. Limpy is great because he's comfortable and very affordable coming it at around $12. One thing about Mr. Limpy is that the size names are a bit misleading, the 'medium' is quite big, so again skew more conservative when picking your size. You might also find some trouble getting him in deeper skin tones. here are so many different packers that it's hard to narrow down the list. you can check out TransGuySupply and ftmessentials for more affordable soft packers ala Mr. Limpy.
This is the Mr. Limpy, small in light beige. Mr. Limpy is available widely online, simply search the name!
Higher End Soft Packers
While Mr. Limpy is great, for those that want a more realistic, or customizable prosthetic, there are higher end packers available. While there are many businesses that make soft packers these are some of the favourites, ranked from cheapest high end to the top of the line, ultra realistic soft packers.
1. Banana Prosthetics. These are nice because they are realistic, and come in different sizes, circumcised, and uncircumcised. These range from about $60 to $80.
2. Gramma's Sausages. This shop allows for purchasing either pre-made or custom prosthetics. Boasting 12 options, these hand made packers are very popular, they start at around $70
3. Gendercat. Coming in around $250-300 these packers are quite nice, especially for the prices comparable to other packers. Gendercat is known for their strokers, which aren't packers, but are very nice.
4. ReelMagik. While these packers start at a lower price depending on the model, the extensive customization options, create a large opportunity for the price to rise. Reel Magik packers are considered one of the most, if not the most realistic soft packers available, they also sell packers for other uses as well.
5. Emisil. These are the most expensive soft packers we will talk about, starting at almost $300. While the price is shocking, they make up for it in the sheer quality of the products, with 3D movable testicles, triple layer silicone skin, and 5 colour options for pubic hair.
SP2, Banana Prosthetics v. 2
ReelMagik Basic Packer
Gendercat 3in JR
Gramma's Sausages Vienna
Stand to Pee ‖ STP Packer
STPs can be used to create a bulge, like soft packers, but as the name suggests, their true purpose is to allow the user to pee standing up. These packers will be hollow, with one end used to cup the present anatomy, and will have an opening at the urethra. When you use an STP for the first time, it is best to practice. It's recommended that you undress completely and use it somewhere like the shower, this is because some STPs might have a narrow urethra that could cause back up and leakage, or you could misalign your urethra with the opening in the STP. Overall, it is best to practice using an STP at home before taking it public. The STP is wonderful because it allows trans men and trans masculine people to use urinals and get the standing to pee experience, previously unavailable to us.
Emisil Junior FL01
Peecock Gen4x 3.75"
Because of their construction, STP packers can be a bit trickier to pack with, which is where a product like a harness might be beneficial. In almost everywhere you can buy a packer, you can also buy a harness, or special packing underwear. My favourite brands are Paxsies and trans guy supply's Cake Bandit. There are also joey pouches, just like everything, the possibilities are bountiful those are just some of my favourites, but you don't need to use one of these. A pair or tight boxer briefs, briefs, or a jockstrap, can hold a packer in place just fine.
Almost all of the brands previously listed under soft packers, also sell STP packers, an additional brand to bring up in this category is PeeCock who makes a 3 in 1, soft packer, STP, and play packer.
Hard Packers ‖ Pack n' Play
Hard packers, are packers that simulate an erect penis, and can be worn for engaging in penetrative sex or masturbation. While some packers come as an STP with an insertable rod to make the packer stiff. Other hard packers are designed only for sexual use, and will always be hard, making them unsuitable for day to day packing. Just like with the STPs, all brands mentioned have hard packer options, which are all very good, with varying levels of functions, certain insertable rods have a well that allows the wearer to simulate ejaculation, others have customizable bases, like lips, anuses, or vaginas, that fit to your bottom growth (clitoris) and allow for pleasure for the wearer.
In a similar vein there are strokers, toys meant for masturbation, these suction on to the bottom growth of those on T, allowing for an experience like jerking off, which can be beneficial for those with intense bottom dysphoria, made worse by not being able to masturbate the way a cis man might. These vary from looking like a penis, to the less realistic simple tubes. MorMe Prosthetics has a very highly praised stroker collection, these are best if you want a stroker that looks like a phallus. If that isn't as important to you gendercat has nice strokers, and ftm pitstop offers the shot pocket, an affordable stroker.
Resource List
MorMe Prosthetics Original Stroker
Shotpocket Pleasure Sleeve
I know I've thrown a lot of different brands at you, and for that I apologize. Here are all of the packer brands that I have mentioned, as well as a few other brands that we love.
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Hormones
Blockers
Trans men and trans masculine people that want to begin transition before natal puberty have the choice of going on hormone blockers. For all bodies, there are two options for blockers. The first one is an arm implant of histrelin acetate, brand name Supprelin® LA. Supprelin is a gonadotropin releasing hormone agonist that puts a pause on natal puberty. The implant is 3.5cm and lasts for one year, after this year it must me removed and/or replaced. In general it is important to know that hormone blockers are VERY expensive. One implant/ a year of Supprelin is going to cost almost $50,000.
Your other options are leuprolice ancestate, brand name Lupron and triptorelin, band name Triptodur. These are injections. They are in the same category as Supprelin (GnRH agonists). They is administered intramuscularly every 3-4 weeks, about once a month. A 6 month supply of Lupron could cost around $12,300.
Beginning blockers can be a bit of a tricky process. You and your child should see a paediatric endocrinologist, or normal endocrinologist who works with trans people. For insurance approval, you'll need to go through rounds of mental health evaluations. Before starting blockers and while taking them, your will need to get blood draws to check in on your hormone levels, as well as other health markers that can be impacted by blockers, such as bone density.
While not technically blockers, some guys choose to use birth control to stop menstruation. Getting a period can cause a lot of dysphoria, and oral birth control can be used to prevent this. By not taking the placebo pills, you can skip a cycle. This should be discussed with your doctor.
Testosterone
HRT, Testosterone, T! What is typically the first step of one's medical transition. AFAB people that want to appear more masculine and develop male secondary sex characteristics can choose to start taking synthetic testosterone. There are many different ways for someone to take testosterone, a chart of basic information on the most common is shown below. Following the chart we will discuss the changes you can expect and the timeline of said changes, as well as how one can begin taking testosterone.
Injection
The most common way to take testosterone is injections. There are two types of injection -- Intramuscular (IM) and subcutaneous (SubQ). Intramuscular injections are injections that deliver the testosterone into the muscle. Subcutaneous on the other hand are injected beneath the skin into the fat.
IM needles are typically 1.5" in length, SubQ are 5/8". While the size of IM can sound intimidating, both IM and SubQ are associated with little to no pain when done properly.
Always follow the directions given to you by your doctor. This is not medical advice.
Something to note about testosterone injections is potential allergens. The testosterone is suspended in oil, either sesame or cottonseed. If you have allergies to these it might be better to explore other methods of delivery.
Pros of Injection
A big pro for injection is the ease of access. While testosterone can be difficult to get in the beginning, injections are the most common method of delivery. Because of this it is the easiest to find in pharmacies since some might not carry other types of T. The abundance also means it has the lowest cost per month. Another benefit is the frequency, T injections are done weekly or every two weeks, compared to other common methods that are done daily. For the forgetful among us, this can make it harder to miss a dose. While not confirmed, the widely held belief among trans men and trans masculine is that with injection T, changes come faster than with topical.
Cons of Injection
The biggest con of injection is the fact that it is injection. Many people have a fear or general unease around needles, that plus the fact that usually you are doing these yourself, there is high potential for anxiety. Along with this a con is pain, obviously compared to a gel it, injection does hurt more especially if you have a lower pain tolerance. Another con is when you are underage, a lot of times you have to go into a medical establishment and have someone else administer the injection for you, this can be quite inconvenient but others prefer having someone else do the injection for them, and some people choose to continue seeing a healthcare professional for administration.
Transdermal
The second most common way of taking testosterone is transdermal methods. Transdermal refers to the process of absorbing medication through the skin. Like injection there are two options for transdermal testosterone: gel and patch. The gel is known commonly by the brand name AndroGel, the name brand for the patch has been discontinued but generic versions are still available.
Transdermal T is applied to dry skin daily, typically applied to the upper arm. T gel can come in a larger size pump bottle or in daily sachets, the dose is rubbed into the skin daily. The patch is applied and changed out every 24 hours. It can be kept on for swimming, exercise, and most other activities.
Pros of Transdermal
The obvious advantage of transdermal testosterone is that it is painless, there is no needle involved which is very nice for those that cannot do injections. Because of the lack of needles, the process of taking transdermal T is very easy, fast, and does not require a healthcare professional to deliver it. Transdermal testosterone is also more discreet than injections, if you want to be stealth (not being known as trans). While not as common as injections, transdermal T is easier to find than other options. Speaking from personal experience about 1/6-1/8th of the trans men and transmasculine people I know use the gel/patch.
Cons of Transdermal
A main concern about transdermal T is the price. T gel in the United States has an average monthly out of pocket cost of anywhere from 100-685$. Testosterone patches which are harder to find than gel have an even higher cost per month of 300-740$. Granted these are general numbers and will vary on location, if you are using generic or name brand, and if you are able to get your testosterone covered by insurance. Another concern for transdermal T is transference, especially if you choose to use T gel. The gel can be transferred from your hands or arm to other people directly or via shared objects in your household (towels, blankets, etc). This is a concern if exposure is continued as it could cause those around you to get doses of testosterone. To mitigate these risks you must be sure to rub in the gel completely and wash your hands thoroughly after application. The last con is the fact that it must be applied daily which can be inconvenient.
Pellet
One of the newer forms of T that people are using is the pellet. The testosterone pellet is about as it sounds a pellet of testosterone that is inserted under the skin in the buttocks. The pellets slowly dissolve delivering testosterone over longer periods of time. This is done in a doctor's office and requires numbing injections prior to insertion.
The pellet is the least common way of taking T, personally, I don't know anybody that uses the pellet. It is typically used by people that have been on T for longer periods of time. It is not common to start with the pellet.
Pros of Pellets
Pellets are preferred by some people because they are only done every 3-6 months so you do not have to keep up with weekly or daily medication. Additionally, the dissolving of the pellets allows for a steady stream of testosterone, which prevents some of the peaks and crashes in T levels associated with methods like injection.
Cons of Pellets
Pellet usage is very rare and it may be difficult to find doctors in your area that do pellet procedures. Pellets are also quite pricey costing at least 650$ per pellet. Some people have also reported having a harder time getting insurance to cover pellets compared to other methods. The most obvious con (and the reason I will not use pellets) is the process of it. Pellets must be done in office, the doctor will inject a local anesthetic, make a small incision, and use a tool to insert pellets into the fat between the skin and muscle of your butt. So if you don't want to take injections because of the needles, pellets won't be a good alternative. Pellet insertion is a tricky process to describe, I have linked a demonstration from a popular trans specializing doctor above, as well as images of the tools used.
What to expect from testosterone
HRT impacts everyone's body uniquely but there are changes you can expect to happen within a certain time frame. Taking testosterone essentially causes a second puberty similar to the primary puberty experienced by natal males. Some changes from testosterone are permanent while some will go away in you stop taking it. Along with desired changes there are some changes that might not be ideal, I will cover those as well. As with any medication, there are potential side effects that could impact your health. Testosterone is considered to be a very safe medical intervention but it is still a medical intervention and comes with some concerns.
Changes from T
NECK UP CHANGES
- Change in Face Shape
- Facial Hair Growth
- Change in Hair Texture
- Possible Hair Line Receding
- Voice Drop
GENERAL BODY CHANGES
- Fat Redistribution
- Body Hair Growth
- Changes in Skin
- Increased Muscle Mass
- Increased Sweating
- Change in Smell
- Increased Blood Pressure
- Increased Cholesterol
- Increased Red Blood Cell Count (helps anemia)
SEXUAL CHANGES
- Clitoral/"Bottom" Growth
Bottom growth can be uncomfortable at times but applying ice can help. The average size for bottom growth is 1-4cm
- Cessation of Menstrual Cycle
- Increased Libido
- Changes in Sexuality
- Possible Vaginal Atrophy
If you experience this change and want to treat it, an OB-GYN can prescribe medicated creams to ease discomfort. You may benefit from an estrogen cream which help prevent/stop atrophy.
Timeline and Permanence
Surgery
Surgery is the typically the final and most permanent step to transitioning. FTM and trans masculine people have different options for gender confirmation surgery the most well known are top surgery and bottom surgery. There are other forms of gender affirming procedures like body and facial masculinization, hair transplants, or other filler to square out the face. Surgery is a big step and requires a lot of thought, discussion, professional consultation, and money. Top surgery can be done without being on hormones. Fat redistribution from T may make your chest slightly smaller but being on T is not a requirement for getting top surgery.
Top Surgery
Top surgery is the most common gender affirming surgery sought out by trans men and trans masculine people. Top surgery refers to the surgical removal of breast tissue and the creation of a chest that resembles that of someone born male. There is a common misconception that to get top surgery you must be on testosterone, this is untrue. While fat redistribution from T may make your chest smaller and possible aid in qualifying for different types of top surgery, it is not necessary. Some surgeons may have a personal policy requiring hormones, but I have found that the vast majority do not.
* Other/Hidden Fees include cost of consultation, anesthesia fees, and travel fees
Double Incision
Double incision is one of the most common types of top surgery. Double incision is done by first removing the nipples, making incisions underneath the breast and removing breast tissue, the surgeon may insert drains under the skin to aid in healing, the nipples can be resized and attached or left off, nipple bolsters are stitched on to the graft to minimize the risk of them falling off. During the recovery process you will be asked to wear a compression garment (called the post-op binder). The binder is recommended to be worn for up to a month, drains, and nipple bolsters are worn for a week before they are removed. There are restrictions on movement/lifting for about 6 weeks following the procedure. You may return to work after about 1-2 weeks post op. Double incision is preferred because it can be done no matter what size your pre-op chest is. Because there are large incisions there will be scars usually two curved scars directly beneath the pec muscle, surgeons can make the scars deeper u shapes or straight across depending on patient request. If you have a larger chest or more breast tissue in the middle of your chest you may get one large incision across your chest.
One week post-op
There are some risks with double incision, but overall it is a very safe procedure. There is risk of nipple graft rejecting and falling off, or loss of long term sensation post op. Note however that you will have decreased/no sensation for a period of time post-op but in most cases in returns. One of the cosmetic risks is something called dog ears, small pieces of skin that stick out on the sides of your chest, these can be removed with additional minimally invasive surgeries, sometimes not even requiring general anesthesia. One of the more serious risks is hematoma following surgery, in some cases they can resolve on their own but sometimes require additional surgery to fix.
If you choose not to get nipple grafts, you can go on to get medical tattooing to create the appearance of nipples.
The following pictures are taken from the gender Confirmation Center who performed my top surgery, and my own pictures at 1 week and 1 year post-op. For reference, I had a 32DD chest before my top surgery
One year post-op. Note that some body shape changes are due to beginning testosterone after top surgery
Periareolar
Periareolar top surgery, also called peri, is one of the main three top surgery types that are performed. A reason it is less common than double incision is because it requires having a small chest pre-op and a certain amount of skin elasticity. In peri the nipple is left attached, a larger circle is cut around the nipple, tissue is removed and the remaining skin is pulled toward the nipple and is reattached. The Gender Confirmation Center describes this with: "it mimics the act of pulling a drawstring bag closed." It is likely that you will also have to wear a post-op binder after peri top surgery, it may be worn slightly longer than with double incision but it varies between surgeons. The movement restrictions last about the same time as double incision, about 6-8 weeks. You can return to work 1-2 weeks after surgery. The only scaring with peri is around the nipple which means it is very discreet after healing is done.
Keyhole isn't as common as the other two because it requires such a small chest to begin with. Like all other surgeries there are risks. The cosmetic concern with keyhole is associated with the fact that there is no skin removal so there is a possibility of looser skin on the chest. And because the opportunity for nipple customization is reduced there can be concern of prominent nipples
The risks of surgery are similar to any time you have an anesthesia event. Because the nipple stays attached there is no risk of losing nipple sensation or having the nipple fall off. The cosmetic concerns associated with peri are puckering around the nipple and the fact that nipple size is not changed, they might appear larger than a cisgender man's nipple, or might be lower than ideal. Revisions are very common with periareolar top surgery with a revision rate of 40-60%
Keyhole
Keyhole is the third of what I like to call the big 3 top surgeries. Key hole requires a very small chest and high skin elasticity pre-op. In keyhole an incision is made around the base of the areola and sometimes on the side of the chest by the armpit. Liposuction is used to remove breast tissue and the incisions are closed. With keyhole, unlike double incision and peri, there is no removal of excess skin. You may be able to have some nipple resizing but not to the degree possible with double incision. Like peri the nipple is left attached so sensation is maintained. A post op binder is worn after keyhole for a longer time, an average of 1-6 weeks. The movement restriction are the same as the others 6-8 weeks. With keyhole you can return to work after about 2 weeks. The scarring with keyhole surgery is almost invisible.
Inverted T and Buttonhole
Inverted T top surgery and Buttonhole top surgery are very similar procedures, the only difference is buttonhole does not have the vertical incision present with inverted T. Inverted T looks similar to double incision but keeps the nipple attached and involves a vertical incision to help the surgeon remove tissue and mitigate skin draping. Even though the nipple stays attached there is a higher chance that there will be decreased or lost nipple sensation. Inverted T is almost the opposite of keyhole in terms of requirements, it is preferred because it is efficient for patients with large chests with low skin elasticity. Buttonhole as mentioned is almost the same but because there is no vertical incision there is less skin removal.
Buttonhole
As mentioned, both buttonhole and inverted T have chances of decreased or loss of nipple sensation, the risks however are less than those associated with double incision.
Inverted T
Fishmouth
Fishmouth is very rarely used. First the nipples are resized and the outer layer of skin surrounding them is removed but is kept anchored to the body. An ellipsis around the base is removed and the tissue is removed. The incision is closed over top of the nipple. The skin directly above the nipple is then removed allowing it to be visible. Drains may be inserted. This technique results in scars that go through and around the nipple, significantly higher than the scars from double incision. A post op binder is used for the same duration as the others, with the same movement restrictions.
The biggest concern with fish mouth is the shape and location of the scars. They are quite prominent and in a non-anatomical location. These scars are the reason that fish mouth is one of the least commonly performed type of top surgery.
Lollipop
Lollipop top surgery is like a slightly altered form of peri. The same circle of skin is excised around the nipple with some resizing to the areola. The bottom of an oval is then cut out of the lower side of the chest connected to the areolar incision. Tissue is removed, and the remaining skin is joined together creating the same scar as a peri top surgery but with a vertical incision coming from the bottom of the nipple. This surgery is good for people that have smaller chests but who do not qualify for periareola top surgery as it allows for more skin removal. The healing process is therefore very similar to peri top surgery, drain are not used but there is a possibility that you will need a post op binder. The recovery process follows the same timeline as all other types.
The cosmetic concern is the vertical incisions and scars, however some people prefer it because it is not as easy to spot as top surgery scars the way that double incisions is.
Bottom Surgery
Bottom Surgery, is the gender affirming surgery that takes natal female genitalia creates that mimic those of a natal male (a phallus and testicles). Bottom surgery methods allow for grafts to be used to create a more standard sized phallus, or can work with the growth from testosterone making a phallus resembling a micropenis. Bottom surgery can also include hysterectomy, oophorectomy, and vaginectomy.
* Other/Hidden Fees include cost of consultation, anesthesia fees, travel fees, treatment for complications, additional procedures (glansplasty, urethral lengthening, testicular implants), and medical tattooing
Phalloplasty (Phallo)
Phalloplasty is the more invasive, risky, longer type of bottom surgery. Phalloplasty is the term covering all types of phalloplasty like RFF, ALT, ABDO, and MLD. All types use a skin flap from a donor site on the body to create a phallus. Phalloplasty can also involve urethral lengthening (UL), allowing you to be able to pee standing up. Phalloplasty is a multistage procedure, having a total of three stages. The stages involve creating the phallus, skin grafting to the donor site, urethral lengthening, creating the tip of the penis (glansplasty), creating the scrotum, placing testicular implants, removing the vagina, uterus, and ovaries, and placing erectile implants. Stage 1 of phallo is the initial grafting to create a phallus. Stage 2 of phallo is done 5-6 months after the first surgery, and stage 3 12 months after stage 2. Following Stage 1, you will also have a catheter and may need it further if you get UL. Phalloplasty is a risky surgery, the most common complication occurring in those that chose to get UL who develop fistulas in the urethra. A fistula is the unusual connection from the urethra to another part of the body. The other common issue is failure of the flaps used in creating the phallus. While it is risky and has a long recovery process (5 days in the hospital following surgery, 6-8 weeks until you can return to work, and up to 18 months for the phallus to return to baseline), it produces the most cis looking phallus in terms of length and girth. Once recovered it can be used for penetrative sex compared to metoidoplasty which usually does not illicit this result. It is also the best surgical option if you want UL, it is not a guarantee that you can get it with metoidioplasty.
TYPES OF PHALLO:
RFF:
RFF phalloplasty stands for radial forearm flap. It uses a graft from the forearm (wrist to mid forearm) taking skin, fat, arteries, and veins to create the phallus. Another skin graft is used to cover the donor site. This is the most common type of phalloplasty. For RFF your surgeon will check the blood flow and nerve connection on the donor site. Before you can get RFF you must undergo electrolysis to remove the hair from the donor site.
ALT:
ALT is anterolateral thigh flap phalloplasty. The graft takes the same material as in RFF but from the thigh. A skin graft is also used over the donor site. ALT is less common because it requires a certain amount of blood flow and existing material, measured with a pinch test. Before you can get ALT you must undergo electrolysis to remove the hair from the donor site.
ABDO:
ABDO or abdominal phalloplasty doesn't use a graft but instead makes incisions in the supra-pubic area to create the phallus, this avoids the prominent scars associated with other phalloplasty methods. While this is nice, ABDO means that you won't have erotic sensation in the phallus, and urethral lengthening is not an option. The urethra will stay in its original position. Before you can get ABDO you may have to undergo electrolysis to remove the hair from the supra-pubic area.
MLD:
MLD is musculocutaneous latissimus dorsi skin flap. The procedure is like RFF and ALT except the graft is taken from the side of the back and does not require an additional skin graft. Like ALT the surgeon will have to check the blood flow to the site. Before you can get MLD you may have to undergo electrolysis to remove the hair from the donor site.
Phalloplasty Scars
RFF Phallo
ALT Phallo
MLD Phallo
ABDO Phallo
Metoidioplasty (Meta)
Metoidioplasty is a far simpler procedure than phalloplasty. It involves cutting ligaments in a process called "clitoral release", the surgeon will then use the existing tissues to create a shaft around the clitoral growth from testosterone. In some cases, you can also get urethral lengthening, for this the surgeon will use a graft from the inside of your cheek, but the same risks apply as with UL in phalloplasty. In later surgeries you can get a scrotoplasty using the outer labia and scrotoplasty implants. A full metoidioplasty involve a vaginectomy but that is not required. Implants will typically be done in a different surgery from the initial procedure. The recovery is far easier than phalloplasty. Meta is done as an outpatient procedure so you won't have to stay in the hospital post-op. The stages can be done as little as a few months apart. Recovery will be a bit more complicated if you decide to get urethral lengthening. Because meta uses the existing anatomy, sexual sensation is maintained. The con of meta would be the size, the size of the phallus post-op is dependent on your size from bottom growth going into the surgery. Typically the phallus is between 1 and 3 inches, some surgeons can add a few centimetres of size ion girth, but otherwise the size is still relatively small and is almost always not usable for penetrative sex. The best way to describe it is as a micropenis. SO when choosing between the two bottom surgeries it comes down to preference in size compared to the risks of getting a more complex surgery like phallo. Price also plays a role, meta, while still expensive, is significantly cheaper than phalloplasty.
Other Surgeries
While we have talked about the common transitional surgeries, there are other gender affirming surgeries that people may want to access. These tend to be more under the category of cosmetic. Typically, they are also surgeries that cis men might seek out, and usually are far less invasive.
Body Masculinization /Contour
Body Masculinization surgery is done by removing fat from areas of the body that are considered "feminine" and possibly moving them to more "masculine" areas of the body. This is essentially liposuction in targeted areas to create a more "male body shape". Usually fat will be taken from around the hips, thighs, legs, and butt. This is a minimally invasive surgery with a speedy recovery time, you can walk around the same day you get it, light activity is possible within days, and you'll have light lifting restrictions for 3-6 weeks.This surgery will run between $8-9,000 out of pocket.
Before and After Body Masculinization Surgery
Facial Masculinization (FMS)
Facial Masculinization is a surgery done on the face to create a more angular and masculine looking face/face shape. It can involve reshaping bone and soft tissue to create more defined: cheeks, chin, forehead, nose, throat, or jawline. This is a more invasive process than body masculinization but still recovery is only about 2-6 weeks depending on how much you get done. Do note that these changes will be permanent. This is not a specific "trans surgery" so this can be done by almost any qualified plastic surgeon. This surgery can be costly at around $20-30,000 without insurance.
Before and After FMS of the jaw and chin