Information collection made by and for the trans community.
MTF Transition
This page contains information on hormones, surgeries, and more for trans women and trans feminine individuals. Content warning for talk about and images of genitalia and medical procedures.
Beginning Your Transition
Tucking
Tucking is the process of concealing the bulge created by natal male genitalia. This can be done with tap, gaffs, or tucking underwear. Not all trans woman or trans feminine people find tucking necessary, but it can be helpful for the comfort of some. Many trans people have also explained that they find it a good safety tool to prevent getting targeted in public.
Safety
Should you choose to tuck, there are some safety items that you should know. If you've looked into tucking at all, you've likely heard these a million times, but they are important to make sure that no temporary or permanent damage is done to your body. Tucking can cause damage to your body, these are only made worse when tucking unsafely. Some risks of tucking include UTIs, general issues with urine flow, fungal infections, or testicular twisting/inflammation.
1.If you use tape, DO NOT use duct tape, electrical tape, vinyl tape, or any tape other than those designed to be used on the body, Non-medical grade tape can cause reactions on your skin and cause issues when untucking.
2. Do not tuck while sleeping, and take care about how tight you tuck when exercising or swimming.
3. Tuck for no more than 8 hours a day.
4. Do not push your body past its limits. Don't push or pull things to the point of pain or extreme discomfort.
Tucking is not comfortable but it should not be painful. If you feel any pain, stop tucking immediately, If the pain continues, seek medical care. Tucking in general can cause reductions in your fertility, if you are interested in having biological children, it might be best to avoid tucking or to use a sperm bank if you can.
Methods for Tucking
The first step to all of these methods is placing the testes into the inguinal canal. This is the space that they were in before dropping. If you've ever worked out extremely hard or jumped into cold water, you are familiar with the sensation of the testes up into the inguinal canal. To get them into the canal, place two or three fingers on the testicles and gently guide them up into the canal. This can be easier if you lay down, but it can be tricky to get the hang of at first. It may be uncomfortable but it should not cause pain. This step of tucking can be skipped but it may cause results to be less flat or smooth. If you choose to skip this part, simply push the testes to the sides when tucking.
TAPE
Before tucking with tape, make sure that you have removed hair from the tucking area, this will make the untucking process easier and less painful. With the testes secure in the inguinal canal, guide the penis back and between the legs, ideally this will help keep everything in the canal. You can wrap the scrotum around the penis. Using medical safe tape, place one end on the upper pubic area. For comfort, you can place a protective barrier between the skin and the tape, this is accomplished by placing the barrier on the tape once it is attached to the pubic area. Pull the tape back, over the penis and back securing the tape above the buttocks. You can place additional pieces of tape along the sides of the original, to help secure the tuck. This method is preferred as it allows for maximum control over the tuck. However, you cannot use the bathroom when tucked this way. Linked below is a more in depth instructional sheet, created by a brand that also sells tape specifically for tucking.
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As for untucking, peel the tape off slowly. If you have trouble removing tape, you can apply a wet washcloth or soak in warm water to loosen the tape. You can also use medical adhesive remover.
Alternatives
UNDERWEAR/GAFF
Gaffs are compression undergarments worn to conceal the bulge of natal male genitalia. They can be their own piece of fabric worn under normal underwear or more commonly are built in to the underwear, these can be called tucking underwear. Once the testes are in the inguinal canals, move the penis back and between the legs, hold this in place before stepping into the gaff/underwear. Pull it up as normal. These may not be quite as secure as tape, but it certainly is easier and you can use the bathroom wearing them. Looking through reviews, there are some common favourites shown below.
If taping isn't something you are interested in, and you aren't able to get tucking underwear, there are some alternatives. They may not work as well as specific tucking products, but they will do the job. in a pinch
SPANX/TIGHTS
Using a simple pair of Spanx can help with smoothing and shaping. In the same vein, wearing one or two pairs of tights or pantyhose can have the same effect. You can find tutorials online for making your own gaff using these materials.
PANTIES
Wearing one tight pair of normal panties can help with security, or wearing two pairs of normal underwear can help with concealment. You can also use a bikini bottom as underwear, this can help because of the tightness
DANCE BELTS
A dance belt is a tight garment worn by dancers with AMAB genitals. It is designed to secure and smooth out the appearance of a bulge when worn under tights. In a pinch the smoothing effect and the compression can also aid in tucking.
Chest Padding
Padding is the use of certain padding tools to create the appearance of breasts for those with flat chests, or minimal growth from hormones. Padding is a great way to alleviate chest dysphoria in trans women and trans feminine people.
Ways to Pad
There are different things you can use to pad ranging from budget conscious to more expensive.
PADDED BRAS
The easiest way to pad is simply by wearing a padded bra. While it may not provide the appearance of a large chest, it definitely gives something. You can find padded bras essentially anywhere and in different styles. For extra size you can use padded push-up bras or if you don't want to use padded bras, simply a push-up bra. These are also nice as they can provide room to grow into as you get growth from HRT
STUFFING
INSERTS
For extra padding you can stuff you can stuff your bra. There are many different ways to do this. Some people chose to use tissue, others socks. Some people also just double up on bras for extra volume. The only thing to keep in mind with this method is practice. It is easy to overstuff or place the stuffing in an odd position which can make the final product look suspicious. It is best to start slow and do trial runs at home.
Another way to pad is using breast inserts. These come in varying price points and with varying amounts of realism. Some have adhesive so you can simply adhere them to your skin, others may need to be held in place with the use of a pocket bra, which can be found in multitudes online. You can also use double sided tape to make non-stick inserts sticky, just be careful if you have sensitivities to adhesive. If your skin is sensitive you can also pick up medical adhesive as an alternative to tape.
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A simple internet search turned up some of these insert options:
Blockers
Hormones
Trans women and trans feminine 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.
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For AMAB bodies, there is an additional concern that if blockers are started too soon, and testicular growth is stunted, certain types of bottom surgery will be more difficult or even impossible.
Feminizing Hormones
Hormone Replacement Therapy is for people with AMAB bodies that want to develop more feminine features and the secondary sex characteristics of a cis woman. HRT for trans women and trans feminine people is more than just taking estrogen. It is a three step process, beginning with taking testosterone blockers, then you can add estrogen, finally after prolonged estrogen use you can begin progesterone.
T BLOCKERS
Before you can begin taking cross-sex hormones you have to suppress the hormones already in your body. To do this you will take an anti-androgen. The most common being Aldactone (Spironolactone). Spironolactone is taken as a tablet in high doses to reduce the amount of testosterone in your body. After somewhere between 4-8 weeks of taking Spironolactone you can begin estrogen. Note that as long as you want to be on feminizing hormones you will have to continue taking T blockers. Spironolactone typically costs between $15-25 out of pocket.
ESTROGEN
AMAB people that want to appear more feminine and develop female secondary sex characteristics can choose to start taking synthetic estrogen (Estradiol). There are many different ways for someone to take estrogen, 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 estrogen.
Injection
One way to take estrogen is through injections. There are two types of injection -- Intramuscular (IM) and subcutaneous (SubQ). Intramuscular injections are injections that deliver the estrogen into the muscle. Subcutaneous on the other hand are injected beneath the skin into the fat.
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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 estrogen injections is potential allergens. The estrogen is suspended in oil, cottonseed or castor depending on what type. 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 fact that injection estrogen is that it bypasses the digestive system. With oral estrogen the levels depends on the digestive system for the hormone to enter the body while injection introduces it quickly. Another benefit is the frequency, estrogen 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.
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 an oral or topical delivery, 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 estrogen is transdermal methods. Transdermal refers to the process of absorbing medication through the skin. There are three options for transdermal estrogen: gel, patch, and spray. The gel is known commonly by the brand name EstroGel.
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Transdermal estrogen is applied to dry skin daily, typically applied to the upper arm. Estrogen 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 weekly or twice a week. It can be kept on for swimming, exercise, and most other activities. Lastly is estrogen spray. Spray is applied to the skin each morning.
Pros of Transdermal
The obvious advantage of transdermal estrogen 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 estrogen is very easy, fast, and does not require a healthcare professional to deliver it. Transdermal estrogen is done either daily or every few days so it can be easier to remember.
Cons of Transdermal
A concern for transdermal estrogen is transference, especially if you choose to use gel or spray. The risk is highest with children and pets. The gel can be transferred from your hands or arm to other people directly or via shared objects in your household (towels, blankets, etc). To mitigate these risks you must be sure to rub in the gel completely and wash your hands thoroughly after application. If you are using spray make sure it is dry before continuing on with your day. The last con is the fact that it must be applied more often than injection and application takes longer than oral estrogen does.
Oral
Oral estrogen is exactly as it sounds, estrogen taken by mouth. The most common ways to take estrogen is with an estradiol tablet (Brand names: Estrace, Ovocyclin, and Progynova). It is taken daily. And estrogen is released into the body via the digestive system.
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The tablets start at 2-4mg daily and can go up to 8mg.
Pros of Oral
The obvious advantage of oral estrogen, like transdermal, 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 oral estrogen is very easy, fast, and does not require a healthcare professional to deliver it. Oral estrogen, being the most common form is easier to get in pharmacies compared to other methods of delivery. Oral estrogen is nice because the tablet is taken regularly at the same time each day. This type of delivery is nice as it keeps your hormone levels regular, there are no highs and lows like those associated with injection.
Cons of Oral
A con of oral estrogen is the demographic that it is best for. Oral estrogen is not recommended for people with liver issues or those above a certain age, typically over 45. For people in this demographic or for women with a history of heart/liver problems transdermal estrogen is considered the safest route. The last con of estrogen is that it has to go through the digestive system before it is absorbed into the body. The time it takes for the estrogen to be delivered is longer than injections.
Pellet
One of the newer forms of E that people are using is the pellet. The estrogen pellet is about as it sounds a pellet of estrogen that is inserted under the skin in the buttocks. The pellets slowly dissolve delivering estrogen over longer periods of time. This is done in a doctor's office and requires numbing injections prior to insertion.
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The pellet is the least common way of taking estrogen, personally, I don't know anybody that uses the pellet. It is typically used by people that have been on estrogen 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 estrogen, which prevents some of the peaks and crashes in 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 200$ per pellet (usually you have two pellets inserted per session). 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 of pellet insertion above, as well as images of the tools used.
What to expect from estrogen
HRT impacts everyone's body uniquely but there are changes you can expect to happen within a certain time frame. Taking estrogen essentially causes a second puberty similar to the primary puberty experienced by natal females. Some changes from estrogen 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. Estrogen is considered to be a very safe medical intervention but it is still a medical intervention and comes with some concerns.
Changes from Estrogen
NECK UP CHANGES
- Change in Face Shape
- Facial Hair Thinning
- Change in Hair Texture
- Stopping of Hair Line Receding
- More Emotional
GENERAL BODY CHANGES
- Breast Growth (increased with progesterone)
- Fat Redistribution
- Body Hair Thinning
- Changes in Skin
- Decreased Muscle Mass
- Decreased Sweating
- Change in Smell
- Decreased Blood Pressure
- Decreased Cholesterol
- Decreased Red Blood Cell Count (worsens anemia)
SEXUAL CHANGES
- Genital Shrinkage
- Possible PMS/PMDD Symptoms
- Decreased Libido (helped by progesterone)
- Decreased Spontaneous Erections
- Possible Change in Sexuality
- Possible Testicular Atrophy
- Decreased Sperm Count
Concerns about performance on Estrogen can be discussed with your doctor, it may be worth it to ask about erectile dysfunction medication (Viagra)
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Timeline and Permanence
PROGESTERONE
Progesterone is not a necessary step in taking feminizing hormones, some doctors consider it a non-standard course of treatment. Progesterone is added to the hormone regiment after estrogen levels have levelled out, typically at least 6 months of being on estrogen.
Progesterone is taken as a pill, costing about $18-20 for 30 capsules.
There are no major changes from progesterone the way there are for estrogen. On progesterone you should notice: changes form estrogen happening faster, decreased testosterone production (typically not enough to stop use of T-blockers), further breast growth, increased bone density, better sleep, and an increase in cardiovascular health. It may also decrease male pattern hair growth in some people.
Nonsurgical Procedures
Laser/Electrolysis
Laser Hair Removal and Electrolysis are both used to reduce or remove unwanted body or facial hair.
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Laser Hair removal is considered a reduction of hair as opposed to a total elimination. Laser works best on dark hair and light skin and doesn't work for people with blond, white, grey, or red hair. Laser works by using light to target melanin in hair. Laser is not a one time procedure, it is done in 6-8 sessions (30-60 minutes) with 4-8 weeks between each session.
Laser costs depend on location. Typically facial laser hair removal will be $150 per session. Prices increase as more areas are targeted on the highest end being $1000 a session for full body treatment. In the end, it also depends on where you go for treatment.
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Electrolysis is the permanent removal of hair. It works on all types of hair. Electrolysis uses a fine needle to deliver electric currents to the hair root of each follicle. It is done with an average of 10-14 sessions (lasting between 30 minutes to multiple hours), sessions are done every 4-6 weeks. This means a full electrolysis treatment can take upwards of a year.
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Electrolysis costs more than laser in the long term. An hour of electrolysis can be $50-200, keep in mind that a single session may be several hours.
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Laser and/or electrolysis are frequently done before surgical interventions like FFS or bottom surgery.
Voice Training
Unlike testosterone, taking estrogen does not change your voice. This can be frustrating but a lot of trans women and trans feminine people do voice training. Voice training is learning how to adjust how you speak. To get the most out of voice training you should do exercises frequently and consistently.
There are free exercises online that you can use. For the most effective training, you can see a professional voice coach for individual sessions. The cost of voice training classes varies by instructor, prices typically begins at $20-25 per hour.
Surgery
Surgery is the typically the final and most permanent step to transitioning. MTF and trans feminine people have different options for gender confirmation surgery the most well known are FFS, top surgery, and bottom surgery. There are other forms of gender affirming procedures like body feminization, hair transplants, or other filler to round out the face. Surgery is a big step and requires a lot of thought, discussion, professional consultation, and money.
Top Surgery
Top surgery is one of the most common gender affirming surgery sought out by trans women and trans feminine people. Top surgery also called breast augmentation, involves using fat grafting or implants to increase breast size and produce a chest resembling that of someone born female.
* Other/Hidden Fees include cost of consultation, anesthesia fees, and travel fees
Saline Implants
Saline implants are the original type of implant, and the cheapest. They are made of a silicone shell and filled with sterile salt water (saline). When they are inserted, only the shells go in at first, the implant is then filled once the implant has been places. The implants may be inserted sub-muscular or sub-gandular. Sub-muscular may look more natural but recovery is more painful, sub-glandular may be able to accommodate larger implants. Your surgeon can work with you to determine which approach is best. There are four ways for an implant to be inserted. The first is inframammary fold/sub-pectoral. In this method an incision is made in the breast fold. This is the most common approach but it may not be ideal if your breast do not have a fold under their pre-op breasts, if you do not the scar may be more prominent. The next type is trans-axillary, in which the implant is inserted through incisions in the armpit. This method results in no scars on the breast but it may be more difficult for the surgeon to insert the implants symmetrically. If corrective surgeries are required later down the line it is likely that an incision will be made in the breast. The third type is peri-areolar, where the incision is around the nipple, the scar blends in with the edge of the areola. This method is best for women with small breasts (no fold) but runs the risk of damaging nipple sensation.
The last type is trans umbilical breast augmentation (TUBA). TUBA is the least performed type of breast augmentation, and is not recommended by surgeons. It is done via an incision in the belly button, which is why this approach is only available for saline implants. There is an increased risk of damage to the implant with this method and you may need additional incisions on the breast. Saline breast implants are not as widely used as they tend to not look as natural as silicone implants. They can ripple, and some people say they can feel the water in the implant. These implants last 10-15 years. An advantage to these implants is that, in case of rupture, the saline is absorbed by the body and does not pose a health threat. Additionally, because they are filled once they are inserted, the incisions tend to be smaller than silicone implants, and they are the least expensive type of implant.
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Recovery takes about 1-2 weeks before a patient can return to work. It will be six weeks before all movement restrictions are lifted. Everyone's body reacts to surgery differently but it can take about 3 months to see final results. Over the months most patients have full sensation in the breast.
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Saline implants are FDA approved for patients 18 years of age and older.
Silicone Implants
Silicone implants are the most commonly used in breast augmentation, however they do cost more than saline implants. They are made up of a silicone shell (textured or non-textured) and filled with silicone gel. They are inserted fully filled. The implants may be inserted sub-muscular or sub-gandular. Sub-muscular may look more natural but recovery is more painful, sub-glandular may be able to accommodate larger implants. There are three methods for insertion of silicone implants. The first is inframammary fold/sub-pectoral. In this method an incision is made in the breast fold. This is the most common approach but it may not be ideal if your breast do not have a fold under their pre-op breasts, if you do not the scar may be more prominent. The next type is trans-axillary, in which the implant is inserted through incisions in the armpit. This method results in no scars on the breast but it may be more difficult for the surgeon to insert the implants symmetrically. If corrective surgeries are required later down the line it is likely that an incision will be made in the breast. The third type is peri-areolar, where the incision is around the nipple, the scar blends in with the edge of the areola. This method is best for women with small breasts (no fold) but runs the risk of damaging nipple sensation.
Silicone implants are preferred as they tend to look and feel more realistic. On average they last 20-25 years. Should a silicone implant rupture, it may stay rather contained in surrounding tissue (silent rupture). There is a possibility that a rupture can lead to swelling, pain, size/shape change. lumps, and/or hardening. Because the silicone gel can't be absorbed by the body, it is important to monitor for rupture. After a silicone implant is placed, it is recommended that you go in for imaging to make sure the implants are intact. 5-6 years after the surgery you'll go in for either an MRI or an ultrasound, then once every 2-3 years going forward.
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Recovery takes about 1-2 weeks before a patient can return to work. It will be six weeks before all movement restrictions are lifted. Everyone's body reacts to surgery differently but it can take about 3 months to see final results. Over the months most patients have full sensation in the breast.
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Saline implants are FDA approved for patients 22 years of age and older
Cohesive Gel Implants (Gummy Bear)
Gummy bear implants are the newest and most expensive implant type used in breast augmentation. They are made up of a textured silicone shell and filled with a thick silicone gel, this silicone is thicker than that used in a typical silicone implant. The silicone filling is a firm cohesive gel. They are inserted fully filled. The implants may be inserted sub-muscular or sub-gandular. Sub-muscular may look more natural but recovery is more painful, sub-glandular may be able to accommodate larger implants. There are three methods for insertion of silicone implants. The first is inframammary fold/sub-pectoral. In this method an incision is made in the breast fold. This is the most common approach but it may not be ideal if your breast do not have a fold under their pre-op breasts, if you do not the scar may be more prominent. The next type is trans-axillary, in which the implant is inserted through incisions in the armpit. This method results in no scars on the breast but it may be more difficult for the surgeon to insert the implants symmetrically. If corrective surgeries are required later down the line it is likely that an incision will be made in the breast. The third type is peri-areolar, where the incision is around the nipple, the scar blends in with the edge of the areola. This method is best for women with small breasts (no fold) but runs the risk of damaging nipple sensation. In all of these methods, the nature of the implants may require a larger incision, which risks more prominent scarring.
Gummy bear implants are preferred as they tend feel the most realistic, leaving a soft to the touch sensation. Since the gel is firmer they also hold their shape extremely well. On average they last upwards of 20 years. Their construction means that these implants are less likely to rupture. Should a gummy bear implant rupture, it is less likely to leak, but it still can. There is a possibility that a rupture can lead to swelling, pain, size/shape change. lumps, and/or hardening. Because the cohesive silicone gel can't be absorbed by the body, it is important to monitor for rupture. After a silicone implant is placed, it is recommended that you go in for imaging to make sure the implants are intact. An average of 3 years after the surgery you'll go in for either an MRI, then once every 2-3 years going forward.
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Recovery takes about 1-2 weeks before a patient can return to work. It will be six weeks before all movement restrictions are lifted. Everyone's body reacts to surgery differently but it can take about 3 months to see final results. Over the months most patients have full sensation in the breast.
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Saline implants are FDA approved for patients 22 years of age and older
Fat Grafting
Unlike the other forms of breast augmentation, fat grafting does not require any foreign materials being placed in the body. A fat grafting augmentation is done by using liposuction to harvest fat from one or more parts of the body, the fat is then injected into your breasts. This method is considered to be fairly pain free compared to other forms of breast augmentation. It involves very slight scarring, and lasts for life. But, this approach does not allow for as large a change as an implant. For reference, one typically increases 1-2 cup sizes after fat grafting. Should you chose, you can get fat grafted over existing implants. This approach may not be as successful if you have particularly tight skin or if you don't have a significant amount of fat available for harvesting.
Recovery for fat grafting takes 1 week, with movement restrictions lasting 3-6 weeks. At this point, all major swelling should be gone and you can see the final results.
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This approach can be done at ages 18+
Bottom Surgery
Bottom Surgery, is the gender affirming surgery that takes natal male genitalia creates that mimic those of a natal female. Bottom surgery methods allow for current genitalia to be used to form a clitoris, labia, vulva, and a vagina. Bottom surgery can also include Orchiectomy, penectomy, and vulvoplasty. Moving forward just a TW that there will be discussion of surgery that can be a bit graphic.
*Other/Hidden Fees include cost of consultation, anesthesia fees, travel fees, treatment for complications, and additional procedures
Vaginoplasty
Vaginoplasty is the surgery that involves the removal of the penis, testicles, and scrotum. The current anatomy is rearranged to create a vagina, clitoris, and vulva. There are different types of vaginoplasty: penile inversion, rectosigmoid, dimple, and Supron technique. The removal of the testicles (orchiectomy) can be done before a vaginoplasty or at the same time. Each type has its own pros and cons. Vaginoplasty is a fairly safe procedure, and is much simpler compared to FTM bottom surgeries. The most common risks from a vaginoplasty are bleeding, infection, stricture, necrosis, urinary issues, fistulas, and vaginal prolapse, but again these are not very common. On the highest end the rates of complication are 15%, while this seems high the most common complications are easily manageable (bleeding and infection). Before a vaginoplasty, you will have to have hair removal on any part of external anatomy that will be made internal. Recovery for a vaginoplasty is long. Following surgery you will stay in the hospital for 5-6 days and will have a catheter and drains placed. These will be removed upon discharge. It takes 6-8 weeks to recover. Beginning at 8 days post-op you will be asked to douche at least once a week. During the first few weeks post-op you will need to dilate twice a day for 15 minutes. Dilation involves inserting a dilator into the vagina to make sure it stays open. Dilation is going to be a part of post-op maintenance forever, but the frequency does decrease as time goes on. As you continue with dilation the size of the dilator will increase. A typical dilation schedule is: months 0-3/3x a day with a 1-1/8" dilator, months 3-6/Daily with a 1-1/4" dilator, months 6-9/every other day with a 1-3/8" dilator, months 9+/1-2x a week with a 1-1/2" dilator.
SUPORN TECHNIQUE:
The Suporn technique also known as the Chonburi Flap, was created by Dr. Suporn Watanyusakul. This is a non-penile inversion method of vaginoplasty. Using an incision between the rectum and prostate, perforated scrotal skin is used as the vaginal lining. The remaining intact skin makes up the labia majora. Penile tissue is used to form the labia minora and clitoral hood, the head of the penis becomes the clitoris. This method is preferred because it is said to provide greater depth, more sensation in the inner labia, and better cosmetic results. This method is newer and the reviews are mixed as it can be hard to find surgeons that perform this surgery. Before opting for the Suporn method, make sure you do your research on what surgeon you'll be seeing and what former patients of them have to say.
TYPES OF VAGINOPLASTY:
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PIV:
PIV stands for Penile Inversion Vaginoplasty. This is the most common type of vaginoplasty. In PIV the head of the penis is used to create the clitoris, the surgeon will make an incision between the rectum and prostate, this tunnel will become the new vagina (neo-vagina) the skin from the penis and/or scrotum is used to line the tunnel, thus the name penile inversion. If there is not enough skin your surgeon may use a graft from another part of your body. The remaining skin is used to make the labia majora and minora. This approach has a drawback in that the vagina will not have natural lubrication
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RECTOSIGMOID:
With rectosigmoid vaginoplasty, the head of the penis is used to create the clitoris, an incision is made between the rectum and prostate, at the same time the surgeon will remove about 6" of your sigmoid colon. This will be used as the lining of the new vagina. The remaining skin is used to create the labia majora and minora. This approach is good for people that may not have enough skin for PIV, it is also liked because the mucus from the colon allows the neo-vagina to have natural lubrication.
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ZERO DEPTH/DIMPLE:
Zero depth vaginoplasty is exactly what it sounds like. The head of the penis is made into a clitoris, the penis and testicles are removed and used to create a labia majora and minora, and no vaginal canal is made. This approach is preferred in older patients, or those who don't want to have vaginal sex. This method also means you won't need to dilate.
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These are vaginal dilators
Other Surgeries
Most people focus on top and bottom surgery as the only forms of gender confirmation surgery, but there are more. Especially for trans woman and trans feminine people, facial surgery is a big step in transition. On a smaller scale, there is also body feminizing contour. Both of these surgical options can relieve lots of dysphoria.
Facial Feminization Surgery
Facial feminization surgery, commonly called FFS, is an often sought out surgery. It is an umbrella term for multiple different procedures that work to make the face, hairline, and neck more feminine. FFS can be done in different stages with each procedure or as one, it depends on what you want done as well as the opinion of your surgeon. In general, FFS involves reshaping bone and soft tissue. FFS can include hairline and forehead contour, brow and eye lift, a rhinoplasty (a nose job), jaw contour, chin reduction, and a tracheal shave (reduction of the Adam's apple), and liposuction/fat grafting. FFS doesn't have to involve all of these, it is all dependent on what results you want from the surgery. Whatever incisions are made during FFS are masked and won't be noticeable. FFS recovery is about 2-4 weeks depending on what you get done. Each person's recovery is different and swelling may last longer than the recovery period. During recovery you may have drains placed. Because it is not one uniform procedure, the price of FFS ranges widely, without insurance can cost between $20,000-30,000.
Body Feminization/Contour
Body Feminization surgery is done by removing fat from areas of the body that are considered "masculine" and possibly moving them to more "feminine" areas of the body. Essentially targeted liposuction and fat grafting to create a more "female body shape". The fat is typically moved to the hips, buttocks, and abdomen creating a curvier appearance. Body contouring is not as invasive as FFS, during recovery you'll have to wear a compression garment and can return to work after about 2 weeks. In the weeks following surgery swelling and bruising are to be expected. Out of pocket, body feminization surgery can cost between $3,000-15,000.
