Female-to-male surgery is a type of gender-affirmation or gender-affirming surgery. There are multiple forms of gender-affirming surgery, including altering the genital region, known as “bottom” surgery.
There are multiple forms of gender-affirming surgery, including the removal of breasts — a mastectomy — and the altering of the genital region, known as “bottom” surgery.
Examples of bottom surgery include:
- removal of the uterus called a hysterectomy
- removal of the vagina, known as a vaginectomy
- construction of a penis through metoidioplasty or phalloplasty
This article describes female-to-male gender-affirming surgeries. It also discusses recovery and what to expect from a transgender penis.
Before having female-to-male gender-affirming surgery, a person will often receive testosterone replacement therapy (TRT).
They may then undergo one or more of the following types of procedures.
Chest restructuring or top surgery
A person in transition may wish to have a subcutaneous mastectomy to remove breast tissue. The surgeon will also make alterations to the appearance and position of the nipples. Many people refer to these procedures as “top surgery.”
Meanwhile, TRT will stimulate the growth of chest hair. A
Removal of the uterus, ovaries, and fallopian tubes
A person may wish to undergo this type of surgery if they are uncomfortable having a uterus, ovaries, or fallopian tubes or if hormone therapy does not stop menstruation.
In a partial hysterectomy, a surgeon will remove only the uterus. In a total hysterectomy, they will also remove the cervix.
A bilateral salpingo-oophorectomy involves the removal of the right and left fallopian tubes and ovaries.
Metoidioplasty
A metoidioplasty is a method of constructing a new penis, or neopenis. Research from 2021 shows this procedure has a low risk of complication and a high satisfaction level. A metoidioplasty has positive cosmetic and functional outcomes.
This procedure involves changing the clitoris into a penis. A person will receive hormone therapy before the surgery to enlarge the clitoris for this purpose. During the procedure, the surgeon also removes the vagina in a vaginectomy.
In addition, they lengthen the urethra and position it through the neopenis. To achieve the lengthening, the surgeon uses tissues from the cheek, labia minora, or other parts of the vagina. The aim of this is to allow the person to urinate while standing.
An advantage of metoidioplasty is that the neopenis may become erect due to the erectile abilities of clitoral tissue.
Phalloplasty
A phalloplasty uses grafted skin — usually from the arm, thigh, back, or abdomen — to form a neopenis. Compared with a metoidioplasty, a phalloplasty results in a larger penis. However, this neopenis cannot become erect on its own.
After a period of recovery, a person can have a penile implant. This
Disadvantages of a phalloplasty include the number of surgical visits and revisions that may be necessary, as well as the cost, which is typically higher than that of a metoidioplasty.
Scrotoplasty
A person may decide to have a scrotoplasty — creating a scrotum — alongside a metoidioplasty or phalloplasty.
In a scrotoplasty, a surgeon hollows out and repositions the labia majora to form a scrotum and inserts silicone testicular implants.
The recovery time from female-to-male surgery varies, depending on the type of procedure and factors such as the person’s overall health and lifestyle choices. For example, smoking
Following gender-affirming surgery, most people need to stay in the hospital for at least a couple of days.
After leaving the hospital, the person must rest and limit strenuous activity.
Complications
As with any surgery, all gender-affirming surgeries carry a risk of:
- infection
- bleeding
- reactions to anesthesia
Some complications of a metoidioplasty or phalloplasty include:
- Urethral fistula: A tunneled connection that forms between the urethra and another part of the body.
- Urethral stricture: A narrowing that causes a blockage of urine flow within the urethra.
A person who has had a phalloplasty may experience scarring in the area where the surgeon has taken the graft or a skin graft failure.
A person who undergoes a metoidioplasty may have erections and enjoy more sensation in their neopenis. However, the penis will be relatively small in size. A neopenis that results from a phalloplasty is usually larger, though it may be less sensitive. To have erections, a person will need a penile implant.
These procedures
A 2018 study found that 94–100% of participants who had undergone gender-affirming surgery reported satisfaction with the surgical results, with the variance depending on the type of procedure.
The 6% of people who reported dissatisfaction or regret did so due to preoperative psychological symptoms or complications following the procedures.
The outlook for female-to-male surgery depends on the type of surgery, the person’s health, and other factors.
It is important to work closely with a qualified plastic surgeon, urologist, gynecologist, and mental health professional to ensure the best outcome.
It is also essential to follow recovery guidelines and attend all follow-up appointments.
There are several types of gender-affirming surgeries that a person can help a person during a transition.
These procedures broadly fall into top or bottom surgery. Top surgery is a colloquial term for chest restructuring procedures, while bottom surgery refers to operations changing genitalia. There are multiple forms of both surgeries and can include the removal of breast tissue and the creation of a penis.