FtM Gender-Affirming Surgery: Masculinising Options Explained

FtM (masculinising) gender-affirming surgery covers chest (top) surgery, hysterectomy, metoidioplasty, and phalloplasty; chest surgery is the most commonly sought of these for trans men. Not everyone has all, or any, of them; surgery is one option among many, not a requirement of being a trans man¹. All are accessed through an assessed pathway under the WPATH Standards of Care, Version 8 (SOC-8), 2022².

I am a trans woman, so I write this overview from the shared parts of the journey, the assessment and the pathway I know first-hand, and from listening carefully to trans men who have been through the operations themselves. This guide is reviewed by a consultant gender-affirmation surgeon for clinical accuracy. For the central picture across all of gender-affirming surgery, start with our overview of gender-affirming surgery.

What is FtM gender-affirming surgery?

It is the group of masculinising surgeries that align the body with a trans man’s gender, ranging from chest surgery to genital surgery. The main procedures are:

• Chest (top) surgery: removes breast tissue and contours a masculine chest.
• Hysterectomy: removal of the uterus, with or without the ovaries, often done laparoscopically.
• Metoidioplasty: uses the hormonally enlarged clitoris to create a small phallus.
• Phalloplasty: builds a phallus from a skin flap, staged over multiple operations.

Each is a separate decision. Many trans men have chest surgery and no genital surgery; others choose differently. The decision is individual and made with a clinical team.

Chest (top) surgery: the most common

Chest (top) surgery, a masculinising mastectomy, is the most commonly sought gender-affirming surgery for trans men. It removes breast tissue and contours a masculine chest. Recovery is comparatively quick: it is often a day case or 1 night, with heavy activity avoided for about 4 to 6 weeks and drains often in for 1 to 2 weeks¹.

It is generally low-risk, with recognised possibilities including haematoma, infection, scarring, and changes in nipple sensation. We cover the techniques, scars, and results in detail in top surgery.

Hysterectomy

Hysterectomy is removal of the uterus, with or without the ovaries, and is often done laparoscopically (keyhole). Some trans men choose it as part of their care; others do not. It is a considered decision with its own implications, made with a clinical team.

Because it can be done laparoscopically, recovery is often quicker than open surgery, though your surgeon gives you a timeline for your individual case.

Metoidioplasty and phalloplasty

Metoidioplasty and phalloplasty are the two genital masculinising options, and they trade off length against complexity and risk. Metoidioplasty uses the hormonally enlarged clitoris to create a small phallus, with a lower complication rate and shorter recovery than phalloplasty, but limited length; people are typically off work about 4 to 6 weeks¹.

Phalloplasty builds a phallus from a skin flap, commonly the radial forearm or anterolateral thigh. It is staged over multiple operations, with the total process commonly 12 to 18 months, and it carries the highest complication rate of common gender-affirming surgeries; urethral complications such as strictures and fistulae are the most frequent and often need further surgery². We set these out honestly in metoidioplasty and phalloplasty.

The pathway and honest figures

Masculinising surgery is accessed through an assessed pathway, and the honest figures matter to the decision. Under SOC-8, most genital surgery needs one referral from a qualified health professional and about 12 months of continuous hormone therapy where hormones are not contraindicated². On the NHS, care is accessed via a Gender Dysphoria Clinic, where a first appointment commonly takes several years¹.

Regret after gender-affirming surgery is about 1 in 100 across a large pooled meta-analysis, low but not zero³. Nothing here is personal medical advice; decisions are made with your own clinical team. To understand the assessment and referrals, see the pathway to gender-affirming surgery.