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Guide to FTM surgery

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Start Here: Your Guide to FTM Surgery

Thinking about surgery but not sure where to begin? This guide walks you through every FTM procedure, the order people usually take them in, what to expect from consultation to recovery, and how to choose the right surgeon.

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Top Surgery

Top Surgery
Hysterectomy

Hysterectomy
Metoidioplasty

Metoidioplasty
Phalloplasty

Phalloplasty
Facial Masculinization

Facial Masculinization
Body Masculinization

Body Masculinization
Nick Peplow

hi, I’m Nick — welcome!

Nick Peplow

the short version

What Is FTM Surgery?

FTM surgery (female-to-male surgery) is a group of gender-affirming plastic and urologic procedures that align a transgender man’s body with his male gender. If you’re starting to think about surgery, or you’re deep in the research and drowning in tabs, this is the place to get clear answers.

Most transgender men start with top surgery, or chest masculinization, and for many it’s the only procedure they ever have. Others go on to bottom surgery, which covers hysterectomy and vaginectomy as well as the genital reconstruction options of metoidioplasty, phalloplasty and scrotoplasty. Facial masculinization and body masculinization round out the picture.

I built this site to give you the straight answers I couldn’t find in one place: who each procedure is for, how it’s done, what recovery is really like and what it costs. No jargon, no sales pitch. And when you’re ready, I’ll help you find a surgeon who specialises in gender-affirming care.

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New on the site

What does FTM mean?

FTM stands for female to male. What it means, who uses it, the terms people use instead, and the other things FTM can stand for when you see it outside a trans context.

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Looking for something specific?

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Double incision Top surgery Bottom surgery

Top Surgery

Chest reconstruction. The breast tissue comes out, the chest is shaped flat, and the nipples are resized and kept or grafted. For most trans men, the first surgery and often the only one.

Double Incision Top Surgery

The most common technique. Horizontal scars, works for any chest size, with four variants covering nipples and closure.

Peri-Areolar Top Surgery

For small chests with tight skin. A scar hidden at the areola edge, sensation usually kept, and a real risk of needing a second operation.

Keyhole Top Surgery

For the smallest chests. One short scar hidden under each areola, no skin removed, sensation usually kept, and a narrow window of people it works for.

Inverted-T Top Surgery

For larger chests that want to keep nipple sensation. The nipple stays on a stalk of tissue instead of being grafted, and the price is an anchor-shaped scar.

Top Surgery Revision

A second, smaller operation to fix what the first left behind. A dog ear, a widened scar, a nipple sitting off. Common enough to plan for.

See all top surgery guides →

Bottom Surgery

Two groups of operations. The ones that remove, hysterectomy and vaginectomy, and the ones that build a phallus, from your own clitoris or from skin taken elsewhere.

Removal

Hysterectomy

Removing the uterus through a few keyhole cuts, home the same day or the next. The quietest bottom surgery, and the one that opens the door to the rest.

Oophorectomy

Removing the ovaries, nearly always alongside a hysterectomy. Minutes on the table, nothing extra to heal, and a permanent decision about hormones and fertility.

Vaginectomy

Closing the vaginal canal for good. Nearly every surgeon requires it before lengthening the urethra, because that is where the new urethra runs.

Reconstruction

Metoidioplasty

A small phallus built from the clitoris testosterone has already grown. Nothing taken from elsewhere, every nerve kept, and the best sensation of any genital surgery.

Phalloplasty

A full-sized penis built from your own skin, taken from the forearm, thigh, back or belly and rejoined under a microscope. The biggest operation in transgender care.

Scrotoplasty

Building a scrotum from the outer labia during meta or phallo, left empty to heal, with testicular implants as an optional second step.

Erectile Implants

The device that lets a phalloplasty penis get hard. A pump in the scrotum or a bendable rod, fitted last, and the step most likely to need redoing.

Glansplasty

Sculpting a defined head on a phalloplasty. A small, cosmetic operation, usually done at a later stage, and the ridge can flatten.

See all bottom surgery guides →

Face & Body

The procedures that reshape what testosterone does not fully change. Rarely funded, rarely required, and for most trans men a much later decision, if at all.

Facial Masculinization

Forehead and Brow Masculinization

A heavier brow ridge and flatter forehead from a custom implant or bone cement, through a scalp incision. The biggest facial procedure.

Jaw and Chin Masculinization

Jaw angle implants and a chin implant or genioplasty for a wider, squarer lower face, all through incisions inside the mouth.

Cheek Masculinization

Buccal fat removal to hollow the lower cheek, or implants for a squarer midface. A small refinement through the mouth, not a gender signal.

Adam's Apple Augmentation

A cartilage graft over the voice box through a small neck incision. A small operation with a reliable change, and very few surgeons who do it.

Masculinizing Rhinoplasty

Augmentation rhinoplasty that builds the bridge and drops the tip for a straighter profile. A refinement, best done last, a year to judge.

Hairline, Hair and Beard Transplants

FUE transplants that square the hairline into an M or fill a beard testosterone left patchy, under local by hair surgeons, final at a year.

Body Masculinization

Liposuction and Body Contouring

Liposuction to reduce hips, thighs, flanks and lower abdomen for a straighter silhouette. Fat moves with weight and hormones, so timing is the decision.

Hip Reduction

Liposuction of the hips, outer thighs and flanks to straighten the line from ribs to thigh. Takes the fat, not the bone, so the result depends on which your width is.

Pectoral Implants

Solid silicone shapes placed under the chest muscle to give a flat chest the bulk that training never delivered. A fixed object inside a moving muscle, which is the whole trade.

Abdominal Etching

Liposuction that carves the lines between abdominal muscles into view. Only works on lean people, and only stays while they stay lean.

See all face and body guides →