Female-to-male surgery is a type of gender affirming care. There are multiple forms of gender affirming surgery, including procedures that alter the genital area, which are known as “bottom surgery.”
There are multiple forms of gender affirming surgery, including the removal of breasts (also known as top surgery) and the altering of the genital region (also known as bottom surgery).
Examples of bottom surgery include:
- hysterectomy (removal of the uterus)
- vaginectomy (removal of the vagina)
- metoidioplasty or phalloplasty (construction of a penis)
This article describes female-to-male gender affirming surgeries. It also discusses recovery and what to expect after having surgery to construct a penis.
A note about sex and gender
Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Learn more.
Before having female-to-male gender affirming surgery, a person will often receive testosterone replacement therapy.
They may then undergo one or more of the following procedures, depending on what they choose.
Chest restructuring, or ‘top surgery’
A person in transition may wish to have a mastectomy to remove breast tissue. The surgeon will also make changes to the appearance and position of the nipples. Many people refer to these procedures as top surgery.
Meanwhile, testosterone replacement therapy 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 the ovaries.
Metoidioplasty
A metoidioplasty is a method of constructing a new penis, or neopenis. According to some research from 2021, this procedure has a low risk of complications 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 addition, they lengthen the urethra and position it through the neopenis. To complete the lengthening of the urethra, the surgeon uses tissues from the cheek, the labia minora, or other parts of the vagina. The goal 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 involves using grafted skin — usually from the arm, thigh, back, or abdomen — to form a neopenis. A phalloplasty results in a larger penis than a metoidioplasty would. However, this neopenis cannot become erect on its own.
After a period of recovery, a person can receive a penile implant, which
Disadvantages of a phalloplasty include the number of surgical visits required 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 — the creation of 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 after female-to-male surgery varies, depending on the type of procedure and factors such as the person’s overall health and lifestyle habits. For example, smoking
Most people will need to stay in the hospital for at least a couple of days after gender affirming surgery.
After leaving the hospital, the person must rest and limit strenuous activity.
Complications
Like any other surgery, all gender affirming procedures pose a risk of:
- infection
- bleeding
- reactions to anesthesia
Possible 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 skin graft. It is also possible that the skin graft may fail.
A person who has undergone a metoidioplasty may be able to have erections and experience more sensation in their neopenis. However, the penis will be relatively small in size.
A neopenis that results from a phalloplasty is usually larger, but it may be less sensitive. A person will need a penile implant in order to experience erections.
For trans people, these procedures
The outlook for female-to-male bottom surgery depends on the type of surgery, the person’s health, and other factors. Most people report satisfaction after the procedure.
In a 2018 study, 94% to 100% of participants who had undergone gender affirming surgery reported satisfaction with the 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 after the procedures.
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 may choose during their transition. These procedures broadly fall into the category of either top or bottom surgery.
“Top surgery” is a colloquial term for chest-restructuring procedures, while “bottom surgery” refers to operations that change the genitalia.
In female-to-male surgery, procedures may create a neopenis or scrotum and may also involve the removal of organs. The decision of which type or types of surgery to undergo is deeply personal.