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FTM Transition Can Be More Than Just a Top Surgery

FTM Transition Can Be More Than Just a Top Surgery

By Beverly Fischer on September 16, 2020

Gender Affirmation Back to Blog


Maybe you’ve had gender-affirming top surgery to masculinize your chest, or maybe you’ve decided that it isn’t a step you’re ready to take. Either way, there are other paths to start or continue your journey to the body in which you feel most at home.

Facial Masculinization Surgery (FMS)

There’s no one “ideal” way to look masculine– you’re just as much of a man without a square jaw and sharp features! But if your facial structure is too far from the masculine profile you’ve dreamed of and it causes you anxiety, you do have the option to undergo facial masculinization surgery.

FMS is actually a collection of plastic surgery procedures for different areas of the face and throat, and you can decide with your surgeon which ones best suit your goals. Rhinoplasty (“nose jobs”), forehead lengthening, cheek augmentation, chin or jaw recontouring, and thyroid cartilage enhancement (to create more of an Adam’s apple) or tracheal shaves (to create less of an Adam’s apple) are all options.

Masculinizing Hormone Therapy

This one may be familiar to you already, because many top surgery patients undergo hormone therapy early in their transition. It involves injections or a patch or gel of testosterone to suppress menstrual cycles and inhibit estrogen production, as well as to encourage secondary sex characteristics such as facial hair and deepening voice.

Although many transgender men feel more comfortable in their bodies and experience less gender dysphoria when they’re on testosterone, there are a number of side effects to be aware of. These can include weight gain, oily skin/acne, male pattern baldness, sleep apnea, and exacerbation of certain chronic medical and psychological conditions. Talk to your physician about the risks, but know that hormone therapy can dramatically improve the lives of transgender men, despite the side effects.  

Vocal Cord Surgery

It’s much less common for transgender men to undergo vocal cord surgery than it is for transgender women, because testosterone therapy usually creates a deep enough voice on its own. However, a procedure is available that’s called medialization laryngoplasty (or masculinization laryngoplasty), which augments the vocal cords with implants to lower vocal pitch. If you’re choosing not to undergo hormone therapy, or you feel it hasn’t had the desired effect on your vocal range, this could be an option for you.


Not all transgender men will feel the need to undergo this major surgery to remove their uterus (hysterectomy), vagina (vaginectomy), and/or possibly also ovaries and fallopian tubes (salpingo-oophorectomy), but it is a step that many do take.

Some transgender men already suffered conditions such as endometriosis, polycystic ovary syndrome (PCOS), or heavy periods/severe cramping, and seek out these procedures as a result. For others, it may be an advantage to undergo this surgery because the lack of estrogen production after removing the ovaries allows the patient to reduce his testosterone dosages. Yet others may have a family history of ovarian or other cancers and get surgery as a preventative.

Masculinizing Phalloplasty/Scrotoplasty/Metoidioplasty (“Bottom Surgery”)

For a long time, mainstream culture imagined that being a transgender man automatically involved what’s commonly called “bottom surgery”– that is, having a surgically-constructed penis and testes. That’s not the case at all. You are a man whether or not you receive any medical intervention to affirm your gender, and many transgender men prefer not to undergo this procedure. Some consider it too risky and invasive, while others prefer not to identify their gender by their genitals.

There are two approaches to transmasculine bottom surgery. Metoidioplasty involves medically enhancing the clitoris to function as a penis, including repositioning the urethra, enlarging the clitoris through hormone therapy, and enhancing the neopenis through tissue grafts. While the neopenis in this case may be on the smaller side, the advantage is that it may be able to achieve erection because clitorises can become erect.

Phalloplasty, on the other hand, uses skin grafts to construct a neopenis entirely and to lengthen and position the urethra within it. While this neopenis can’t naturally achieve erection, it is larger and the addition of penile implants later can make erection and penetration possible.

Scrotoplasty may or may not be performed alongside either of these procedures, to reshape the labia into testicles with silicone testicular implants.

Non-Medical Support for Your Transition

Not every aspect of your transition relies on medical intervention, of course. You can seek out speech therapy to enhance your lowered vocal pitch and even change your speech patterns and inflections to sound more traditionally masculine. Personal trainers who specialize in transgender clients can work with you to shape your muscle tone. Appearance or wardrobe consultants can help you learn grooming and dressing habits that best suit the you that you want to show the world. Many tattoo artists work with transgender men to enhance nipple grafts or cover or adorn top surgery scars. Aestheticians can recommend products for managing the oily skin or acne you might get from hormone therapy. There are more and more professionals out there every day stepping up to meet the needs of the transgender community.

What’s next?

Trying to decide what steps to take in your gender affirmation process, or looking for recommendations for a specific procedure? Contact us and let us answer your questions!

Advanced Center for Plastic Surgery | (410) 308-4700 | Website | More posts

Dr. Beverly A. Fischer is passionate about her role as a leading female plastic and cosmetic surgeon in Baltimore, Maryland and beyond. She believes that plastic surgery makes a positive, life-changing difference, whether you’re renewing your body, face, and skin or embarking on an entire gender transition.

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