Female-to-male (FTM) or transmasculine gender-affirming surgery can include different procedures depending on a person’s goals, anatomy, health history and priorities. There is no single operation called “FTM surgery,” and patients do not need to complete every available procedure or follow one universal sequence.
This guide consolidates several older broad FTM articles into one current overview. For clinic-specific information, visit our FTM gender-affirming surgery service page.
What procedures can be part of FTM care?
Top surgery / chest masculinisation
Top surgery commonly involves removal of breast tissue and reshaping of the chest. Technique selection depends on chest size, skin elasticity, nipple position, scarring preferences and the amount of contouring required.
Hysterectomy and related procedures
A hysterectomy removes the uterus. Depending on the individual plan, surgery may also involve removal or preservation of the ovaries and/or fallopian tubes. These choices can affect fertility and hormone needs, so they should be discussed before surgery.
Metoidioplasty
Metoidioplasty uses hormonally enlarged clitoral tissue to create a small phallus. The exact operation can include additional procedures such as urethral lengthening or scrotoplasty depending on goals and anatomy. Urinary and sexual-function expectations should be discussed carefully before surgery.
Phalloplasty
Phalloplasty constructs a phallus using tissue from another part of the body. It is often a staged procedure and can involve donor-site considerations, urethral reconstruction, scrotoplasty and later implants in selected patients. Complication and revision risks should be discussed in detail.
Scrotoplasty
Scrotoplasty creates a scrotum, often using local genital tissue. Testicular implants may be considered at a suitable stage for some patients. Implant-related and wound-healing risks should be part of informed consent.
Vaginectomy and other genital procedures
Some transmasculine genital-reconstruction plans include closure or removal of vaginal tissue, while others do not. The choice depends on the planned reconstruction, anatomy, urinary goals, sexual goals and individual preference.
Is testosterone required before every FTM procedure?
No single rule applies to every operation. Some patients use testosterone as part of their gender-affirming care and some do not. Requirements can vary by procedure, clinical situation, institutional policy and local guidance. If hormone therapy is being used, it should be prescribed and monitored by an appropriately qualified clinician. See our gender-affirming hormone therapy guide.
Fertility considerations
Some treatments and surgeries can reduce or remove reproductive potential. If genetically related children may matter in the future, fertility-preservation options should be discussed before procedures such as hysterectomy/oophorectomy or treatments that may affect fertility.
How is the surgical plan chosen?
A consultation should cover the patient’s priorities, anatomy, medical history, current medicines, previous surgery, smoking or nicotine use, fertility goals, urinary goals, sexual-function goals, scar preferences, donor-site considerations and ability to manage recovery or staged procedures.
Possible risks
Risks depend on the exact operation and may include bleeding, infection, scarring, wound-healing problems, altered sensation, contour irregularity, urinary complications, fistula or stricture after urethral reconstruction, donor-site problems, implant complications, need for revision surgery and anaesthetic risks. Not every risk applies to every procedure.
Recovery
Recovery ranges from shorter periods for some procedures to longer and staged recovery for complex genital reconstruction. Follow-up, wound care, activity restrictions, catheter care where relevant and return-to-work timing should come from the treating team rather than a generic timeline.
Planning questions
- Which procedures match my goals?
- Can procedures be combined or should they be staged?
- What scars and sensory changes should I expect?
- How could fertility be affected?
- What urinary or sexual-function outcomes are realistic?
- What are the main complications for the exact technique?
- How much help will I need during recovery?
You can also review FTM surgery results where appropriate, while remembering that another patient’s outcome cannot predict an individual result.
For an individualized plan, book a consultation.
This guide is for general education and does not replace individualized medical or surgical assessment.
