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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
Bangkok from above, the Chao Phraya river winding between towers

clinic guide

The Best FTM Surgery Clinics in Thailand

Choosing who to trust with your chest or your body, thousands of miles from home, is one of the biggest calls you will make. These are the Bangkok clinics I would point a friend to, ranked, with what each does for trans men and how to get a quote before you fly.

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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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Double incision
Top surgery
Bottom surgery
Phalloplasty

Nobody needs all of it. Most trans men start with top surgery and for many it is the only operation they have. Bottom surgery, if it happens, usually comes later, and facial and body procedures fit in anywhere. Start Here walks through every procedure and surgery order covers what goes first and why.

Chest size, skin elasticity and where your nipples sit decide it more than preference does. Double incision suits most chests; keyhole and peri-areolar need a small chest with tight skin; inverted-T is the middle ground. The top surgery hub compares them side by side, with scars, sensation, recovery and cost for each.

Two different things. Removals (hysterectomy, oophorectomy, vaginectomy) recover like abdominal surgery. Reconstruction (metoidioplasty or phalloplasty, with scrotoplasty and implants as later stages) is a bigger commitment spread over one to two years. The bottom surgery hub explains each and how they combine.

Self-pay in the US, top surgery is roughly $6,500–$14,000, depending more on the surgeon and city than the technique; hysterectomy is similar. Reconstruction runs from about $10,000 for a simple metoidioplasty to $50,000 or more across the stages of a phalloplasty. Many US plans and the NHS fund top and bottom surgery, with paperwork and, on the NHS, a wait measured in years. See costs by procedure and insurance.

Top surgery: desk work in two to three weeks, lifting and exercise from four to six, scars fading over a year. Hysterectomy is similar. Metoidioplasty is a few months. Phalloplasty is two or three operations over twelve to twenty-four months, each with its own recovery. The hubs have the detail for top and bottom surgery.

Most surgeons and funders build on the WPATH standards: in practice one letter of support for top surgery and often two for genital surgery, nicotine stopped for weeks either side, and often a BMI range. Testosterone is not required for top surgery but metoidioplasty depends on it. Eligibility covers the criteria; the process section of Start Here covers referral to surgery day.

New on the site

The History of the World's First Trans Phalloplasty

The History of the World's First Trans Phalloplasty

Michael Dillon, Harold Gillies and the thirteen or so operations between 1946 and 1949 that built the first phalloplasty for a trans man, and what has and hasn't changed since.

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.

See all blog posts →

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.

Which Top Surgery Technique Is Right for You?

How surgeons choose a top surgery technique, which parts of the decision are yours, and how to read a borderline chest.

Top Surgery Cost

What top surgery costs by technique and country, what a quote should include, and how revision policies change the real price.

Top Surgery Recovery

What is particular to top surgery recovery: technique differences, nipple graft care, how the chest settles, and when to call.

Top Surgery Scars: Care and Results Over Time

Top surgery scars by technique, how they change over eighteen months, what goes wrong, and what a revision can fix.

Top Surgery Results: What to Expect

Realistic top surgery results: contour, nipple size and position by technique, sensation, revision rates and how the chest changes.

Breast Reduction

A smaller chest rather than a flat one. Some breast tissue stays, the nipple stays on its nerve supply, and the result is meant to be kept, not upgraded.

Nipple Reconstruction and Areola Tattooing

Rebuilding nipples after top surgery, with a small skin flap for shape and tattooing for colour. For failed grafts, nippleless chests or a change of mind.

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 finish what testosterone starts, shaping the brow, jaw, chest and hips once hormones have done their work. A personal choice, usually made a few years into transition, and a good one when the timing and surgeon are right.

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.

Facial Masculinization Cost

Typical costs for each facial masculinization procedure and why they are rarely covered by insurance.

Facial Masculinization Recovery

Swelling, bruising and healing timelines for facial procedures, and when results settle into their final look.

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.

Body Masculinization Cost

Typical self-pay prices for liposuction, hip reduction, pec implants and etching, how quotes differ, and why insurance won't pay.

Body Masculinization Recovery

Healing from liposuction, hip reduction, pec implants and etching side by side: compression, swelling and when to call.

See all face and body guides →