Eligibility for FTM Surgery

By Nick Peplow·Founder and editor

Last reviewed 8 September 2026· How this site is researched

Before anyone will book you in, someone has to decide you're eligible. Who that someone is, and what they ask for, depends on where you live, who is paying, and which surgeon you pick. This section walks through the common requirements one at a time so you can work out what applies to you and start collecting what you need early.

Most of the requirements trace back to one document. The WPATH Standards of Care are the guidelines a lot of surgeons, insurers and public health systems lean on. They aren't law, and plenty of surgeons interpret them loosely or tightly, but if you understand what's in them you'll understand why you're being asked for things.

The requirement that trips most people up is letters of support. Top surgery usually needs one letter from a mental health professional; bottom surgery usually needs two. Getting these can take anywhere from a week to over a year depending on your route, so I'd start on this before you do anything else. The page explains who can write them, what they need to say, and what to do if you're stuck on a waiting list.

Not every surgeon works this way. Some run an informed consent model, where you have a conversation with the surgeon about risks and benefits and sign off yourself, without a therapist's letter. It's more common for top surgery than bottom surgery, and more common with private surgeons than public systems.

Then there are the physical requirements. Some surgeons want a minimum time on testosterone, others don't care. Many have a BMI cut-off, and it varies a lot between surgeons and procedures. Almost all of them will tell you to stop smoking, vaping and any nicotine for several weeks either side of surgery because nicotine badly affects healing. The pages on each of these give you the ranges you'll actually see, not just the official line.

There are also separate pages for people under 18 and for non-binary people, since the rules and the reactions you get from clinicians are often different.

None of this is medical advice. It's what I've pieced together from a decade of sitting in on consultations, from surgeons' published criteria, and from what patients have told me. Always check the specific surgeon or programme you're dealing with, because they set their own rules and those rules change.