FAQ
On this page
Short answers to the questions I get asked most often, each one pointing at the page that goes properly into it. I have coordinated patients through this for over a decade and sat in on a lot of consultations; I am not a doctor, and none of this is medical advice.
Getting started
Do I need a diagnosis or letters before surgery?
Usually yes for bottom surgery, often for top surgery, and it depends on where you are and who is paying. Most surgeons follow WPATH standards, which call for one or two letters from mental health professionals depending on the procedure. Some private top surgeons work on informed consent with no letters at all. See WPATH criteria and letters of support.
Do I have to be on testosterone?
Not for top surgery. Most surgeons will operate whether you are on T or not. For metoidioplasty, T is essential because the surgery relies on growth from hormones, and most surgeons want at least a year. For phalloplasty and hysterectomy it is not required. See testosterone requirements.
Is there a BMI limit?
Many surgeons set one, some do not, and the number moves by procedure: the limits quoted for top surgery and hysterectomy are generally higher than those for phalloplasty. It is about anaesthetic and wound risk rather than cosmetics, though it is applied unevenly. Being turned down by one surgeon does not mean every surgeon will. The BMI requirements page has the ranges by procedure.
Can I have surgery if I am non-binary?
Yes. Many surgeons operate on non-binary patients and letters can be written to reflect that. Some public systems still expect a binary narrative, which is a problem with the system rather than with you. See non-binary.
How do I find a good surgeon?
Start with how often they do your specific operation, then how they show results on bodies like yours, then how straight they are about complications and who pays for a revision. Choosing a surgeon goes through each of those. A surgeon directory is on its way.
Top surgery
Which technique will I get?
Mostly determined by chest size and skin elasticity. Larger chests or looser skin generally mean double incision with nipple grafts. Small chests with good elasticity may qualify for peri-areolar or keyhole. The surgeon decides at consultation, but you should understand why. See which technique.
Will I lose nipple sensation?
With double incision and free nipple grafts, erogenous sensation is usually lost for good, though light touch often comes back to some degree. Peri-areolar and keyhole keep the nipple attached, so it is usually kept or partly kept. See double incision and results.
What will the scars look like?
Double incision leaves two horizontal scars across the chest that fade over 12–18 months but do not disappear. Peri-areolar leaves scars around the areola only. Scar care and genetics both matter. See scars and scar care.
How long does top surgery recovery take?
Back to desk work in one to two weeks, lifting and full arm movement at around six weeks, final results at a year. Drains usually come out within the first week. See top surgery recovery.
What if I am unhappy with the result?
Revisions are common and usually minor: dog ears, nipple size or position, small contour issues. Ask about revision policy before booking, since some surgeons include them within a year and some charge. See revision.
Bottom surgery
Metoidioplasty or phalloplasty?
Meta uses your existing growth from testosterone, is a smaller operation with fewer stages and preserves sensation well, but produces a small phallus. Phallo builds a larger phallus from a skin flap, takes multiple stages and carries higher complication rates, but allows for penetrative sex with an implant. See meta vs phallo.
Do I need a hysterectomy before bottom surgery?
For vaginectomy, almost always yes, either before or at the same time. For meta or phallo without vaginectomy, not necessarily. Many teams combine hysto with the first stage. See hysterectomy and which surgery first.
Will I be able to pee standing up?
Only if you have urethral lengthening, which is optional with both meta and phallo. It is the part surgeons consistently describe as the most complication-prone, mainly fistulas and strictures, and plenty of people choose to skip it for exactly that reason. See sensation and function.
Will I have sensation and be able to orgasm?
With meta, almost everyone keeps full sensation because the tissue is your own. With phallo, tactile sensation develops over months to a couple of years as nerves grow in, and orgasm is usually possible because the clitoral tissue is buried at the base. See sensation and function.
Costs
How much does surgery cost?
Self-pay, roughly: top surgery £6,000–£11,000 in the UK and $6,500–$14,000 in the US. Hysterectomy is similar or more. Metoidioplasty ranges from around $10,000 for a simple release to $50,000 with urethral lengthening, and phalloplasty runs from about $50,000 into six figures across all stages. Every one of those ranges is wide for real reasons, and Thailand and Europe sit well below the US. The full table is on costs by procedure.
Will insurance or the NHS cover it?
In the US, many plans now cover top and bottom surgery but the approval process is slow and specific. The NHS funds top surgery, hysterectomy and bottom surgery through gender clinics, with long waits. Canada and Australia vary by province and state. See insurance, NHS, Canada and Australia.
Is going abroad cheaper?
Often, especially for top surgery in Thailand, Poland or Turkey. The savings are real but so are the costs of travel, accommodation, a caregiver's time and the difficulty of aftercare from a distance. See surgery abroad and hidden costs.
Recovery
How long will I need off work?
Desk work: a couple of weeks after top surgery, a few after a hysterectomy, more like a month or two after meta, and longer again for each major phalloplasty stage. Anything physical needs more, and your surgeon will sign off the actual date. Time off work breaks it down.
Do I need someone to look after me?
For the first few days after any of it, yes, and most clinics will not discharge you to an empty house. A week of help is about right for top surgery, considerably longer for bottom surgery. Hand whoever it is the caregiver guide; it is written for them.
When can I exercise again?
Walking from day one. Light cardio at around four weeks after top surgery. Upper body lifting is usually cleared at six to eight weeks, and later for bottom surgery. Pushing too early stretches scars and risks bleeding. See exercise.
What complications should I watch for?
Fever, spreading redness, sudden one-sided swelling, bleeding through dressings, and any chest pain or calf swelling, which can be clots. Call the clinic if you are unsure; they expect it. See complications and the recovery timeline.
New to FTM surgery?
Start with the guide: every procedure, the order most people take them in, and what to expect from consultation to recovery.
start here →