Start Here: Your Guide to FTM Surgery
Thinking about FTM surgery and not sure where to begin? This page is the map for the whole site. It covers the four groups of procedures, the order most people have them in, what the process looks like from first appointment to being healed, and where to go next depending on what you are trying to find out.
I have spent over a decade coordinating patients through hospitals in Bangkok, sitting in on consultations and watching recoveries up close. I am not a doctor, and this site is not medical advice. It is what that vantage point teaches you, written down plainly so you can ask better questions of the surgeon who will actually examine you.
On this page
The four groups of procedures
Nearly everything falls into one of four categories, and each has its own hub on this site.
Top surgery is chest reconstruction. It is the most common FTM surgery by a wide margin, the most widely available, and for a lot of people the only one they ever have. There are four techniques, and which one you get depends mostly on your chest size and skin.
Bottom surgery is a broad group. Removal procedures like hysterectomy, oophorectomy and vaginectomy, reconstruction procedures like metoidioplasty and phalloplasty, and the add-ons that go with them: scrotoplasty, urethral lengthening, erectile implants. Each has its own trade-offs in sensation, appearance, function, cost and recovery.
Facial masculinization reshapes the bone and soft tissue of the face. Brow, jaw, chin, nose, Adam's apple, hairline. It is the least common group, because testosterone changes the face a lot on its own.
Body masculinization is contouring for the torso and hips, mostly liposuction, with implants and etching for people who want more definition than hormones and training will give them.
Before you read anything else
Write down which group you are actually here for, and one sentence on why. Most people arrive thinking about one procedure and leave the site reading about three, and the sentence is what brings you back to the one that matters.
The order most people go in
There is no rule, but there is a pattern, and it exists for practical reasons rather than tradition.
Top surgery usually comes first. It has the biggest day-to-day effect, the shortest recovery of the major procedures, and it does not interact with anything you might do later. Many people have it within the first year or two of transition, sometimes before starting testosterone.
Bottom surgery, if it happens at all, comes later. Metoidioplasty relies on the growth testosterone produces, so surgeons want to see at least a year or two on hormones. Phalloplasty has no physical dependency on time, but it is a bigger commitment and most people want time to be sure. Within bottom surgery, hysterectomy often goes first as a standalone operation, sometimes years ahead of anything else, and it is commonly required before vaginectomy or urethral lengthening.
Facial and body procedures fit in anywhere. Nothing depends on them and they do not depend on anything, though most surgeons want you a year or more into testosterone so they are working with a face or body that has stopped changing. Some people combine body contouring with top surgery in one operation.
The surgery order guide walks through this in detail, including how to stack procedures if you are trying to minimise time off work or the number of anaesthetics.
What the process looks like
Wherever you are and whatever you are having done, the path runs through roughly the same five stages. The durations are typical, not promises; the funding stage is the one that varies most.
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1
Referral and letters
Weeks to months
A diagnosis, one or two letters of support from mental health professionals, and for some procedures evidence of time on testosterone. Informed consent clinics, mostly in the US, skip some of this. Eligibility for FTM Surgery ›
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2
Consultation
1–2 hours
The surgeon examines you and you settle which technique fits your body and what you want from it. Ask about complication rates, revision policy, and results on bodies like yours.
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3
Funding
Weeks to years
Private, insured or public. A few weeks and a deposit privately; months of prior authorisation for insurance; potentially years on a public waiting list.
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4
Surgery
Hours to a week
A couple of hours as a day case for keyhole top surgery, through to eight or ten hours and a week in hospital for phalloplasty.
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5
Recovery
Weeks to two years
The part people underestimate. Drains, compression, restricted movement, scar care, and the slow return to normal.
At the paperwork stage
Keep every letter, referral and approval in one folder, scanned, from day one. I have watched surgery dates slip by months because a single letter had to be re-issued, and the people it never happens to are the ones who could send everything within the hour.
Realistic timelines
From deciding you want surgery to actually having it, budget at least six months in the fastest private scenario, and one to three years if you are going through insurance or a public system. That includes getting letters, waiting for a consultation, then waiting for a surgery date. Popular surgeons book a year or more ahead.
Recovery from top surgery is typically six to eight weeks before you are back to most activity, with scars settling over a year. Hysterectomy is similar. Metoidioplasty is a few months. Phalloplasty is a multi-stage process, usually two or three operations spread over twelve to twenty-four months, with meaningful recovery after each one. Facial and body procedures range from a couple of weeks to a couple of months depending on what is done.
How to use this site
If you are brand new, read the top surgery hub first even if you are not planning it. It is the simplest example of how all of this works, and every procedure page on the site follows the same shape: who it is for, how it is done, recovery, scars, sensation, risks, results, alternatives, cost, and how to choose a surgeon. Once you have read one, you can read any of them fast.
If you already know which procedure you are looking at, go straight to that hub and then the procedure page. If you are at the paperwork stage, start with eligibility. If you are trying to work out whether you can afford it, start with costs. If you have a date booked, the planning and recovery sections are what you need.
When you are ready to talk to someone, the surgeon directory lets you filter by procedure and country. Listings are free and nobody has paid to be there.
Nothing on this site is medical advice. Your surgeon knows your body; I do not. Use this to ask better questions.
Frequently asked questions
Do I have to be on testosterone before surgery?
Not for top surgery with most surgeons. Metoidioplasty depends on it. Facial and body surgeons usually want a year or more so they are working with a settled face or body. See the order most people go in.
How long does the whole thing take?
Six months at the fastest, privately. One to three years through insurance or a public system. See realistic timelines.
Which page should I read first?
The top surgery hub, even if you are not planning it. It is the simplest example of how the site works.
Is this medical advice?
No. It is what a decade of coordinating patients teaches you, written down. Your surgeon examines you; this site helps you ask them better questions.