Female-to-Male (FTM) Gender-Affirming Surgeries: A Complete Guide

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Female-to-Male (FTM) Gender-Affirming Surgeries: A Complete Guide

For many transgender men, gender-affirming surgeries are an important step in aligning their body with their gender identity. While not every trans man chooses surgery, for those who do, it can greatly improve confidence and quality of life.

In India, these surgeries are gradually becoming more available in larger hospitals and private clinics, but they require proper planning, medical evaluation, and psychological readiness.

Do You Need a GID Certificate for Surgery?

Yes ✅.

  • Just like with Hormone Replacement Therapy (HRT), most surgeons in India ask for a Gender Incongruence Certificate (GID Certificate).

  • For surgery, doctors usually require a fresh certificate from a psychiatrist & Psychologist to confirm that the person is mentally and emotionally ready for irreversible procedures.

Role of Hormone Therapy Before Surgery

Testosterone therapy plays an important role before FTM surgeries:

  • Stops menstruation, which prepares the body for hysterectomy.

  • Increases clitoral size, which helps in metoidioplasty (creating a small penis from the clitoris).

  • Improves muscle mass, making results of top surgery (mastectomy) look better.

  • Usually, doctors recommend at least 12 months of HRT before genital surgeries.

Types of FTM Surgeries

1. Mastectomy (Top Surgery)

  • What it is: Removal of breasts and chest contouring to create a masculine chest.

  • Methods:

    • Double incision mastectomy (for larger breasts, with nipple grafts).

    • keyhole surgery (for smaller breasts, minimal scars).

  • Risks: Scarring, loss of nipple sensation, asymmetry.

  • Best time: After 12 months of testosterone therapy.

2. Hysterectomy & Oophorectomy

  • What it is: Removal of the uterus (hysterectomy), ovaries, and fallopian tubes.

  • Purpose: Stops menstruation permanently, lowers cancer risk, and removes estrogen source.

  • Risks: Infection, bleeding, early menopause symptoms if not on testosterone.

  • Best time: After at least 12 months on testosterone.

3. Metoidioplasty

  • What it is: Uses the enlarged clitoris (from testosterone) to create a small penis.

  • Purpose: Gives natural erectile tissue, allowing standing urination in many cases.

  • Pros: Uses the body's own tissue, less scarring, shorter recovery.

  • Cons: Penis size is usually small (3–8 cm).

  • Risks: Fistulas (urine leakage), strictures (narrowing of urethra).

4. Phalloplasty

  • What it is: Construction of a penis using skin grafts (from forearm, thigh, or abdomen).

  • Purpose: Creates a larger penis than metoidioplasty; can be fitted with penile implants for sexual function.

  • Methods:

    • Radial forearm flap phalloplasty (most common, natural look).

    • Anterolateral thigh flap phalloplasty (for those who don’t want arm scars).

  • Risks: Longer surgery, graft failure, scarring, need for multiple stages.

  • Best time: Usually after hysterectomy and several months/years of HRT.

5. Scrotoplasty with Testicular Implants

  • What it is: Creation of a scrotum using labia majora tissue; silicone testicular implants can be added.

  • Often combined with: Metoidioplasty or phalloplasty.

  • Risks: Implant rejection, infection, scarring.

6. Other Possible Surgeries

  • Body contouring: To create a more masculine body shape.

  • Urethral lengthening: To allow standing urination (usually done with metoidioplasty or phalloplasty).

When is the Right Time for Surgery?

Doctors usually recommend:

  • At least 12 months of testosterone therapy before major surgeries like metoidioplasty or phalloplasty.

  • Stable mental health and a fresh GID certificate.

  • Good physical health (normal sugar, liver, kidney tests).

  • Top surgery can be done earlier (after a few months of testosterone).

Risks of FTM Surgeries (General)

  • Infection, bleeding, scarring.

  • Anesthesia complications.

  • Emotional adjustment if results don’t match expectations.

  • Need for revision surgeries.

  • Genital surgeries (phalloplasty/metoidioplasty) may need multiple procedures for best results.

Conclusion

FTM surgeries in India include mastectomy, hysterectomy, metoidioplasty, phalloplasty, and scrotoplasty. They can be life-changing for transgender men, but they require planning, patience, and medical supervision.

Steps to keep in mind:

  1. Get a fresh GID certificate before surgery.

  2. Be on testosterone therapy (at least 12 months before major genital surgeries).

  3. Do all required medical tests.

  4. Choose an experienced surgeon familiar with transgender healthcare.

These surgeries are not just about changing the body but about living confidently in one’s true identity.



                                                                 


Click here to read more https://akesohealth.co.in/

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