A trans man can have a combination of male urologic reconstruction procedures as part of gender affirming surgery (GAS). These procedures include metoidioplasty to craft a larger organ from the clitoris and phalloplasty to construct a penis.
For this qualitative study, we interviewed 10 participants who had given birth while identifying as trans men. Their experiences provided insight into the complexities of transition and reproduction.
Hormone Replacement Therapy (HRT)
Hormone replacement therapy (HRT) is a common treatment for transgender people to help them feel and appear more like the gender they identify with. For men, this means testosterone. This hormone causes the body to make changes similar to those seen in cis males during puberty, called secondary sex characteristics.
This type of cross-sex hormone therapy has many benefits for transgender people including improved mental health and increased sexual satisfaction. While there are some risks to long-term hormone use, most experts in the field of transgender healthcare and major medical associations support the use of hormones for all transgender individuals who desire them.
It’s important to note that the results of masculinizing HRT will differ from one person to the next. For example, some trans men will be able to grow full-length beards while others may not. This is because hormones can alter the body in different ways and these changes are irreversible. For this reason, a physician should monitor hormone levels and provide regular lab work such as cholesterol, blood sugar, and liver enzymes.
Gynecologic Surgery
Many trans men choose to have gynecologic surgery to remove female organs, primarily the uterus and cervix. This may be done to stop periods or as part of a larger gender affirming surgery.
A hysterectomy removes the uterus and cervix as well as any fallopian tubes and ovaries. This is a popular option for people who were presumed to be female at birth and have dysphoria related to the presence of reproductive organs. It is also often the first step in a series of surgeries to improve body image and self-esteem.
Some people decide to have chest surgery, known as “top surgery,” and genital surgery such as increasing the length of the clitoris (metoidioplasty) or creating a penis (phalloplasty). It is important for health care providers to be familiar with the full range of these surgical options, which are available at specialty clinics. The World Professional Association for Transgender Health has published standards of care to guide clinicians.
Breast Surgery
Some trans people identify as the opposite gender of their assigned sex at birth. This feeling is known as gender dysphoria. Some choose to stylize their appearance with clothing and make-up to align with their inner sense of self, but others might opt for surgery that alters their body.
Surgical options might include procedures to create a scrotum, called scrotoplasty, place testicular prostheses or increase the length of the clitoris, called metoidioplasty. Alternatively, the uterus and fallopian tubes can be removed, called a hysterectomy.
Another procedure, commonly referred to as FTM chest surgery or transgender mastectomy, removes breast tissue and contours the chest to appear more male. FTM chest surgery can be performed with varying techniques, depending on the person’s chest size and goals of gender transition. If you have small breasts, you might be able to have a procedure that sparsely removes skin and the areola and nipples, called nipple-sparing subcutaneous mastectomy. Non-erotic sensation to the nipples may return in months to years after surgery.
Plastic Surgery
Transgender people whose gender identity does not match the sex assigned to them at birth suffer from severe gender dysphoria. While clothing and make-up can help them look more masculine, many choose to have plastic surgery for a more complete change. These gender-confirming surgeries, also called genital reconstruction or reassignment procedures, are safe and can be performed by qualified surgeons.
Female-to-male (FTM) plastic surgery can include a variety of procedures to give a more chiseled male facial appearance, including forehead lengthening and augmentation, brow lift, cheek augmentation, rhinoplasty, jaw contouring and Adam’s apple enhancement, as well as liposuction. In addition to FTM facial surgery, many transgender men choose to have bottom surgery as part of their gender confirmation journey.
These surgical procedures can have some long-term health implications and should be discussed with a transgender medical care team. This team should consist of a psychiatrist, psychologist, urologist and gynecologist. Some types of gender reassignment surgery can limit fertility. If this is a concern, individuals can freeze mature eggs with a procedure called egg cryopreservation or embryos with a process called embryo cryopreservation.