Transgender Female to Male FAQ

People who are considering making the transgender female to male transition often have a lot of questions about the process. Given the radical changes that the process involves, it would be more surprising if patients did not have a lot of questions. Here are some of the more common questions that people ask regarding the coming changes in their lives.

Do I need to be on testosterone therapy before I can undergo top surgery?

The answer to this depends. U.S. insurance carriers often require a full year of hormone replacement therapy (HRT) before you can undergo top surgery (which alters the structure of your chest by removing breasts and realigning the bones to make them resemble a man’s body more closely). However, WPATH Standards of Care do not mandate hormone therapy. Testosterone therapy can help, though, because it helps you build larger chest muscles. This provides a more significant contour for the surgeon to follow, which can yield more desirable results. You can also build larger chest muscles with push-ups, bench presses and other chest exercises, though.

What is WPATH? What are their Standards of Care?

The World Professional Association for Transgender Health (WPATH) published their Standards of Care (SOC) in order to protect transgender female to male patients — as well as those biological men who identify as women. The purpose of the SOC is to give health professionals clinical guidance in the areas of helping transgender, transsexual and other gender nonconforming persons find effective and safe ways to get the most out of their lives. This help can take the form of gynecologic or urologic care, primary care, communication and voice therapy, reproductive options and a wide range of mental health services — as well as surgical and hormonal treatments. WPATH gathered the best available expert consensus in the medical community as part of writing these standards.

According to WPATH, who should undergo transgender female to male surgery?

The WPATH statement lists for criteria for transgender female to male surgery. These include a persistent and thoroughly documented case of gender dysphoria; the capacity to arrive at fully informed choices and consent to medical treatment; have all significant mental health and/or medical conditions under control at the time of the surgery; and be at majority age in the country of surgery (or follow SOC guidelines for adolescents and children).

What is the best way to ready my body for transgender female to male surgery?

Smokers should stop immediately, but if that isn’t possible, they should stop a minimum of two weeks before the operation. Smoking harms the healing process and can cause nipple grafts to fail. Adopt a balanced and healthy diet, along with a regular exercise program. The more muscle tone that you have in the chest and the rest of your body, the more pleasing your surgical results will be. Also abstain from alcohol for two weeks before the operation because it can boost bruising and bleeding. You may be asked to stop your testosterone therapy for up to a month before the operation. Discuss any other medications with your surgeon and your anesthesiologist.

Why would the doctor want me to stop testosterone therapy before the surgery?

There are two reasons that some doctors ask their patients to take a break from testosterone leading up to and following the transgender female to male surgery. Some research has identified a link between higher testosterone levels and a slower healing process for the incisions. Testosterone also tends to make blood thicker, boosting the danger of deep vein thrombosis, or blood clotting. There is some disagreement about both of these claims in the medical community, though, as some evidence shows that testosterone can actually fight the formation of blood clots and helps lessen pain from incisions. This is a question to discuss with your surgeon.

When can I return to exercising after the surgery?

Patients should start walking and other light activities within a couple of days after surgery, as it helps speed up healing. When it comes to more strenuous exercise, particularly weightlifting, you should wait at least six weeks. Bodybuilders who have undergone a double incision top procedure should wait as long as three months before doing heavy chest workouts so that they do not stretch the scars from the incisions.
For more information: Click here to learn more about transgender female to male transformation or click here to search for a gender reassignment surgeon.