Masculinizing Surgery - Healthnile.com

Overview

Masculinizing gender-affirming procedures help transgender patients achieve physical traits that better match their gender identity. Common options include chest (top) surgery to create a flatter, more masculine chest and genital (bottom) surgery to change anatomical features. These procedures may have positive effects on overall well-being and satisfaction for many individuals.

Masculinizing surgery is not required for everyone. Some people decide not to have surgery for personal, financial, or health reasons. Potential risks include changes in fertility, sexual sensation, and the need for ongoing care. Healthcare providers can help clarify options, risks, and expectations.

Reasons People Choose Masculinizing Surgery

Individuals choose masculinizing surgery to help their physical appearance match their gender identity. For many, this process is important to reduce feelings of discomfort related to gender dysphoria. The procedure can play a key role in gender affirmation by helping people feel more comfortable and confident in their bodies.

People have different reasons for seeking these surgeries. Some want to improve their sense of self and mental well-being. Others look for relief from emotional distress. Common goals of masculinizing surgery include:

Creating a more masculine chest, either by removing breast tissue or adding pectoral implants.
Removing reproductive organs such as the uterus, cervix, fallopian tubes, or ovaries.
Reshaping external genitalia, including procedures like vaginectomy, scrotoplasty, metoidioplasty, or phalloplasty.
Adjusting body shape through body contouring.

Every person’s journey and needs are unique. Choosing gender-affirming care, including surgery, is a personal decision and can help individuals live in a way that feels true to themselves.

Possible Health Issues

Some masculinizing surgeries can cause a person to lose the ability to have biological children. These surgeries may remove or damage the reproductive organs, so it is important to talk with a doctor before the operation if having children is a future goal.

Options to Save Fertility Before Surgery

Method	Steps Involved	Notes
Egg Freezing	Ovary stimulation, retrieval, freezing	Can use eggs later
Embryo Freezing	Same as egg freezing plus fertilization	Needs sperm partner/donor
Ovarian Tissue Freezing	Surgery to remove tissue, freezing, future re-implantation	Still being studied

Egg Freezing (Mature Oocyte Cryopreservation): Medical teams stimulate the ovaries to produce eggs, collect these eggs, and then freeze them for later use.
Embryo Freezing (Embryo Cryopreservation): This process fertilizes the eggs with sperm before freezing.
Ovarian Tissue Freezing: Surgeons remove and freeze part of the ovary. Later, they can put the tissue back into the body.

Risks and Contraindications

Certain surgical procedures can result in irreversible infertility.
Certain health conditions may prevent people from using specific fertility preservation options.
Hormone use in fertility treatments may not be suitable or safe for everyone.
People must plan fertility preservation before surgery, as options are very limited afterward.
Healthcare providers can help choose the best and safest method.

Steps to Get Ready for Surgery

Giving Your Permission

Anyone planning on this kind of surgery needs to give documented permission after learning about all parts of the process. This includes understanding possible risks and benefits, knowing how much the procedure costs, and exploring if there are any non-surgical options that could help instead. People should also set realistic goals and expectations for what the surgery may accomplish.

The healthcare team explains possible complications, such as effects on future fertility or sexual function. Because some results of masculinizing surgery cannot be undone, it’s important to fully consider what giving permission means before going forward.

Health Check and Readiness Review

Before surgery, a provider, often someone experienced in transgender health, leads a detailed health review. The process may include:

Reviewing personal and family medical history.
Doing a physical exam.
Running lab tests.
Checking if the person has had any masculinizing hormone therapy (like testosterone enanthate or testosterone cypionate).
Making sure vaccines are up to date.
Screening for conditions such as HIV, other sexually transmitted infections, or lung and heart issues.
Discussing tobacco, drugs, or alcohol use.
Reviewing mental and emotional health, including possible gender dysphoria and support systems.
Discussing plans for birth control, fertility, and sexual health.

Endocrinology specialists may help, especially for those already on testosterone or other hormones. The evaluation may involve guidance on stopping some medicines, not using nicotine, and making changes in daily habits as suggested by the healthcare team.

A behavioral health evaluation is also often part of the process. This check includes:

Focus Area	Examples
Mental health	Managing depression, anxiety, or substance use.
Gender-related questions	Understanding the impact of gender dysphoria.
Support & planning	Measuring family/friend support and future care.
Hormone use	Reviewing use of unapproved supplements or hormones.

Additional Planning Points

Insurance is a big issue for many. Health insurance tends to cover some but not all aspects of masculinizing surgery. People should contact their insurance company directly before taking further steps. This helps avoid unexpected costs and lets them plan accordingly.

People can connect with others who have had the surgery for support. Peer support groups are available locally and online, and professionals may recommend trusted resources. Sharing experiences helps people understand what to expect and make informed choices.

Those on masculinizing hormone therapy must follow directions from their care team about continuing or pausing hormones as surgery approaches. Each step aims to ensure safety and set each person up for the best recovery possible.

What you can expect

Surgery to Create a More Masculine Chest

Many people choose surgery to remove breast tissue and shape a flatter, more masculine chest. Surgeons select the type of surgery based on breast size and body shape.

Common Procedures

Double Incision Chest Surgery: Surgeons use this method for those with larger breasts. They make two cuts under and above the breast, remove tissue and some skin, and often remove and reshape the nipples to look more male before reattaching them. The new nipples do not have feeling after surgery.
Chest Surgery with Nipple Preservation: This option fits people with smaller breasts. The surgeon removes tissue through cuts under the breast, leaving most skin in place. The nipples and areolas remain connected, which helps keep sensation.
Periareolar Chest Surgery: This also suits those with smaller breasts. The doctor cuts around the areola (the area around the nipple) to take out tissue. The skin, nipples, and areola are left attached for feeling to stay.

Table: Comparison of Chest Surgery Options

Procedure Type	Ideal Candidates	Scarring	Nipple Sensation	Skin Removed
Double incision	Larger breast size	Noticeable	No	Yes
Nipple preservation	Smaller breast size	Minimal	Usually kept	No or minimal
Periareolar	Smaller breast size	Least	Usually kept	No

After Surgery

People might need to remain in the hospital overnight. They may not be able to lift heavy objects or use their upper body much for up to six weeks. Healthcare providers can advise when it is safe to return to normal activities. Even after surgery, some breast tissue remains in the chest. People may still need breast cancer screenings. Doctors can advise on ongoing checkups.

Other Options Related to Chest Appearance

Some people use liposuction to remove extra fat for smoother chest lines.
Body contouring can further shape the torso for a more masculine look.

Surgery for Creating Male Genitalia

Surgeons can build or change the genitals as part of gender affirmation, depending on personal goals, health, and desired outcome.

Lengthening and Reconstruction Procedures

Metoidioplasty: Surgeons use the existing clitoris, made larger by hormone therapy, to form a small penis. They free the clitoris and often use tissue from inside the mouth to lengthen the urinary tube, letting the person stand to urinate. Typical results create a penis about 1 to 3 inches (3 to 8 cm) long. Feeling and the ability to have an orgasm are usually kept. Sometimes, doctors may remove the uterus, cervix, and ovaries before this surgery.
- People usually recover from metoidioplasty in about two weeks.
- A catheter (tube) helps drain urine temporarily after surgery.
Phalloplasty: Surgeons create a penis using skin taken from another part of the body, like the forearm or thigh. They roll and shape the skin into a penis and place it above the clitoris. This operation often leaves large scars at the donor site.
- Surgeons may lengthen the urinary tube, join nerves for sensation, and form the head of the penis (glansplasty).
- Medical tattooing can help make the new penis look more realistic.
- After surgery, a tube drains urine for a while, and the person often stays in the hospital for several days.
- Healing can take up to 12 weeks or more.
- The penis will not become hard on its own—a separate implant is needed for sexual intercourse.

Surgery Type	Resulting Penis Size	Urination Standing	Sensation	Typical Hospital Stay	Risks/Notes
Metoidioplasty	1–3 inches	Yes	Usually yes	~1 night	Less visible in clothing
Phalloplasty	Varies, often larger	Yes	Partial	Several days	May need more surgeries

Scrotal Construction

Scrotoplasty builds a scrotum by using labia tissue. Surgeons place expanders under the skin and fill them over months until enough space is available for testicular implants.
- Risks include discomfort, infection, or the implants wearing through the tissue.

Other Related Surgeries

Surgeons may remove the ovaries (orchiectomy) and uterus (hysterectomy) before or along with genital surgeries.
Plastic surgery and hair transplantation may add masculine features in other areas, especially if facial changes are desired.

These surgeries carry possible risks, including bleeding, infection, and problems with healing.

Results

Following gender-affirming surgery, many individuals notice improvements in well-being and sexual health. Those who follow their health team’s guidance tend to recover more smoothly and report higher satisfaction.

Key Factors in Recovery

Continued care and regular follow-up visits
Communication with healthcare professionals
Monitoring long-term health

Consistent support helps people maintain good health and feel authentic in their gender.