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All You Need To Know About Female To Male Gender Reassignment Surgery

Gender Reassignment Female to Male

All You Need To Know About Female To Male Gender Reassignment Surgery

Female to male gender reassignment surgery is an umbrella term. It refers to a broad range of surgical procedures that treat gender dysphoria in trans men.

There are many surgical procedures you can undergo to help you look and feel more masculine. The type of gender-affirming surgery you choose is a personal decision that requires a great deal of thought and consideration.

If you’re considering gender reassignment surgery, below you’ll find an outline of the most common procedures. This can help you figure out the right course of action for you.

Bottom Surgery

When it comes to bottom surgery, the most common procedures for trans men are a metoidioplasty and a phalloplasty. Both surgeries create male genitalia, but do so in different fashions.


In a metoidioplasty, a phallus is created from the clitoris, which is already enlarged from hormonal treatments. Your surgeon first detaches the clitoral ligaments so the clitoris can lengthen and drop. Then, your surgeon sculpts the head of the clitoris to resemble the head of a phallus.

A metoidioplasty may also include the placement of testicular implants. Some patients also opt for a urethral lengthening, which extends the urethra so it connects with the new phallus. This allows transgender men to pee out of their phallus.


A phalloplasty is a bit more complicated. Surgeons use a tissue flap taken from another part of the body to create a phallus. The donor site depends on the patient’s body type, but it is often taken from the forearm or thighs.

A phalloplasty is a multi-step procedure. How many steps are required vary from patient to patient.

During the first stage of a phalloplasty, your surgeon will remove the tissue flap and use it to create a phallus.

When tissue is taken from the forearm, your first surgery entails the creation of the new phallus. Then, 3 to 5 weeks later, a surgeon places a skin graft over the donor site. When skin is taken from other body parts, like the thigh, you can usually have the skin graft put in place during the initial procedure.

How the stages of a phalloplasty unfold from there vary. In 5 to 6 months, you can opt to have further surgery to create a scrotum, lengthen the urethra, and remove the vagina.

You also opt for a third surgery to place testicular implants and an erectile prosthetic. This is usually done 12 months after the first procedure.

How do you choose between a phalloplasty and a metoidioplasty?

The decision is highly personal and there are benefits and drawbacks to each procedure. It really depends on your personal needs.

A metoidioplasty has a shorter healing time, is generally more affordable, and has lower rates of complications. It also maintains the erotic sensitivity of the clitoris and gives the phallus natural erectile function.

A phalloplasty makes it easier to have penetrative sex and creates a longer phallus. Some men also feel it looks more natural.

If you initially choose a metoidioplasty, you can opt to undergo a phalloplasty later on. A phalloplasty, however, is not reversible. Many transgender patients feel more comfortable starting with a metoidioplasty and deciding later whether they want to undergo further surgery.

Top Surgery

Top surgery entails a mastectomy to remove breast tissue followed by chest reconstruction. The precise procedure varies from person to person. A lot is dependent on individual body type.

Most procedures start by removing breast tissue from under the chest skin. If you have smaller breasts, this can be done via incisions made around the border of your areola. However, if you have large breasts, your surgeon may have to remove and reattach your nipples and areolas.

Recovery usually takes several weeks, in which you’ll need to wear a compression wrap and avoid heavy lifting.

Some patients undergo further surgery after the recovery depending on their results. For example, you may opt for surgery to correct scarring or contour your chest.

Other Surgical Options

Top and bottom surgery are not the only surgical options for transgender men. There are various surgical procedures you can undergo to make your appearance more traditionally masculine.

As with any other form of plastic surgery, it all depends on your personal goals.

Clavicle Lengthening 

Clavicle lengthening, also called shoulder lengthening or widening, increases the width of your shoulders to create a more masculine appearance.

During clavicle lengthening, your surgeon creates an incision in the clavicle bone and cuts diagonally. Your surgeon then slides the bone ends over one another. This increases length anywhere from 15 to 18 centimeters. The bones are then connected with a supportive metal plate and screws, allowing them to heal.

Recovery takes about 4 months. You will wear a sling for 2 weeks after surgery and refrain from exercise for 12 weeks.

Facial Masculinization Surgery

Facial masculinization surgery refers to a broad range of procedures designed to make your face appear more masculine. Facial masculinization can be a single surgery or a multi-step process.

You’ll have to meet with a plastic surgeon to create a plan for you. Common types of facial masculinization surgeries include forehead lengthening, cheek augmentation, rhinoplasty, chin contouring, Adam’s apple enhancement, and jaw reshaping.

Frequently Asked Questions

Does this affect fertility?

It depends on your course of treatment.

Some trans men may opt to have hysterectomies or ovariectomies to remove reproductive organs. This is usually done prior to bottom surgery.

Other transgender men may want to carry their own biological children. In this case, you can forego these procedures to preserve fertility.

Some transgender men want their own children, but think pregnancy and childbirth would trigger dysphoria. You can look into egg freezing and gamete banking. Discuss these options with your doctor prior to undergoing surgery.

Can you still orgasm?

Usually, you should be able to achieve orgasm after female to male gender reassignment surgery. In fact, many studies indicate transgender men report higher levels of sexual satisfaction after surgery.

Do I need a mental health screening first? 

It depends. Insurance companies and surgeons often require a mental health screening prior to procedures like top and bottom surgery. The evaluation assesses your overall mental health and history of gender dysphoria.

Ask your surgeon and insurance company about their specific requirements. Usually, you will need a letter of support from a mental health provider with knowledge of transgender care and health.

What are the costs of Gender Reassignment Female to Male surgery?

It depends on your treatment, but costs can be as low as $7,000 or as high as $50,000. However, more and more insurance companies are opting to cover costs associated with gender reassignment surgery. Talk to your provider about coverage. 


Deciding on gender reassignment surgery is a major decision. There is no right or wrong way to transition. The first step to figuring out your surgical plan is educating yourself about your options.

With enough time and research, gender-affirming surgery can have an invaluable impact on your overall happiness and mental health. A 2018 study found almost 95% of people who had undergone such procedures were happy with the final results.

Ready to get started? Leif Rogers is an Ivy League-educated, board-certified plastic surgeon. If you’re interested in gender reassignment surgery, get in touch with his team to schedule a consultation.

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Leif Rogers MD, FACS
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By submitting this form I agree to receive email communication regarding your products, service and offers that might interest me.
Leif Rogers, MD FACS