Female-to-Male (FTM) Gender Confirmation Surgery: Stages and Potential Complications

Female-to-Male (FTM) gender confirmation surgery is a complex and specialized procedure in sexual and mental health treatment. Some individuals may need genital surgery and gender confirmation due to a mismatch between their physical body and their internal identity. This procedure is carried out in several stages, including tailored psychological counseling, hormone therapy, and multiple surgeries. This article explains all the stages of FTM gender confirmation, recovery period, complications, and lifestyle. Stay with us for more details.

What is Female-to-Male Gender Confirmation?

Female-to-Male, or FTM, gender confirmation is a set of medical, psychological, and surgical stages. This procedure is performed for individuals whose physical body is female but whose gender identity is male. These individuals believe that their body does not align with their gender identity. The FTM process helps these individuals acquire their true physical body and develop a masculine appearance, voice, physical characteristics, and male genitalia. This gender confirmation is a multi-stage path, and each individual undergoes all or part of it, depending on their needs and budget, and with full awareness.



Stages of FTM Gender Confirmation

The FTM gender confirmation process is performed in several key stages.

1. Psychological Evaluation: In the first stage, the person must undergo a psychological assessment. The psychological specialist, through successive counseling sessions, confirms that the person truly has a persistent gender incongruence and needs gender confirmation.
2. Medical and Hormonal Screening: In the second stage, the individual must undergo medical examinations and hormonal tests. After medical approval, the person enters a period of testosterone therapy to enhance masculine physical characteristics.
3. Surgical Decision: At this stage, the individual decides whether or not to undergo surgery. Surgery includes top surgery (mastectomy/chest reconstruction), bottom surgery (removal of the uterus and creation of male genitalia). This process may take several years.

Hormonal Treatment in FTM Gender Confirmation

Hormone therapy is one of the main stages in the FTM path before any surgery. Physicians start the hormone injections with a low dose in the first few months and then gradually increase it. As a result, the body adapts to it and develops fewer side effects.

Testosterone and its Effects on the Body

Testosterone is the most important male hormone, and its use has significant effects on the bodies of trans individuals. This hormone causes a deepening of the voice, an increase in muscle mass, a reduction in subcutaneous fat, the cessation of menstruation, and an increase in facial and body hair. Sexual desire increases after hormone injection, and the clitoris enlarges. An enlarged clitoris is helpful in genital confirmation surgery.

Changes in Voice, Hair, and Body Composition

During hormone therapy, the voice gradually deepens and masculinizes. This change is irreversible; even if the treatment is stopped, the voice will not return to its initial higher pitch. Beard and mustache hair will grow, but it takes about one to two years to become dense. This hormone also affects body shape. Body fat shifts from the hips and thighs towards the abdomen and upper body, resulting in a more masculine body shape. During this time, muscles will gain volume faster with exercise.

Necessary Medical Care and Potential Complications

During the treatment period, the person must be under continuous medical care. During hormone therapy, blood testosterone levels must be constantly tested and kept within a safe range. The liver, hemoglobin, cholesterol, and blood pressure must be continuously monitored to prevent problems such as clotting, heart problems, and a severe increase in red blood cells. Some individuals may experience side effects such as mood swings or acne in the first months. The doctor usually prevents these complications by changing and reducing the dose, and starting treatment with a low dose.

Surgical Procedures in FTM Gender Confirmation

FTM surgery includes various procedures. Individuals must receive full counseling to decide whether to undergo all or only some of these procedures. Some only undergo hormone therapy. Some only have top surgery, and others also go through the stages of bottom surgery. These surgeries must be performed by specialist and experienced plastic surgeons or urologists.

Top Surgery or Chest Reconstruction

This surgery is also called mastectomy. In this procedure, breast tissue, excess fat, and loose skin are removed to give the chest a flat, masculine appearance. Depending on the breast size, various techniques are used in this operation, such as the periareolar incision or the complete incision under the breast (Double Incision). This procedure is permanent and satisfying. Most individuals feel more confident and free after this surgery.

Bottom Surgery or Genital Reconstruction

Bottom surgery is the most complex stage of FTM. The main goal of this procedure is to create a male external genitalia with a natural shape and appearance, and capabilities such as standing urination, erection, and sexual intercourse. This surgery is performed using various styles and methods.

Metoidioplasty

In this method, the clitoris, which has enlarged with hormone therapy, is used to construct a small penis. In this operation, the clitoris is brought down. The recovery period for this method is short, and its complications are fewer. However, the size of the penis is small in this method, and standing urination is not achieved for all individuals.

Phalloplasty

In this method, tissue from the thigh, forearm, or abdomen is used to construct a larger penis. This surgery is usually performed in several stages, and a penile prosthesis is typically implanted for full erection capability. The penis is larger and more natural in this method, but the recovery period is longer, and the risk of infection or graft problems is higher.

Scrotoplasty

This procedure is performed along with phalloplasty to create testicles. In this method, the labia majora are converted into a scrotum, and if needed, testicular prostheses are placed inside it.

Removal of the Uterus and Ovaries (Hysterectomy and Oophorectomy)

The removal of the ovaries is optional for some and mandatory for others. Hysterectomy (uterus removal) and Oophorectomy (ovary removal) cause menstruation to stop and eliminate female hormones. Removing the ovaries helps the testosterone dose remain more stable and have fewer fluctuations.



Facial Masculinization Surgery (FMS)

This procedure is completely optional. Some individuals undergo surgeries such as jaw contouring, forehead shortening, or chin augmentation to bring the face closer to masculine features. This stage will have a significant impact on individuals' self-confidence in social settings.

Satisfaction Rate with FTM Gender Confirmation

According to international studies and statistics, the satisfaction rate with FTM surgery is very high. Testosterone and hormone therapy, and mastectomy, are highly satisfactory for most individuals because they are easier stages and bring people closer to their gender identity. However, because phalloplasty has high complexity, a long recovery period, or high cost, it may have different opinions compared to other stages. Overall, most individuals feel more comfort and closeness to their real body and gender identity after going through the various stages of gender confirmation.

How Much Does FTM Surgery Cost?

FTM surgery is considered expensive and costly in Iran and other countries worldwide. The cost of surgery depends on various factors such as the type of procedure, the expertise and experience of the doctor, and the patient's condition. The cost of FTM surgery in Iran is usually over 150 million Tomans. Note that this surgery is not covered by insurance.

Post-Surgery Lifestyle

The lifestyle after FTM surgery is highly conducive to its success, just like any other surgery. Individuals should avoid lifting heavy objects and strenuous physical activities. After a few days of rest, light physical activities such as walking help improve blood circulation and accelerate healing. Smoking must be stopped because it slows down the healing process and increases the risk of infection. The individual's diet should be nutritious and include protein, vitamin C, and plenty of fluids. White and red meat, fish, legumes, fruits, and leafy green vegetables should be part of their diet.

Recovery Period and Post-Surgical Care

The recovery period after surgery is usually one to two weeks, and sometimes longer. Doctors usually prescribe a special compression garment, anti-infective medications, painkillers, and healing creams for a few weeks. The patient must keep the surgical site and wound clean and should not bathe until the doctor permits. Regular follow-up to check the person's general health status and the condition of the wounds is mandatory.

Wound Healing, Nutrition, and Home Care

Surgical wounds usually close after a few weeks, but reaching the final desired state requires several months. Using healing ointments or silicone sheets is effective in improving the wounds. Home care, including sufficient rest and sleep, abstinence from alcohol and smoking, adequate water intake, proper nutrition, and having mental and physical calmness, will be very influential in the recovery process.

Use of Compresses and Exercises

In the first weeks, you can use cold compresses to reduce swelling and bruising. Also, depending on the patient's condition, the doctor may suggest stretching exercises or gentle massages. Exercises help tissues heal in a shorter time. Note that exercises are completely different for mastectomy versus phalloplasty. Therefore, always perform the type of exercise as instructed by the doctor.

Warning Signs for Re-visiting the Doctor

If you experience symptoms such as high fever, bad odor from the wound site, discharge of pus from the wound, severe pain, severe redness and inflammation, abnormal bleeding, or difficulty urinating after the operation, see a doctor immediately. Sometimes, psychological symptoms such as severe depression, anxiety, or panic attacks also occur in individuals. These symptoms should also be discussed with a specialist psychiatrist.



Potential Complications of FTM Gender Confirmation Surgery

FTM surgery is usually performed without serious complications, and individuals return to their routine life after a few weeks. However, in rare cases, this operation may have the following complications:

Infection, pain, or failure of tissue grafting

Sometimes, the graft in the new genital tissues does not take hold completely, requiring further corrective surgeries. Also, bottom surgery may be accompanied by wound infection if the doctor is not specialized or if hygiene practices are not followed.

Psychological challenges after surgery

Although most individuals feel a greater sense of freedom or peace after gender confirmation surgery, some may also experience a period of anxiety or depression. During this time, the support of family and friends and consulting a psychologist can be very helpful.

Conclusion

Gender confirmation surgery, or FTM, is a complex medical procedure performed in several stages. Psychological assessment and counseling sessions, medical tests, hormone therapy, and surgery are among the stages of FTM gender confirmation. Surgery is performed in several stages on the upper and lower body. Most individuals feel a greater sense of freedom and closer to their gender identity after undergoing the operation.

Frequently Asked Questions

How long does FTM gender confirmation take?

It will take two to five years, depending on the patient's condition.

What happens in FTM surgery?

The female genitalia is removed or reshaped to resemble the appearance and function of male organs.

Is FTM surgery painful?

The surgery is performed under general anesthesia. Post-operative pain is also controlled with medication.

Is FTM gender confirmation possible without surgery?

Yes, some individuals only undergo hormone therapy and do not have surgery.

What role does testosterone play in FTM gender confirmation?

It causes the creation and enhancement of masculine characteristics such as the deepening of the voice, changes in body shape, and the growth of a beard and mustache.

How long is the recovery period after FTM surgery?

Depending on the body's condition and the type of surgery, the recovery period varies from a few weeks to several months.

Can a woman change her gender to male?

Yes, if a gender incongruence is diagnosed and confirmed by specialists, women can also undergo gender confirmation.

Can a woman fully transition into a man?

They can transition to a large extent in terms of appearance and function to a man.

What is a woman called when she transitions to a man?

A transgender man or an FTM individual.

Can a girl naturally transition to a boy?

No, it requires medical and legal approval, hormone therapy, and medical care.