Female-to-male (FTM) bottom surgery is a profound step for many transgender men toward living a life that reflects their gender identity. The decision to wave gender dysphoria goodbye and live life authentically is becoming increasingly popular, with 25-50% of trans men opting for this life-changing procedure. Yet it comes with its complexities and a vast array of surgical options. Wading through the nuances of FTM bottom surgery can be overwhelming, from selecting the right procedure to finding the best surgeon for your needs.
This article will help you navigate such a significant phase of your transition. Here, you'll find a comprehensive overview of your options, recommendations for experienced surgeons, a breakdown of prospective costs, and a thorough guide on preparation, recovery, and the long-term outlook post-surgery.
Table of Contents
- What is Female-to-Male (FTM) Bottom Surgery?
- FTM Bottom Surgery Options
- Best FTM Bottom Surgeons
- How Much is Female-to-Male Bottom Surgery?
- How to Prepare for Female-to-Male Bottom Surgery?
- FTM Bottom Surgery Recovery
- Female-to-Male Bottom Surgery Results
- Takeaways
What is Female-to-Male (FTM) Bottom Surgery?
Female-to-male (FTM) bottom surgery, also known as transmasculine surgery, is a series of procedures that transform the physical appearance of the genitalia from female to male. This type of sex reassignment surgery is a pivotal component of the physical transition process for many. Genital surgery aims to offer transgender men a body that mirrors their true selves, enhance their mental health, and reduce gender dysphoria.
The term "bottom surgery" encompasses a range of surgical options, which may involve:
- removal of the vagina, uterus, and ovaries;
- construction of a penis.
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What does FTM bottom surgery look like?
The outcomes vary significantly depending on the chosen procedures, the individual’s body, and the surgical techniques.
- Phalloplasty results in a phallus that appears and feels more like a cisgender male penis. The size and shape vary based on the graft site and individual preferences.
- Metoidioplasty results in a smaller, but naturally sensitive phallus that maintains its original nerve connections.
- Scrotoplasty creates a scrotum that is visually similar to that of cisgender males. It is often enhanced with testicular implants to improve the aesthetic and tactile experience.
Let’s take a closer look at these and other trans-male bottom surgery options below.
FTM Bottom Surgery Options
Transgender men have several surgical options to consider in their transition process:
- Hysterectomy — the removal of the uterus. This surgery might appeal to patients who are uncomfortable having a uterus or if hormone therapy fails to stop menstruation.
- Oophorectomy — the removal of ovaries. It's an option for those who want to eliminate the possibility of menstruation and reduce the presence of female reproductive organs.
- Vaginectomy — the removal of the vagina and closure of the vaginal opening. A surgeon often conducts this procedure alongside other gender-affirming surgeries, such as penis creation.
- Metoidioplasty — a single-stage reconstructive procedure that transforms the clitoris into a penis. Before surgery, patients undergo hormone therapy to enlarge the clitoris.
- Phalloplasty — a multi-stage genital reconstruction that creates a penis using skin grafted from other body areas.
- Scrotoplasty — constructs a scrotum from the labia majora and inserts silicone testicular implants. This is an additional procedure that can accompany either metoidioplasty or phalloplasty.
Metoidioplasty vs Phalloplasty Surgery
Metoidioplasty and phalloplasty are the two primary gender-affirmation techniques for constructing a neopenis. While both surgeries offer excellent pathways to masculinity, each differs in its methods and offers unique benefits.
What happens during metoidioplasty?
- Hormonal therapy. The process begins with at least a year of hormonal treatment using testosterone to enlarge the clitoris.
- Clitoral release. The surgeon performs a procedure to cut the ligaments around the hormonally enlarged clitoris, freeing it from the pubic bone.
- Creation of a neopenis. The released clitoris is transformed into a penile shaft (4-6 centimeters). The neopenis retains the capability to become erect naturally without the need for a penile implant.
- Urethral lengthening (optional). Surgeons connect and extend the urethra with tissue from the cheek, labia minora, or other parts of the vagina. This step enables urination while standing.
- Scrotum formation (optional). A scrotum can be created using skin from the labia majora (outer labia), completing the male genital appearance.
⏳Metoidioplasty is a single-stage procedure that takes 2-5 hours to complete.
What are the benefits of metoidioplasty?
- Preserves the erotic sensitivity of the clitoris in the newly formed phallus.
- Has lower complication rates and requires fewer follow-up procedures.
- Minimizes noticeable scarring.
- More affordable: metoidioplasty cost can be 2 times lower than that of FTM phalloplasty.
- Has a shorter healing time compared to phalloplasty.
- Enables natural erectile function, eliminating the need for a penile prosthesis.
What happens during FTM phalloplasty?
- Skin grafting. A phalloplasty begins with selecting a donor site for skin grafting, which is commonly the arm, thigh, back, or abdomen.
- Neopenis construction. The grafted skin is then shaped and attached to the genital area to form a penis. The size and appearance of the penis can be significantly larger than with metoidioplasty.
- Urethral lengthening. Similar to metoidioplasty, the urethra is lengthened to allow the patient to urinate while standing. This step involves using grafts from the mouth or other body parts.
- Scrotoplasty (optional). Patients may also opt for a scrotoplasty to create a scrotum. A surgeon uses labia majora tissue and inserts silicone testicular implants to create a more complete male appearance.
- Erectile implant (optional). Unlike metoidioplasty, a phalloplasty neopenis cannot become erect on its own. After recovery from the initial surgery, an erectile implant can be inserted to allow for erections.
⏳Unlike metoidioplasty, phalloplasty requires multiple stages. Surgical procedures take about 5-8 hours and are spaced out over months to achieve the final results.
What are the benefits of FTM phalloplasty?
- Gives patients the ability to sexually penetrate their partners with the aid of erectile devices.
- Results in a significantly larger phallus (12-15 cm), though it may sacrifice erogenous sensation.
- Offers a more natural-looking male genitalia to some preferences.
Each procedure has its place in the journey towards physical congruence: metoidioplasty is appealing for its functionality and minimal invasiveness, while phalloplasty stands out for its aesthetic and size outcomes.
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Best FTM Bottom Surgeons
Selecting a skilled and experienced surgeon is the key to stellar outcomes. Here are top surgeons specializing in gender-affirming surgeries worldwide, known for their expertise, compassionate care, and outstanding surgical results.
Dr. Ali Nurhan Özbaba📍Turkey
With a remarkable 35-year experience in the medical field, Dr. Ali Nurhan Özbaba is a leading figure in plastic, reconstructive, and gender-affirming surgery. Dr. Özbaba performed over 30,000 treatments. He is an active member of the Turkish Society of Aesthetic Plastic Surgery (TSAPS).
Kucukcekmece Hospital is a multidisciplinary clinic located in Istanbul, Türkiye. Its strongest specialties are plastic surgery, gender reassignment surgery, bariatric surgery, neurosurgery, orthopedics, and cardiology. Kucukcekmece Hospital excels in male-to-female (MTF) surgeries, including top surgery (breast augmentation), bottom surgery (vaginoplasty), facial feminization surgery (FFS), and voice feminization surgery. Kucukcekmece Hospital serves both adults and children. Every year, 45,000 patients choose the clinic for medical care.
Major international patient flow comes from the USA, Asia, Europe, Africa, and Arab League states.
Hospital certificates and accreditation of quality
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Dr. Hakan Teymur📍Turkey
Boasting over 20 years of experience, Dr. Hakan Teymur has established himself as a highly-skilled plastic, reconstructive, and aesthetic surgeon. With more than 1,000 operations to his name, Dr. Teymur's expertise has garnered local and international recognition. He holds memberships in several prestigious organizations, such as:
- the European Board of Plastic, Reconstructive and Aesthetic Surgery;
- the European Society of Aesthetic Plastic Surgery.
Dr. MED Clinic is a private multi-specialty medical center in Istanbul, Turkey. The team is dedicated to plastic surgery, sex reassignment surgery, aesthetic medicine, cosmetology, and weight loss surgery. The clinic's success rate for plastic surgery, including sex change operations, is 98%. Dr. MED specialists apply the latest technologies in plastic and reconstructive surgery, offering such gender-affirming options as top surgery, bottom surgery, and facial reconstructive surgery. Dr. MED Clinic serves only adults. Every year, more than 4,500 patients choose Dr. MED Clinic for medical care. Patients from Europe, the Commonwealth, the USA, Canada, Australia, and CIS visit the clinic most often.
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Dr. Erik Marquez📍Mexico
Dr. Marquez is a prominent figure in aesthetic and reconstructive plastic surgery. He has over 20 years of experience and conducts around 500 procedures annually. As a member of the American Society of Plastic Surgeons, Dr. Marquez brings a wealth of knowledge and skill to each operation. His commitment to the LGBT+ community and specialization in transgender surgeries make him a top doctor for transfeminine procedures.
Advance Health Medical Center is a private multi-specialty medical center in Tijuana, Mexico. The team is dedicated to orthopedics and surgery, including plastic and hand surgery. Advance Health Medical Center is an all-inclusive boutique clinic with over 14 years of experience in medical tourism. It serves both adults and children. 1,000 patients choose Advance Health Medical Center to get medical care every year. Patients from the USA, Canada, and Australia visit the clinic most often.
How Much is Female-to-Male Bottom Surgery?
The average cost of female-to-male (FTM) bottom surgery is around $25,000. However, surgery costs can vary widely depending on the specific procedures, the surgeon's expertise, and the clinic’s location.
Here's a closer look at the average cost range for different types of FTM bottom surgery:
Type of FTM bottom surgery | FTM bottom surgery cost |
|---|---|
Hysterectomy | $9,661 - $22,534 |
Oophorectomy | $11,297 - $18,378 |
Vaginectomy | $6,558 - $7,331 |
Metoidioplasty | $6,000 - $30,000 |
Phalloplasty | $20,000 - $50,000 |
Many surgeons offer packages that combine metoidioplasty or phalloplasty with other procedures like vaginectomy at a reduced cost. Similarly, undergoing a hysterectomy and ovary removal in one session can significantly reduce the total cost compared to having them separately.
💸Budgeting tip: In countries with affordable healthcare, like Turkey and Thailand, the FTM bottom surgery cost can be 2-3 times lower than in the US or UK. Exploring options worldwide can yield substantial savings while maintaining the quality of care.
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How to Prepare for Female-to-Male Bottom Surgery?
Surgery requirements
- Lab testing/medical evaluation to identify any health issues that need to be managed before gender-affirming surgery.
- At least 1 year of hormone replacement therapy (HRT) before surgery is often necessary.
- Two recommendation letters from different therapists.
- Informed consent confirming your understanding of surgery's risks, expected outcomes, and social and legal implications.
- Stop smoking to lower the risk of complications.
❗WPATH guidelines and informed consent are two main models for assessing patients’ suitability for gender-affirming surgeries. Many practices are adopting the informed consent model, which emphasizes patient autonomy. Despite this shift, WPATH guidelines, which necessitate letters of recommendation from mental health professionals, remain prevalent.
Surgery preparations
- Consultation. Choose a board-certified surgeon experienced in gender-affirming surgeries and discuss all aspects of the procedure, including expectations and post-operative care.
- Hair removal. Laser hair removal or electrolysis is necessary for certain surgeries to prepare the donor or surgical site. It may take at least 9-12 months and should be finished 6-8 weeks before surgery.
- Medication and HRT management. Review all medications with your surgeon and pause hormone replacement therapy 2 weeks before surgery.
FTM Bottom Surgery Recovery
How long does it take to recover from bottom surgery?
Recovery times can vary based on the complexity of the procedure, individual health factors, and specific surgical techniques. Recovery from metoidioplasty tends to be quicker and less complicated due to its less invasive nature. FTM phalloplasty, a more significant anatomical alteration, requires several surgeries and a longer recovery period.
Hospital stay:
- Metoidioplasty. Typically, the hospital stay is about 3 days.
- Phalloplasty. More complex, this procedure usually requires a longer hospital stay, often between 5 to 7 days.
Short-term recovery:
- Metoidioplasty. The initial recovery period usually lasts 2 to 4 weeks, during which patients may resume light daily activities, with caution to avoid strain on the surgical site.
- Phalloplasty. Short-term recovery can extend to 4 to 6 weeks. Patients are advised to limit physical activity and may need assistance with daily tasks.
Long-term recovery:
- Metoidioplasty. Full recovery, including the ability to engage in strenuous activities and sexual function, can take from 6 weeks.
- Phalloplasty. Long-term recovery, including the potential for sexual activity, can extend up to 4 months or more. Additional surgeries for implants or revisions may also impact the timeline.
What is sex like after female-to-male bottom surgery?
Both metoidioplasty and phalloplasty present pathways toward fulfilling sexual lives post-surgery, but sensations and functionality of the neopenis vary depending on the procedure.
- Metoidioplasty yields excellent sensation and the ability for an erection due to the preservation of clitoral and genital tissues. While metoidioplasty does not allow for penetrative sex, individuals can still experience sexual arousal, orgasm, and satisfaction. Patients report a 30% increase in sexual satisfaction and orgasm frequency post-surgery.
- Phalloplasty can involve the insertion of an erectile prosthetic for penetrative sex. Although orgasms remain achievable post-surgery, sensation may take up to a year or more to return fully.
What are possible complications?
As with any surgical procedure, gender-affirming surgeries such as metoidioplasty and phalloplasty come with potential complications and risks, including:
- infections;
- excessive bleeding;
- urethral fistulas or strictures, impacting urination;
- reduced sensation or numbness;
- skin graft failure in case of phalloplasty.
These complications are generally manageable with appropriate medical care and follow-up.
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Female-to-Male Bottom Surgery Results
- Improved quality of life. Surveys of post-surgical trans male patients reveal significant enhancement of overall quality of life. They report improvements in self-image, sexual relationships, dating, social interactions, and employment opportunities, as well as reductions in mental disorders and gender dysphoria.
- High satisfaction. According to the Journal of the American Society of Plastic Surgeons, 99.7% of transgender patients who underwent gender-affirming surgeries report satisfaction with the outcomes.
- Scarring. After phalloplasty, scar lines improve over time but do not disappear completely.
- Impact on fertility. Since bottom surgery involves the removal of reproductive organs, patients wishing to have biological children in the future are encouraged to explore fertility preservation options, such as egg freezing, before they undergo surgery.
- Revision surgery. Revision surgeries after female-to-male (FTM) bottom surgery may be necessary to address specific concerns or enhance the outcomes of the initial procedures.
Takeaways
- 25-50% of trans men undergo bottom surgery, striving to enhance their quality of life and self-image. 99,7% of trans people are satisfied with sex reassignment surgery results.
- Surgical options include genital organ removal and penis construction, with key procedures being hysterectomy, oophorectomy, vaginectomy, metoidioplasty, and phalloplasty.
- Metoidioplasty preserves the clitoris's natural erectile function, involves fewer steps, and has shorter recovery times. On the other hand, phalloplasty creates a larger neopenis with the potential for sexual penetration.
- The average cost of trans male bottom surgery is $25,000. However, it can be lower in countries like Turkey or Thailand due to competitive medical tourism, efficient healthcare systems, and lower living costs.
- Preparation may involve consultations, hair removal, medication management, providing informed consent, and securing letters of readiness from therapists.
- Manageable complications include infection, bleeding, and urinary complications. Phalloplasty poses risks of reduced sensation or graft failure.
Related Articles
- Johns Hopkins Medicine. Metoidioplasty for Gender Affirming Care. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/metoidioplasty-for-gender-affirming-care
- Johns Hopkins Medicine.Phalloplasty for Gender Affirmation. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/phalloplasty-for-gender-affirmation
- International Journal of Transgender Health. (2020). Patient-reported satisfaction and quality of life after trans male gender affirming surgery. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8726650/
- International Journal of Transgender Health. (2022). Standards of Care for the Health of Transgender and Gender Diverse People, Version 8. https://www.tandfonline.com/doi/pdf/10.1080/26895269.2022.2100644
- Plastic and Reconstructive Surgery. (2023). Regret after Gender-Affirming Surgery: A Multidisciplinary Approach to a Multifaceted Patient Experience. https://pubmed.ncbi.nlm.nih.gov/36727823/