Transgender people who are assigned female at birth are sometimes called FTM (Female to Male). They can identify as men, as non-binary, or something else. They may also choose to have surgeries that let them feel comfortable and happy with their bodies. This is called gender confirmation surgery or gender-affirming surgery. You may also hear it called “gender reassignment surgery” or “sex change” but many people don’t like these terms.
Not all transgender people choose to have surgery and that’s okay. It’s a very personal and private decision. What kinds of surgery a transgender person chooses to have or not have can be very different from person to person, but there are a few common ones.
To help make things clearer in this article, we’ll use a lot of medical words, like “penis”, “vagina”, or “scrotum”. Many people aren’t comfortable with these words or with phrases like “FTM,” and we support the language that feels best for you. It’s also important to ask people how they identify themselves and their parts when necessary. That way, you can be sure you’re using the words they like.
FTM Top Surgery or “Subtotal Mastectomy”
This is where surgeons remove most of a person’s breasts, but they leave enough tissue to form pecs. There are a couple different ways to do this surgery, depending on the size of a person’s breasts. Those with smaller ones (“A” or “B” cup size) usually have a t-anchor or periareolar procedure. It can also be called a keyhole incision. This is where surgeons make a small cut around the nipple, with very little scarring.
People with larger breasts often need to have a double-incision or buttonhole procedure. This is when surgeons make a bigger cut with a more visible scar. Depending on your operation and your surgeon, they might take your nipples off and reattach them later. If they need to do this, you might not have any feeling in your nipples afterward.
- Time in the Operating Room: 1.5-2 hours
- Hospitalization: Home the same day.
- Recovery Time: 4 weeks, regular physical activity after 6 weeks.
- Cost: Covered by RAMQ, about $9,750 without.
FTM Bottom Surgery or “Phalloplasty”
This surgery creates a penis with a flap of skin that a surgeon takes from another part of your body, usually your forearm. They might also make a scrotum, a testicular implant, or a penile implant. Surgeons can do all of these procedures at the same time or separately. They can also do another operation that makes your urethra longer and lets you pee standing up. A penile implant will let you have erections and penetrative sex with your new penis. But, phalloplasty is a very complicated operation. Because of this, the results can be very different for different people.
- Time in the Operating Room: 6.5 hours
- Hospitalization: 3 nights
- Recovery Time: 6-8 weeks, regular physical activity after 3 months
- Cost: Covered by RAMQ, approx. $43,900 without RAMQ
FTM Alternative Bottom Surgery or “Metoidioplasty”
This surgery lengthens the clitoris to make a small penis, also called a neophallus. It’s an alternative to phalloplasty. Although the penis will only be about 2 inches long, it’ll be super sensitive. You’ll even be able to get small erections. You can often choose to have a scrotum created at the same time.
- Time in the Operating Room: 1-2 hours
- Hospitalization: 2 nights
- Recovery Time: 3-4 weeks, regular physical activity after 6-8 weeks
- Cost: Covered by RAMQ, approx. $25,000 without RAMQ
FTM Reproductive Organ Surgery or “Hysterectomy”
This is when surgeons remove the uterus and sometimes other reproductive organs. These can include the fallopian tubes, the cervix or the ovaries. These surgeries are sometimes done laparoscopically. The surgeon uses cameras and tools inserted through small cuts. These leave only small scars. It’s also sometimes done through the abdomen with a larger cut and a bigger scar. You won’t be able to get pregnant after having this surgery. If your ovaries are taken out, you’ll need to take hormones (either estrogen or testosterone). These help you stay healthy.
- Time in the Operating Room: 1 hour
- Hospitalization: 1 night
- Recovery Time: 4 weeks, regular physical activity after 6 weeks
- Cost: Covered by RAMQ, approx. $6,000 without RAMQ
Other FTM surgeries
There are lots of other kinds of confirmation surgeries that you can get. Some people might want bigger pecs and a more defined chest. Others might want a broader face and an Adam’s apple. But RAMQ and other insurances don’t cover these operations. Some procedures might not be available in Canada. It’s important to speak with a doctor and look at the costs before you book any surgery.
Trans Summer School (Surgery) – Scarleteen
An article about gender confirmation surgeries. It talks about different kinds of surgeries and what to expect at appointments.
Sexual Health for Trans Men
A pamphlet from the Center for Excellence in Transgender Health summarizing sexual health concerns for trans men, including vaginal wall thinning, pregnancy prevention, and chest and cervical cancers.