Transgender people who are assigned male at birth are sometimes called MTF (Male to Female). They can identify as women, as non-binary, or something else. They may also choose to have surgery that lets 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 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, there will be a lot of medical words, like “penis”, “vagina”, or “scrotum”. Many people aren’t comfortable with these words or phrases like “MTF,” and we support the language that feels best for you. It’s also important to ask people how they identify themselves and their parts.That way, you can be sure you’re using the words they like.
MTF Top Surgery or Breast augmentation
This surgery makes a person’s breasts larger. It’s also sometimes called “getting breasts implants”. Some people get this surgery when the hormone estrogen hasn’t made their breasts grow as big as they’d like. The surgeon will insert an implant (a kind of sack filled with saline or gel) into your chest where your breasts are. Because the cuts are usually very small, there’s not a lot of scarring. But you may need to have another surgery in the future as breasts implants sometimes move or break.
- Time in the Operating Room: 1 hour
- Hospitalization: Home the same day.
- Recovery: About a week, regular physical activity after 6 weeks.
- Cost: NOT covered by RAMQ, approx. $7,125
MTF Bottom Surgery or Vaginoplasty
This surgery creates a vagina and vulva out of the tissues of a penis and scrotum. It’s done as a single surgery or many surgeries. After this surgery you’ll have a vagina and you’ll be able to have vaginal sex. Afterwards, your new vagina needs to be cared for, just like any vagina. Your doctor will tell you to use dilators. These are devices that look and feel like dildos. You’ll insert them into your new vagina regularly to stop it from healing closed. You’ll start by dilating 4 times a day for the first month. Eventually this will go down to once a week. Also, you’ll likely need to use lube for penetration, even though your body will start to produce some of its own. You’ll also have a clitoris and should be able to have orgasms.
- Time in the Operating Room: 2 hours
- Hospitalization: 2 nights
- Recovery: 6 weeks, regular physical activity after 6-8 weeks.
- Cost: Covered by RAMQ, approx. $19,300
MTF Reproductive Organ Surgery or Orchiectomy
This surgery removes the testicles. You’ll make much less testosterone and you won’t be able to make sperm anymore. You can often get a vaginoplasty at the same time.
- Time in the Operating Room: 30 minutes
- Hospitalization: Home the same day
- Recovery Time: 10 days, regular physical activity after 4 weeks
- Cost: Covered by RAMQ, approx. $1,700
Other MTF Surgeries
There are lots of other kinds of confirmation surgery that you can get. Some people want the features of their face to be finer and more delicate. Others want to have a higher voice or show less of 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 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.
Male-to-Female Gender Changes and Sexual Functioning
Explains how people can undergo sex changes with surgery and hormones, and some of the specific body functions that change as a result.
Sexual Health for Trans Women
A pamphlet from the Center for Excellence in Transgender Health explaining sexual health concerns for transgender women, including birth control, STIs, maintaining erections on hormones, breast cancer, and concerns around tucking (tucking testicles into the body and compressing external genitals) and pumping (injecting silicone to develop a more feminine body shape).