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    The Essential Guide to Transitioning | Trans Masculine

    The Essential Guide to Transitioning | Trans Masculine Edition is an essential guide to assist not only trans people but cis people as well to learn the processes of how trans people who were assigned female at birth may socially & medically transition. 

    • Mental and physical health along with the stigma that comes along with those issues.
    • Financial problems 
    • Cultural, religious/spiritual problems
    • Risk employment problems
    • Risk of housing problems

    Language in this document will primarily refer to people who were assigned female at birth. It is important to note that intersex individuals can, and often do, refer to themselves as trans men and go through many/most/all of these same treatments, processes, and procedures. 

    Certain sections of this page contains graphic material including real and recreations of surgical procedures, surgical results, prosthetic and real genitalia, etc.

    This is for educational use.

    NSFW sections will be
    marked with
    “⚠” in the title.

    Some NSFW content will have the ability to toggle show/hide, hide being the default.

    A transgender man is typically someone who was assigned female at birth, but identifies as a man. Some may choose to medically transition to alleviate dysphoria and/or increase euphoria by taking testosterone and/or have surgeries. This is to show how some trans men, trans masculine, and AFAB Non-binary people may socially and/or medically transition. 

    Name & Pronouns

    After coming out, a trans person may choose to go by a different name. There are many different factors into how a trans person may decide their new name.

    • Masculine version of their birth name.
    • Asking parent what name ideas they had while pregnant.
    • Researching and choosing their own name.

    They may also change what pronouns, titles, and honorifics to whatever makes the feel more comfortable. Some may chose stereotypical masculine pronouns and titles like he/him/his, Mr, Sir, son, brother, father, boyfriend, husband, etc. Others may feel comfortable with some words or pronouns and not others.  Some may feel nervous or unsure about trying out new pronouns or titles, so they may experiment with different names, pronouns, and/or titles to find out what feels right for them.

    Binding

    Many trans men or trans masculine people will start binding. Binding is when a post pubescent AFAB trans person flattens their breasts with mostly a binder or KT Tape. 

    Photo of 5 trans masculine individuals wearing nude binders from GC2B
    'Black Half-Tank Binder from GC2B, functionality modeled by @aerialgambit (He/they)

    A binder is a compression tank top or sports bra/“half tank” type style that evenly distributes the breast tissue in a safer way that flattens the chest, giving the appearance of a typical male chest and alleviating dysphoria.

    However, those who do not have access to proper binding wear may resort to using other improper materials.

    File:Red X.svg - Wikimedia Commons DO NOT bind with duct tape, ace bandages, or anything that is not a proper binder.

    Binding with these materials can restrict your ability to breathe and move properly. Ace bandages in particular are designed to constrict, so as you breathe, they get tighter and tighter. This can cause bruised or broken ribs, fluid build up in the lungs, and more. Only use a proper binder.

    File:Red X.svg - Wikimedia Commons DO NOT bind for more than 8 hours a day
     
    File:Red X.svg - Wikimedia Commons DO NOT sleep in your binder
     
    File:Red X.svg - Wikimedia Commons DO NOT wear multiple binders at once
     
    File:Red X.svg - Wikimedia CommonsDO NOT wear a binder that is too small or a size down

    File:Red X.svg - Wikimedia CommonsSTOP binding if it hurts or having trouble breathing

    Check, circle, correct, mark, success, tick, yes icon DO get a size up if you’re unsure of your size
    Check, circle, correct, mark, success, tick, yes icon DO take breaks often
    Check, circle, correct, mark, success, tick, yes icon DO Stretch often
    Check, circle, correct, mark, success, tick, yes icon DO make sure you can comfortably take in big deep breaths

    IMPROPER BINDING CAN CAUSE:

    • Bruising
    • Redness
    • Swelling
    • Trouble breathing
    • Chest tightness; soreness that last more than a couple of binder-free days
    • Dehydration
    • Break down of tissue
    • Low skin elasticity
    • Back pain
    • Skin irritation
    • Bruised or broken ribs
    • Fluid build up in lungs

    Binding improperly can cause permanent damage to your body which can affect your top surgery results or cause chronic issues that cannot be relieved after top surgery.

    “97.2% of those surveyed reported at least one negative health outcome that they attributed to binding. 74% reported pain-related concerns—the most common side effect was back pain (53.8%), followed by overheating (53.5%), chest pain (48.8%), shortness of breath (46.6 %), and itching (44.9%). 50 respondents even believed they had suffered from rib fractures as a result of binding.” 

    Where to get binders
    • OUR BINDERS – gc2b
      GC2B: Binders range from $33 – $43 USD. Made BY and FOR trans people
    • Shapeshifters: Prices $50 USD Made BY and FOR trans people
    • FLAVNT Bareskin Binder: Binders are $49.99 USD, US shipping $5, International shipping $15
    • Underworks: Prices range depending on the type of binder, $16-$80 USD.
      • Not specifically made for trans people, this is a generalized compression wear store for cis and trans folks.

    Packing

    Some trans men who suffer from bottom dysphoria may start packing, which is the act of putting a phallic object into the pants to create the appearance of a bulge. It can be just as simple as rolling up a sock and putting it in the pants, while others may go for a packer.

    A packer is a prosthetic penis that is used to alleviate bottom dysphoria. They are usually made of silicone and comes in all shapes, sizes, colors, circumcised or uncircumcised, and functions.

    There are 4 different types of functions packers have

    • Packing: general appearance of having a bulge 
    • STP-Stand To Pee: a funnel giving the ability to pee standing up 
    • Sex: a rod that can erect the prosthetic penis to use for penetrative sex
    • Masturbation: a piece at the base of the prosthetic penis that can be penetrated with the person’s clitoris, working best with those who have bottom growth. 
    Hide
    Show

    Some packers are pretty simple and just act as an object to create a bulge. Sometimes these simpler packers are also STPs. They help the individual urinate while standing. They aren't as detailed and are just meant to get the job done.

     

    Hide
    Show

    Some packers look hyper realistic including detailed custom paint jobs, adhesive pads, glue, and tape, pubic hair, movable testicles, and/or circumcised and uncircumcised.

    You can find packers and STPs here:

    Common Misconception

    It’s a common misconception all packers are solely used for sex or are equivalent to dildos or other sex toys.  Most packers cannot be used for penetrative sex due to the material being too soft and pliable. The shape of the mold itself can also be delicate, attempting to bend the penis back into an erect position can cause the prosthetic to rip and tear.  Only packers that allow/have “pleasure rods” should be used for sex.

    Hormones

    DO NOT attempt to self medicate. Please speak to a licensed medical physician and/or endocrinologist to see if hormones are right for you. 

    Many trans men start their medical transition with Hormone Replacement Therapy by taking testosterone or “T”
     
    Testosterone can be taken via:
    • Injections (the most common)
    • Gels
    • Patches
    • Pills

    Within the few months they will notice some changes, and as time goes on, some of these changes will become more noticeable.

    Changes take up to 2-5 years to complete.

     

    Common Misconception

    It is a common misconception transgender people will produce new hormones after taking HRT for a certain length of time. Transgender people typically take hormones for the rest of their lives. Especially if they no longer have organs that naturally produce their own hormones. It is not possible to start producing their own testosterone after taking it for a certain length of time. 

    Some changes they can expect include but not limited to:
    • Menstruation stops
    • Oily skin
    • Acne
    • Body odor changes
    • Voice beings to deepen
    • Body and facial hair growth
    • Change in sex drive
    • Changes in appetite
    • Gained muscle mass
    • Clitoral growth
    • Slight decrease in breast size
    • Fat redistribution
    • Slight changes in bone structure
    • Male pattern baldness
     

    Maddie, Deutsch. “Information on Testosterone Hormone Therapy.” Information on Testosterone Hormone Therapy | Transgender Care, UCSF Center of Excellence for Transgender Health, transcare.ucsf.edu/article/information-testosterone-hormone-therapy.

    Hormones: A Guide for FTMs. Coastal Health, Transcend Transgender Support & Education Society and Canadian Rainbow Health Coalition, Feb. 2006, apps.carleton.edu/campus/gsc/assets/hormones_FTM.pdf.

    “Masculinizing Hormone Therapy.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 14 Apr. 2020, www.mayoclinic.org/tests-procedures/ftm-hormone-therapy/about/pac-20385099.

    Photo of @RenaissanceQueer before going on testosterone vs. 1 year of being on testosterone.

    Bottom Growth

    One of the common affects from taking testosterone is the enlargement of the clitoris. Typically to alleviate dysphoria, many will call their enlarged clitoris “Bottom Growth or “T-Dick.” Some may simply just call it their penis. Every person is different in how they like to refer to their genitalia. 

    Bottom growth can begin 3 -6  months after starting T and finish 1-2 years after starting T. 

    One can expect the clitoris to become much wider and longer. Depending on the individual, the clitoris can grow up 5cm.

    Permanent vs. Reversible changes

    What happens if you stop taking Testosterone?

    Permanent

    • Voice: Will stay the same as when T was stopped.
    • Facial/body hair: Hair will no longer spread into new areas. Growth rate may slow down slightly but overall growth will not cease
    • Clitoris growth: Will stay the same size as it was when T was stopped
    • Hair Loss on Head: Existing hair loss will still exist, however future hair loss will slow down.

    Reversible

    • Muscle/fat changes: Fat will redistribute to that before taking T
    • Hair Loss on Head: Existing hair loss will still exist, however future hair loss will slow down.
    • Menstrual cycle: Period may return if ovaries are still intact and working properly. 
    • Skin oils and acne may lessen.
    • Body scent may change.
    • Sex drive may decrease.
    • Red blood cell count and cholesterol levels: Will go to pre T levels depending on if the ovaries are still intact and working.

    “Hudson’s Guide: FTM Testosterone Therapy Basics.” Hudson’s FTM Resource Guide, www.ftmguide.org/ttherapybasics.html.

    Microdosing

    Microdosing is taking a smaller than typical dose of hormones that is overseen by a medical professional to slow down or experience minimal amount of changes. There are many reasons why someone may chose to mircodose their hormones. 

    • Feels like changes are too fast
    • Unsure if they are ok with certain changes
    • Required by insurance to get certain surgeries covered. Someone who does not want to go on hormones may go on the smallest dose possible for insurance to cover the cost of surgery, while also experiencing very minimal changes.

    Reproductive Health

    Transgender men, even after some medical intervention, can still become pregnant and give birth to a healthy baby. Not every trans person undergoes bottom surgery. Many still keep their entire reproductive system. As long as the person has a properly working vagina, uterus, ovaries, etc. they can still become pregnant. While the chance of becoming pregnant while on testosterone may decrease, several trans men have been pregnant both before and after medical transitioning. 

    Typically if a couple is purposefully trying to become pregnant and will typically seek help from a medical professional. They will have to stop taking any hormones from the time of trying to become pregnant until the individual becomes pregnant, gives birth, and finishes breast/chest feeding if they chose to do so. The amount of time off of hormones depends on the individuals fertility. 

    Some trans men can still breast feed or “chest feed” as some prefer to call it to reduce dysphoria. Depending on if they had top surgery and what specific type of top surgery. Even cis men can and do breast feed with help from medications like Prolactin.

    Light, Alexis D, et al. “Transgender Men Who Experienced Pregnancy after Female-to-Male Gender Transitioning.” American College of Obstetricians and Gynecologists, California Digital Library University of California, 1 Dec. 2014, escholarship.org/content/qt3dz427qw/qt3dz427qw.pdf?t=ptt5lb.

    Amato, Paula. “Fertility Options for Transgender Persons.” Fertility Options for Transgender Persons | Transgender Care, 17 June 2016, transcare.ucsf.edu/guidelines/fertility.

     

    Content below will contain graphic surgery videos and surgery results.

    Top Surgery

    Top surgery refers to the removal of the breast tissue (Subcutaneous Mastectomy), also called double mastectomy.  

    There are several different types of top surgeries depending on the size, shape, and skin elasticity of the breast. 

    • Double Incision

    • Keyhole

    • Peri-Areolar

    • Inverted-T

    • Minimal Scar

    • Buttonhole

    • Fishmouth

    • Lollipop

     

    Common Misconception

    It is a common misconception getting top surgery before using testosterone, or ceasing the use of testosterone after top surgery will cause breasts to grow back.  

    FTM & FTN Top Surgery DrainsAfter surgery, many patients will have drains placed inside the chest. This is done to drain the fluid produced during the healing process. Drains are emptied typically twice a day and are removed in the doctors office typically 1-2 weeks post-op, depending on the amount of drainage. 

    Surgery Videos

    Surgery Results

     

    Photos from Dr. Scott W. Mosser, MD, FACS
    San Francisco, California.  https://www.topsurgery.net/before-after-photos/mosser.htm 

     

     

    Photos from Dr. Scott W. Mosser, MD, FACS
    San Francisco, California.  https://www.topsurgery.net/before-after-photos/mosser.htm 

    Photos from Dr. Scott W. Mosser, MD, FACS
    San Francisco, California.  https://www.topsurgery.net/before-after-photos/mosser.htm 

    Photos from Dr. Scott W. Mosser, MD, FACS
    San Francisco, California.  https://www.topsurgery.net/before-after-photos/mosser.htm 

    Photos from Dr. Scott W. Mosser, MD, FACS
    San Francisco, California.  https://www.topsurgery.net/before-after-photos/mosser.htm 

    Photos from Dr. Scott W. Mosser, MD, FACS
    San Francisco, California.  https://www.topsurgery.net/before-after-photos/mosser.htm

     

    Bottom Surgery

    Bottom surgery for trans people AFAB is Genital Reconstruction Surgery, usually refers to changing the genitalia from a vulva/vagina into a penis. There are many different combinations of surgeries AFAB individuals could have depending on what they are looking for.

    Some may have a whole new penis constructed along with silicone scrotal implants and a vaginectomy. Some may keep their vaginal canal as well as construct a penis. 

    There are two different types of bottom surgery,
    Phalloplasty and Metodioplasty 
    as well as several different kind of procedures depending on a multitude of factors.

    Phalloplasty ¹
     
    A procedure to surgically create a penis 
     

    Pedicled Flap Phalloplasty 
    “uses a skin flap that has one end left attached to the donor site and the other transposed to a new location, keeping the “pedicle” intact to retain blood supply. Pedicled Flap Phalloplasty techniques typically do not include microsurgical nerve connection (Pedicled ALT Phalloplasty excluded.) Sensation is thus limited to tactile.”

    Free Flap Phalloplasty
    “uses a skin graft that’s freed from the donor site—along with its blood supply, nerves and sometimes muscle—and transferred to the recipient site. Free Flap Phalloplasty techniques typically include microsurgical nerve connection (anastomosis), providing a sensate penis with erotic and/or tactile sensation.”

    Metodioplasty ²
     

    A surgical procedures that work with your existing genital tissue (the clitoris) to form what is called a neophallus, or new penis. It can be performed on anyone with significant clitoral growth from the use of testosterone. 

    Simple/Clitoral release: free the clitoris from surrounding tissue — and doesn’t alter the urethra or vagina

    Full metoidioplasty: Release the clitoris and then use a tissue graft from the inside of your cheek to link the urethra with the neophallus.

    Ring metoidioplasty: instead of taking a skin graft from the inside of the mouth, the surgeon uses a graft from the inside of the vaginal wall combined with the labia majora in order to connect the urethra and the neophallus.

    Centurion metoidioplasty:​ releases the round ligaments that run up the labia from the labia majora, and then uses them to surround the new penis, creating extra girth

    Common Misconception

    It is a common misconception bottom surgery involves a penis transplant from a cadaver’s body. The first successful penis transplant in the United States didn’t happen until 2016 at Massachusetts General Hospital. And the world’s first penis and scrotum transplant until 2018 at John Hopkins Hospital.

    https://www.nytimes.com/2016/05/17/health/thomas-manning-first-penis-transplant-in-us.html?_r=0

    https://www.hopkinsmedicine.org/news/articles/first-ever-penis-and-scrotum-transplant-makes-history-at-johns-hopkins

    • Phalloplasty¹
      • Pedicled Flap Phalloplasty
        • Kim FTM Phalloplasty
        • Abdominal Phalloplasty
        • Bird-Wing Abdominal Phalloplasty
        • ALT Pedicled Flap 
        • Groin Flap Phalloplasty
      • Free Flap Phalloplasty
        • Radial forearm free flap
        • Musculocutaneous latissimus dorsi flap
        • Re-innervated Latissimus Dorsi Free Flap
        • Anterolateral thigh flap
        • Fibula free flap
        • Island tensor fasciae latae free flap
    • Metidioplasty² 
      • Simple release
      • Full metoidioplasty
      • Ring metoidioplasty
      • Centurion metoidioplasty

    1) “FTM Phalloplasty Surgery Procedures – Types of Phalloplasty.” Phallo.net, www.phallo.net/procedures/?fbclid=IwAR3D4uUJTN9s078zNZioKYecWjy_JQGtVyDY6jRu7fNNcd2V7UObzoZqa54.

    2) Clements, KC. Metoidioplasty. Edited by Janet Brito PhD, LCSW, CST , 17 Oct. 2017, www.healthline.com/health/transgender/metoidioplasty#types

    O’Keefe Osborn, Corinne. Phalloplasty: Gender Confirmation Surgery. Edited by Janet Brito PhD, LCSW, CST , 17 Oct. 2017, www.healthline.com/health/transgender/phalloplasty.

    “Metoidioplasty: Boston Children’s Hospital.” Boston Childrens Hospital, Harvard Medical Teaching Hospital, www.childrenshospital.org/conditions-and-treatments/treatments/metoidioplasty.

    Other Surgeries that can be done:
    • Urethroplasty:  Elongating the urethra and rerouting it through the neophallus to give the ability to urinate while standing.  
    • Vaginectomy: Surgical procedure to remove and close the vaginal canal.
    • Hysterectomy: Removal of the uterus, ovaries, cervix, and/or fallopian tubes.

    Graphic content after this point

    image

    Source: https://www.phallo.net/procedures/abdominal-phalloplasty.htm

    A diagram detailing stage one of forearm flap phalloplasty.

    A diagram detailing stage two of forearm flap phalloplasty.

    A diagram detailing stage three of forearm flap phalloplasty.

    Ercolano, Alexa. “FAQ: Phalloplasty: The Johns Hopkins Center for Transgender Health.” FAQ: Phalloplasty | The Johns Hopkins Center for Transgender Health, 17 Sept. 2019, www.hopkinsmedicine.org/center-transgender-health/services-appointments/faq/phalloplasty.

    Surgery Videos

    Surgery Results

    Radial forearm free flap phalloplasty design and outcomes. a, preoperative flap markings. b, neophallus formed by tube in tube design with glansplasty. c and d, neophallus is inset in groin after anastomosis to donor vessels and nerves. Suprapubic catheter and Foley are in place.

    Ascha, Mona, et al. “Figure 2. Radial Forearm Free Flap Phalloplasty Design and Outcomes. a,…” ResearchGate, 10 Aug. 2018, www.researchgate.net/figure/Radial-forearm-free-flap-phalloplasty-design-and-outcomes-a-preoperative-flap-markings_fig2_318771165.

     

    Pedicled anterolateral thigh phalloplasty design and outcomes. a, preoperative flap markings. b, intraoperative formation of tube in tube showing phallic neourethra rolled over urethral catheter with skin for proximal neophallic shaft seen laterally. c, tubularized anterolateral thigh ready to be tunneled into midline male anatomical position. d, immediately postoperatively with scrotoplasty and prior to suprapubic catheter placement.

     

    Ascha, Mona. Outcomes of Single Stage Phalloplasty by Pedicled Anterolateral Thigh Flap versus Radial Forearm Free Flap in Gender Confirming Surgery. ResearchGate, July 2017, www.researchgate.net/figure/Pedicled-anterolateral-thigh-phalloplasty-design-and-outcomes-a-preoperative-flap_fig1_318771165.

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