min read
June 9, 2022
Top Surgery
Top Surgery Recovery

Lots of transgender people feel something called "gender dysphoria," which is the discomfort or distress of varying intensities with one's body, physical attributes, behaviors, etc., due to the incongruence of assigned sex and gender identity. Trans people experience dysphoria in all kinds of ways. There is no one way to experience dysphoria.

A transition includes any step a person takes to affirm their gender identity. Hence,there is no one way to transition. A transition can include a haircut, hormones, surgery, a wardrobe change. But it can also not. Many people break acts of transition into two main categories:

  1. Social transitioning
  2. Medical transitioning

Social transitioning can involve things like telling people that you'd prefer different pronouns or a different name. It can involve a wardrobe change or a change in how one socializes. But it does not have to. For me, social transitioning meant asking people to refer to me with he/him/his pronouns and shopping in the men's section for clothing again. Social transition involved little to no change in my social behaviors.

Hormone Replacement Therapy: this entails taking testosterone (commonly abbreviated as "T") in various forms (see below) or estrogen. These cause an individual to go through either testosterone driven puberty (wherein the voice drops, red blood cell count increases, body hair growth increases, acne increases for the first year or so, etc.) or estrogen-driven puberty.

Here are the various forms of administering hormones:

  • Topical -- comes in either gels or creams that you spread on your body, typically daily. The main risk is that it could get on someone else who wouldn't want the effects of the hormone. The results are also slower, typically, so one can ease into it. This is very uncommon for estrogen administration.
  • Injections -- probably the most common form of testosterone usage. Injections can be weekly or bimonthly or even (with a more recently developed long-lasting shot called Nebido, though not in the US as the FDA has not approved it) every few months.
  • Pellets -- a doctor surgically inserts a few pellets of testosterone every 3-5 months that slowly dissolve in your body, releasing testosterone over time. It seems that people typically start this after having been on injections for a while. One such pellet is called Testopel. Here is a video about my experience with it.
  • Oral pills -- this is probably the most common for estrogen administration. This is not possible for testosterone as testosterone cannot be processed by the liver.

Top Surgery: a double mastectomy for trans masculine folks, and a breast augmentation for trans feminine folks.

See this page for my experience with my top surgery, and this page for my recovery from it.

Here are the several types of top surgery for trans masculine folks:

  • Double Incision. This is what I got. It involves two incisions generally along the line of the pectorialis major muscle, as well as two free nipple grafts taken from the patient's original areola and nipples. The surgeon removes all breast tissue and most of the excess fat from the chest. Nipple sensation post-surgery can come back in full but pleasurable, erotic sensation is physiologically impossible because the nerve stem has been completely severed and one end removed, although some people claim to experience it. The scars along the pec line will never disappear completely.
  • Keyhole. The surgeon makes semi-circle incisions along the base of each areola and removes breast tissue and fat through liposuction. Sometimes, the areolas are resized. This procedure is for smaller chested individuals, (typically A-cup or smaller,) and it preserves the nipple nerve stem, therefore preserving pleasurable nipple sensation.
  • Peri-Areolar. Very similar to Keyhole, but the incisions spans the entire circumference of the areola so the surgeon can resize the areola. See image below for details.
Keyhole v. Peri-Areolar
T-Anchor Double Incision vs. just Double Incision

A lot of surgeons have slightly different techniques but these are the two main ones. There is also the T-anchor surgery which includes a vertical scar extending down an inch or so under each nipple. This preserve nipple sensation when paired with the Double Incision technique. On it's own, as a similar surgery to Peri-Areolar, it can aid in getting rid of excess skin and fat that gathers under the nipples.

Middle Surgery: the removal of one's reproductive organs - uterus, ovaries, fallopian tubes. Many people undergo this because it is a sort of spiritual release of one's original assigned sex, but it also can chemically aid in one's medical transition because ovaries produce estrogen which competes with the prescribed testosterone. Some people experience better results from the testosterone once their reproductive organs are removed. I have not chosen to undergo this as I have not had any problems with my testosterone or uterus thus far and feel no need to rid my body of these organs - but that's just me!

Bottom Surgery. The reconstruction of one's genitalia. Sometimes called "gender reassignment surgery" or "genital reassignment surgery" but many folks find these terms antiquated and/or inaccurate as reconstruction of genitalia does not constitute a "reassignment" of gender identity, but rather an affirmation of it. That is, I am a man regardless of whether or not I get bottom surgery. If I do choose to undergo it, this will be an act of affirmation, not an act of reassignment. For trans masculine folks, bottom surgery can include a vaginectomy (removal and sealing of the vaginal cavity), addition of a penis, and testicular implants. 

Here are the two main types of bottom surgery for trans masculine folks:

  • Metoidioplasty -- creates a phallus from a hormone-enlarged clitoris, the urethra is lengthened so one can pee standing up, some people have testicular implants using the vaginal labia, called a scrotoplasty.
  • Phalloplasty -- the construction of a penis using a large skin graft from the patient's forearm, thigh, or abdomen. This can be a lengthy series of surgeries that are pretty risky, as well. It is not uncommon for infections to occur and parts could die or have to be removed. It is also very expensive.

Trans feminine folks can under go a variety of bottom surgeries as well, including vaginoplasty, orchiectomy, etc.

Facial Feminiziation Surgery (FFS): surgery for trans feminine folks to reconstruct parts of the face to be more gender affirmining.

Note: Do not ask trans people about their surgeries. This is invasive and unnecessary. See this post for more information. Rememeber that "The Surgery" doesn't exist. There are at least 14 different gender affirming surgeries people can get!















LASTLY: Again, everyone's transition is different and it is up to every individual to decide what their transition means to them. Medically transitioning isn't something everyone chooses to do -- in this world, it is also often an immense privilege, either financially or sociopolitically, or both. Those that do choose to medically transition don't all choose to undergo every surgery. A trans* identified person who hasn't gone through any or all of the surgeries or isn't on hormones is not any less of the gender they identify with. Surgery and hormones are a personal choice and do not define one's gender.