Trans man (alt. FtM) is a term which describes someone who is both a man and transgender/transsexual. Trans men were assigned female at birth, but their gender identity is male. They may be referred to as transmasculine. Some trans men wish to transition in order to change their sex characteristics and gender expression to become more masculine. Trans men can have any sexual orientation.

Binding

A flat chest can be achieved in many ways. There are commercially-made specialty binders available worldwide which are safe and effective for the compression of breast tissue and allow for normal breathing in most people.

Other methods of binding include compression bandages, back braces, tape, modified clothing, very firm sports bras and tight-fitting shirts. These methods are more popular with young people who have not yet come out as trans, or those who have limited financial means.

Dangerous binding methods

Binding with tape or elastic/compression bandages can cause serious injury and even death due to asphyxia. If applied incorrectly, they can compress the rib cage so greatly as to make normal breathing impossible, and in extreme cases, bruise or fracture the ribs themselves. Tape is also ill-advised due to potentially permanent damage to the skin caused by adhesives, and due to the inflexibility of materials that puts the wearer at a similar risk as bandages.

Hormone Replacement Therapy

see also Hormone Replacement Therapy

HRT for trans men involves the introduction of synthetic testosterone to masculinize the body. This impacts the individual on almost every level and many patients report changes in energy levels, mood, and appetite. The goal is to provide patients with a body that is more congruent to their gender identity.

HRT can be administered in a number of ways but is most commonly done as an injection in the thigh. Other methods include topical creams or gels, subdermal (under-the-skin) implants, and pills (which are ill-advised due to their negative impact on the liver). Each method has its own dosing schedule and timeline. Some changes (like sex drive and appetite) appear within weeks of starting while others (like facial hair and fat redistribution) can take months or even years to develop.

Changes with HRT

  • Increase in muscle tone
  • Redistribution of body fat (less in hips/breasts, more in stomach)
  • Development of facial and body hair
  • Deepening of the voice
  • Male pattern baldness and receding hairline (for some people)
  • Increased sex drive
  • Increased appetite
  • Skin texture changes (coarser)
  • Clitoral growth
  • Change in scent of bodily fluids
  • Vaginal atrophy & dryness
  • End of periods/menstrual cycle
  • Acne

Irreversible changes

Deepening of the voice, growth of facial and body hair, male-pattern baldness (in some individuals), enlargement of the clitoris,  growth spurt and closure of growth plates if given before the end of puberty and possible shrinking and/or softening of breasts

Reversible changes

Increased libido, redistribution of body fat, ovulation and menstruation, further muscle development, increased sweat and changes in body odor, prominence of veins and coarser skin, acne, alterations in blood lipids, and increased red blood cell count

Common Surgery Options

Chest Surgery (Top Surgery)

Double Incision Method

Can be performed on transmasculine patients with large or sagging breasts. This usually requires a scar extending from underneath the existing breast fold to the lateral outside of the chest. The nipple and areola are removed, resized, and replaced as a “free nipple grafts” in a new position to give a “male” appearance to the chest. The scars are permanent but generally fade over time and can be further hidden by developing ones pectoral muscles (as they will generally fade into the muscle line).

Peri-areolar or Keyhole Method

For transmasculine patients with small breasts who have little breast tissue, breast skin that does not sag, or breast skin that is too tight to perform a double incision method.

Bottom surgery

Hysterectomy

The removal of the uterus. A "complete hysterectomy" includes the removal of the cervix as well.

Oophorectomy

The removal of the ovaries & eggs. Often done during a hysterectomy.

Vaginectomy

The removal of the vagina. Usually required to get a phalloplasty as not having one has been found to increase the rate of complications significantly.

Metoidioplasty

The ligaments holding back the testosterone-englarged clitorus are snipped so that it extends further. Can be combined with urethral lengthening so that one can pee standing up using their neophallus, but this is generally only an option for those who have had significant bottom growth and requires a tissue graft either from the inside of the cheek or the vagina. Phalloplasty

Construction of a penis from tissue harvested from either the forearm, the side of the chest, the pubic area, or the thigh. Implants are generally added so the individual can achieve erection, usually in the form of a pump or bendable rod. These can be used for penetrative sex. Some individuals who have undergone phalloplasty can also ejaculate a small amount via their skeens gland.

Another step to the process, glansplasty, gives the new penis a head/glans similar to a circumcised cis male.

Phalloplasty is generally done over the course of multiple surgeries and is considered a high-risk procedure. Despite this, modern results are generally very good in both appearance and function (and continue to improve each year), and patients generally report significant reductions in (or outright elimination of) bottom dysphoria.

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