Transition Basics for Transgender Men

What Every Transgender Man Should Know

Photo by Chang Duong on Unsplash

The more I talk to other transgender men, the more I realize how many are lacking in some of the most basic information regarding their transitions. Here are a few important things that you should know whether you’re still in the closet or already beginning your transition journey.

Trigger Warning: I will be sticking with medical terminology throughout this piece and will be using language that could trigger dysphoria. I’ve chosen to do so in order to make sure that everything I explain is clear to everyone reading this, including people for whom English is a second language.

Therapy

Seeking therapy before your medical transition can be a wise move for a number of reasons, but it’s important to find the right therapist. If you can find an LGBTQIA friendly therapist in your area, I would recommend that as a starting point for any transgender man who hasn’t begun their medical transition. There are several reasons why this is a good first step:

1. The right therapist can help you better understand your dysphoria and what to expect regarding your transition.

2. They can write letters affirming your gender dysphoria diagnosis, which many medical insurance companies and even doctors may require.

3. They can help you through all the rough patches throughout your transition.

If you do not have access to a therapist where you live, try to seek out resources online. At the very least, find an online group of other transgender men where you can discuss your transition, so they can help you through the ups and downs. There are groups on Reddit, Facebook, and Twitter.

Testosterone

It’s important to have your hormone levels checked regularly. Ideally, you’ll check your levels before you start taking testosterone, and then again, every 3–6 months for the first two or three years. If you can get a referral to an endocrinologist that specializes in gender transition, they can help you understand everything that’s going on as the testosterone starts to make changes. If you are unable to work with an endocrinologist, here’s a list of some things that can change once you start taking testosterone.

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1. Libido. One of the earliest changes you’ll notice is an increase in libido. I was in an almost constant state of arousal within the first 24 hours of having my first injection. This will wax and wane over time, but your libido will remain higher than it was prior to being on testosterone.

2. Bottom growth. Along with the increased libido, you will start to notice that your clitoris will slowly grow larger, and eventually may resemble a small penis. About one to three inches of growth is possible. There will be some increase of girth as well, but usually not much more than the size of a thumb.

3. Body hair. You will eventually start to see an increase in body hair where you hadn’t had any before, including your face. How much and how long it takes to come in depends entirely on genetics.

4. Male pattern baldness. You may lose the hair on your head, especially if baldness runs in your family. Be prepared for this and either accept it if it happens, or work with your doctor to get medications to help fight it (such as taking Rogaine or Propecia).

5. Vocal changes. Your voice will deepen and masculinize on testosterone. How much and how fast depends on a variety of factors, primarily genetics.

6. Fat redistribution. Your fat deposits will shift into a more male pattern on your body. If you currently carry a lot of weight on your hips and thighs, it will migrate towards your belly.

7. Upper body strength. You will see an increase in your upper body strength and your shoulders will widen to a degree, even if you don’t lift any weights.

Some of these changes will begin to appear within days or weeks of starting testosterone. Others will take months and even years to develop. How your body manages it depends a lot on your genetics, however if you have not seen any changes within the first 6–12 months, make sure you get your hormone levels checked. If your testosterone levels are too low, no changes may occur. If they are too high, they will begin to convert to estrogen, which will interfere with any changes.

Binders

Transgender men often have dysphoria surrounding their chests, especially if they have developed large breasts. If you either cannot afford surgery or are not ready to take that route yet, one option is to bind your chest to give it a flat appearance.

You should never use Ace bandages to bind your chest. They are not designed for this and can cause injury, including fractured ribs, if wound too tightly or worn too long. It’s better to save up and buy a binder that’s specially made for this. Even then, you shouldn’t wear them when exercising or sleeping, and it’s best to not wear them for more than 8 hours per day.

The same goes for duct tape or anything else that isn’t specifically designed for chest binding. If you need to bind, there are a lot of safer options. Also, if you cannot afford to buy a specially designed binder, then look into charities that receive donations of binders from trans people who no longer need them after they’ve had their top surgery.

Top Surgeries

There are four kinds of top surgery that transgender men can get, all depending on their current breast and areola size.

Keyhole Incision

The keyhole incision is the least invasive procedure but requires very small breasts and good skin elasticity. A small incision is made to the underside of each areola and the breast tissue is removed. Skin elasticity is important as no excess skin is removed in this procedure.

Periareolar Incision

This procedure also requires fairly small breasts and good skin elasticity. In this case, the incision goes completely around the areola and they are removed and made smaller. The breast tissue is removed and if required an additional incision may be made to remove any excess tissue. Then the reshaped areolas are grafted back in place.

Double Incision with Nipple Grafts

The double incision surgery is probably the most common. This is for any transgender man with larger breasts. With this surgery, a section of skin is removed from each breast, along with most, if not all, the breast tissue underneath. The nipples are also removed and reshaped into a smaller, more masculine size, before being grafted higher on the reconstructed chest.

This surgery will result in a flatter, more masculine chest, with two scars where the extra skin was removed.

Inverted T Incision

This option is used for transgender men with larger breasts that have more excess skin. It’s also a good option for transgender men who have naturally small areola around their nipples, and therefore won’t require them to be resized. Instead of two incisions, one on each breast, there is a single long incision that travels under the breast line and forms a peak in the center between where the breasts were. The breast tissue is removed but the nipples remain in place, therefore not requiring them to be grafted.

Bottom Surgeries

Bottom surgery generally refers to any gender affirming surgery that helps a transgender man reconfigure his genitals to resemble those of a cisgender man. There are two primary types of surgery, with a number of secondary surgical options.

Phalloplasty

Phalloplasty is a surgery that builds a full-sized penis, using the skin from either a transgender man’s forearm or thigh. Taking the skin to build the penis does leave behind a scar but is necessary in order to build the penis. This penis cannot become erect and so there is the option of having an erectile device added to help achieve that function.

This is the most complex bottom surgery option and therefore comes with an inherently higher risk of complications developing. Personally, I would say that this option is best reserved for the transgender men with a high degree of bottom dysphoria. In my opinion, it’s not necessary to have a full-sized penis in order to be considered a transgender man.

Along with the phalloplasty, often there are additional secondary surgeries also performed.

Urethral Lengthening

Using skin from an area, like the inside of your cheek, the urethra can be lengthened and rerouted through the newly built phallus, so that urination while standing becomes possible.

Scrotoplasty

Using the skin from the labia majora, a scrotum can be created, into which synthetic testicles are placed. If an erectile device was added to the phallus, then one of the testicles implanted serves as a pump in order to mimic an erection.

Vaginectomy

A vaginectomy simply closes the vaginal canal and extends the length of the perineum, so it looks more like that of a cisgender man.

Metoidioplasty

If you do not have a high degree of bottom-dysphoria, metoidioplasty is a good alternative to phalloplasty. It works with your existing genitalia instead. As mentioned earlier, testosterone will lengthen the clitoris by as much as one to three inches.

The basic metoidioplasty procedure is also known as a clitoral release, where the clitoris is unattached from the labia minora, which will allow it to hang at a more natural angle for a penis. In addition to this procedure, all the previously mentioned options, including urethral lengthening, scrotoplasty, and vaginectomy can be performed but are all optional. Only choose the procedure(s) that are the best fit for what you need in order to feel comfortable within your own skin.

Hysterectomy

While technically not considered ‘bottom surgery’ it is not uncommon for transgender men to also undergo either a partial or total hysterectomy. This is the same surgery many cisgender women also go through.

When taking testosterone, uterine fibroids can possibly develop and cause cramping pain, especially during orgasm. This is one thing that isn’t well understood in the medical community and is often not told to transgender male patients when we begin our transition.

Do Your Research

This article covered some of the most basic things that every transgender man should know about medically transitioning. However, it is in your best interest to do your own research before taking this step in your transition and make sure you follow the path of transition that is right for you. Only you know what you need and want from your body.

I spent at least two years researching before I began my medical transition. I was able to both understand what my doctors were telling me and ask them the right questions to get the care I need. We still have a long way to go before medical professionals are truly able to provide the right level of care that we need. So for now, we need to be our own advocates and understand as much as we can as we begin our transition journeys.

Personally, I’ve decided to get top surgery and a hysterectomy. I am opting not to have any bottom surgery on my genitalia. I don’t have any significant bottom dysphoria and I don’t want to deal with the risk of complications. Remember, you are not more or less trans if you decide to have all the surgeries, none, or something in-between.