Posted: April 6, 2018
This blog is about hormone requirements before surgery for female to male patients, or transgender men.
First, how long does a patient need to be on hormones before top surgery? Very good news indeed here, there is no requirement! You can have top surgery without ever having been on testosterone. Hormones are not right for everyone, particularly for our non-binary folks, they are not necessarily part of their transition. For this reason hormones are certainly not required before undergoing top surgery for FTM patients. However I am often asked by patients if they should try testosterone for a while, would it possibly shrink things down? Maybe help with the results? The answer to these is dependent on whether you have a small chest or a larger chest. If you have a very small chest to begin with, it could possibly make the difference between whether or not you are a candidate for keyhole versus double incision. This is very rare, usually if you have any extra skin in that area, testosterone is going to do absolutely nothing to shrink that down. Additionally, most often testosterone does not really shrink the breast tissue much at all either. The answer therefore is that it doesn’t make that much of a difference so I don’t usually have patients wait. There are times where a patient’s particular insurance policy could require some time on HRT before top surgery. If that is the case, we can try to work around or with these requirements based on your wishes.
With regards to bottom surgery, there are a number of different options for FMT patients, depending on what your ultimate goals are. If you have opted for a procedure such as metoidioplasty, where you are relying on the current tissue (clitoris), which is already there, to enlarge, your HRT requirements may be different than someone who opts for a phalloplasty. One year of testosterone is required, as Version 7 of WPATH guidelines states, for both phalloplasty and metoidioplasty. This is also where the insurance companies get their requirements from in order to approve your surgery for you. If however, you are pursuing metoidioplasty (enlarged clitoris) as your surgery, it is wisest to wait for two years for the full effects of the testosterone to kick in.
In summary for top surgery no hormones required. For bottom surgery at least one year and sometimes two years is advised.
Dr. Sidhbh Gallagher
University Gender Affirmation Surgery