How to Transition from Female to Male

Transitioning is not a linear, path that sees rapid progress from one binary gender to the other. Each person has their own journey to get to express their true self. Transition begins first with general health care before the actual process of medical and non-medical transition to include legal and psychosocial issues as well as hormone therapy and surgery. Here are some of the steps to take when transitioning from female to male.

Therapy is an important foundation stone to your transition, not just to be sure this is what you want before you go any further, but that you have the tools to deal with the inevitable emotional challenges the transition journey will throw up. Talking to someone about gender dysphoria (the condition of feeling one's emotional and psychological identity as male or female to be opposite to one's biological sex) can help you be open about how you feel and give you the freedom to express yourself in ways that no longer have to be secret, but can be seen as who you really are, including in intimate moments.

Therapy is extremely helpful as support for a life-changing event that will affect every aspect of your life, in some ways you could never expect. A good therapist will help you deal with the reaction of friends, relatives and colleagues as well as other challenges. As well as confirming psychosocial readiness to begin treatment, therapy can also be helpful when dealing with the physiologic response to hormone therapy which is highly individual; the effects of testosterone hormone therapy on fertility; the risk of pregnancy and whether or not you want children in the future.

A therapist or psychiatrist that you talk with will be able to give you a letter to take to your doctor or endocrinologist (doctor specialising in hormones), so you can begin hormone therapy, though some will just interview you directly and not need a letter.

The doctor can prescribe testosterone, which is a controlled substance, by gel, patch or injection, the latter being the most common because of its efficacy. Testosterone hormone therapy requires patience as the effects can be impacted by age, genetics, lifestyle and more. Over time, your voice will drop, menstruation will cease, muscle mass will increase, and facial hair will appear. Some of these changes, such as increased muscle mass can be reversible, whilst a deepened voice is irreversible.

There are risk factors in taking testosterone hormone therapy, but your care provider will prepare a careful evaluation of risks and benefits. There are several ways to minimise risks that can be discussed with your medical team to ensure the clinical effects are as expected.

Trans men maintained on testosterone hormone therapy require long-term follow-up care through annual check-ups which can include checks on bone density to check for osteoporosis, but there are other checks of the chest, colon, cervix and ovaries.

Sex reassignment surgery for female-to-male transition includes a variety of surgical procedures that alter female anatomical traits to provide physical traits more appropriate to the trans man's male identity and functioning. However, not all FTM will choose to have any or all of the surgery, though the majority do choose a bilateral mastectomy with chest reconstruction, though scarring and decreased nipple sensation can occur. Other surgical options include hysterectomy with or without oophorectomy, though the option of keeping one or both ovaries can help maintain bone density. Hysterectomy is usually required prior to undergoing vaginectomy, scrotoplasty, and phalloplasty.

Metoidioplasty, or clitoral release, can lead to the creation of a convincing penis. Erectile abilities and sensation are preserved, and mild penetration can be achieved. It is also possible to include vaginectomy, scrotoplasty and urethroplasty in the surgery, the latter of which makes it possible to urinate through the clitoris.

Another possible surgery is phalloplasty, which is the construction of a phallus about the size of an erect male-assigned penis, which is created from a graft from the thigh. Urethroplasty usually is done at the same time with size and appearance usually prioritised over erectile capacity or erotic sensation. A secondary surgery can insert a semi-rigid or inflatable penile prosthesis.