DISCLAIMER!!! All medical information is right to best of my knowledge! Apologies if any turns out to be wrong
For a transgender male having ‘Top surgery’, breast removal, is almost a guarantee (for example I am part of a number of group contacting me with over 15,000 transgender males around the world and I have never spoken to a single one who didn’t want their breast removed. Like most Trans male I want top surgery and it is something I can’t wait to finally have, to have flat chest and not worry about it. There are a couple different ways to achieve this. The most common are;
1) would Peri-areolar which is for guys with a chest size of B cup or smaller – in the UK. During this surgery the breast is removed through a small incision at the bottom of the areola, the nipple itself is left intact.
2) Double incision this procedure is ideal for medium to large chested men. During this procedure, the skin on the chest is opened along two horizontal incisions, at the top and bottom of the pectoral muscle. The skin is pulled back and the breast tissue is then removed, Nipples are removed, re-sized and grafted on the chest, this often leads to the person having little to no sensation of the nipple.
3) The Inverted-T Top Surgery procedure is ideal for medium to large chested men who wish to retain the most sensation possible in the nipple. The procedure is similar to Double Incision Top Surgery: skin on the chest is opened along two horizontal incisions, at the top and bottom of the pectoral muscle. (The muscle itself is not touched.) The skin is pulled back and the breast tissue is then removed.
Bottom surgery on the other hand is very different. I would guess that worldwide less in 50% of transmen get any form of bottom surgery. A big reason Trans men don’t get the surgery is the cost (roughly £50,000 for all stages), I would also guess that in countries, like the UK, where there is more funding and help to pay for such an expensive surgery the percentage of guys getting it would be much higher. There are two types of bottom surgery Metoidioplasty and Phalloplasty, they are both very different.
-Metoidioplasty (known as Meta for short) take advantage of the fact that testosterone causes a Trans males clitoris to grow longer. By cutting the ligament that holds the clitoris in place under the pubic bone, as well as cutting away some of the surrounding tissue, the surgeon is able to create a small phallus from the elongated clitoris. In order to further enhance the result, fat may be removed from the pubic mound and skin may be pulled upward to bring the phallus even farther forward. It also includes a urethral lengthening procedure to allow the patient to urinate through the penis while standing. Depending on the goals of the patient, the vaginal cavity may or may not be closed or removed, this is known as a vaginectomy. A phallus created by Meta would not be able to penetrate during sex.
-Phalloplasty (known as Phallo for short) come in a two different forms depending one where one the person’s body the skin comes from, it can come from the forearm or groin.
-Forearm Phalloplasty is the most common, this procedure is considered by many to produce a more realistic-looking, and the forearm skin is shaped into the new penis and grafted into place on the groin, where the nerves and blood vessels are connected. Some surgeons will connect the brachial nerve of the forearm to the pudendal nerve of the clitoris. A urethra is typically created using tissue from the labia shaped into an inverted tube. The clitoris is usually left intact near the base of the penis; the exact placement of the base of the penis with regard to the clitoris should be discussed with the surgeon. Usually, a flexible rod must be inserted into the penis or an implanted pump device used in order to achieve an erection. The vaginal cavity will be closed, in a vaginectomy. Phalloplasty is comprised of three stage, most men also have a hysterectomy during the second stage of Phalloplasty.
Here in the UK we have the National Health Service (NHS) paid for by taxes that means that treatment is free, something we are extremely lucky to have. So when I have top surgery it will be on the NHS and thus free for me, however it is still possible to going privately which is the same quality service but normally quicker but at a cost. The same will be true for bottom surgery, so for me the question of money is THANKFULLY not an issue. Things I need to consider are if I want to be able to pee standing up, penetrate during sex and generally have a penis. I discussed the topic at length with my wife, obliviously the final decision would have to be my own as my wife and I could separate and I would have to live with the decision I had made. At this point in time I have decided that bottom surgery, forearm Phalloplasty, is something I do want to have, there is the chance that, that could change but at the moment I don’t see that happening.
-Honest Trans Guy
Testosterone, in the UK, comes in several forms injections, gel/creams. There is also patches, oral and pellet forms however these don’t seem to be used in the UK.
When I first went on testosterone in March 2016 I was put on testogel, which is a gel form of testosterone. It comes in little packets, similar to sauce packets, testogel is applied daily; it is applied as a thin layer onto a person’s stomach, shoulders or thighs. It is applied and then the person has to leave to dry, normally 5-10 minutes before putting clothes on. Testogel should not come into skin contact with a cisgender female or with children.
For the first month I had to put on half a packet a day, then from month 2 till month 4 I put on a full packet as day. After this time I had a return appointment with my gender clinic my doctor felt my testosterone level was slightly too high so I was put onto a routine of full packet one day then half packet the next day and repeated – this went on until Dec 2016 when I swapped from gel form to injections.
As with all forms of testosterone there are pros and cons.
-Injections (commonly in the UK Nebido and Sustanon) are the most common way of getting testosterone. Nebido is injected by a nurse, as it is a thick needle, into the top of the buttocks every three months. Sustanon is normally injected every 2-3 week into the thigh and can be done at home.
-Gel/cream (commonly in the UK Testogel and Testim). As described above tesogel comes in packets and is normally one full packet as day. Testim comes in a pump, like soap, and is normally one or two pumps a day. Daily applications can help give a steady level rather than the up and down that comes with injections.
All of these are available through the NHS or privately. Through NHS each cost the same as a normal prescription (£8.40 per item) that would make testogel and testim a cost of roughly £8.40 per month. Sustanon a cost of roughly £16.80 and Nebido a cost of £8.40 every 12 weeks.
I have found that whilst gel could have been better for regulating my mood, applying it daily was difficult and a three monthly injection is a better fit with my life.
-Honest Trans Guy
Being transgender is the best, worst and most stressful part if being me. I realised I was trans* almost 2 years ago and honestly sometimes I wish I had never realised, but truly I wouldn’t change the last 24 months for the world.
There are days when I wants to rip my skin from my body; want to take a knife to my chest. When all I want to do is curl into a ball and cry until I don’t feel anymore. There are even days where I wish I would just die, and those are days I feel weak and powerless.
Everytime I step out of my house I become aware of my every move, is it to girly. I mental steel myself for being misgendered but honestly nothing can prepare you for knife to heart when it does happen. I convince myself everyone is looking at me. Everyone can tell, that someone will say something, do something, hurt me.
There are times I forget I’m not cisgendered and that moment I remember is the most soul crushing feeling. I have ever experienced. To remember I’m not “normal”, that legally I’m not a man, that I will never get my wife pregnant and create a beautiful new life with her. Those days are the worst, worse then the dysphoria, worse that the staring, worse then then misgendering or the jokes. Those are the only times I wish I had never realised.
BUT there are days where I notice a new change and feel on top if the world. Days where someone calls me sir and it becomes the most amazing world in the English language.
Days where my niece get my name right and get excited about it. Days where my wife looks at me with so much love I know no matter how hard and shitty things get, I have support, I have love and once this medically transition is over it will all be worth it.
Just a shout out to my wife, my baby brother, and A, because I would have never got this far without you guys. I love you all 💓💓
-Honest Trans Guy