Female-to-Male Sex Reassignment Surgery (FTM SRS)

This is a significant step for individuals seeking to align their physical appearance with their gender identity. With current medical advancements, surgical techniques have greatly improved, enabling transgender men to achieve their goals and live confidently in their chosen gender.

Deciding to undergo gender reassignment surgery is a matter that requires careful consideration, as it represents a major life change. Thoroughly researching and understanding the various procedures is essential. Before making a decision, it is highly recommended to consult with a specialized surgeon experienced in gender reassignment surgery. At The SiB Clinic, you can find experienced and skilled surgeons who can provide personalized advice and evaluations.

Qualifications for FTM Sex Reassignment Surgery

Undergoing female-to-male sex reassignment surgery is a significant decision with specific qualifications that individuals should meet for safety and optimal results. Generally, these qualifications focus on both physical and mental readiness, as well as consistently living in the male gender role.

General Qualifications for Individuals Seeking FTM Sex Reassignment Surgery:

Age: Most guidelines specify a minimum age of 18-20 years, as this is generally when physical and mental development is more complete. In some cases, if under 20, parental consent may be required.
Psychological Evaluation: This is a crucial step. Individuals must undergo evaluation by at least two mental health professionals (psychiatrists or psychologists) to confirm a thorough understanding of gender transition, the presence of gender dysphoria (discomfort or distress due to a mismatch between assigned sex and gender identity), and the mental readiness to cope with the changes that will occur.
Living in the Male Gender Role: Most guidelines recommend a period of living in the male gender role (Real-Life Experience or RLE) for at least 1-2 years to ensure the individual is confident and able to adjust to their new role.
Hormone Therapy: Generally, individuals will have been on continuous testosterone hormone therapy for a period before surgery to induce desired physical changes such as voice deepening, hair growth, and changes in fat distribution.
Physical Health: Individuals must be in good physical health, without serious underlying medical conditions or contraindications for general anesthesia.
Understanding and Support from Others: Support from family, friends, and loved ones plays a significant role in post-operative adjustment.

Preparation Before FTM Sex Reassignment Surgery

Preparing for female-to-male sex reassignment surgery is a crucial step for the success and safety of the procedure. This includes physical and mental preparation, as well as thorough research.

Physical Preparation:

Overall Health: Must be in good general health, without serious pre-existing conditions or conditions that could interfere with surgery and anesthesia, such as heart disease, lung disease, or uncontrolled diabetes. If there are pre-existing conditions, consult with your primary care physician and the gender reassignment specialist to assess readiness.
Weight Management: Should ideally have a body mass index (BMI) below 24, as being overweight or obese can increase the risk of surgical complications.
Smoking and Alcohol Cessation: Should stop smoking at least 4 weeks before surgery and avoid alcohol for at least 2 weeks before surgery, as substances in cigarettes and alcohol affect blood circulation and wound healing.
Discontinuing Certain Medications: Inform your doctor about all medications, vitamins, or supplements you are taking, as some may affect blood clotting or interact with medications used during surgery, such as aspirin, anticoagulants, and vitamin E. Stop these medications as advised by your doctor.
Hormone Adjustment: Generally, individuals seeking FTM surgery will have been on testosterone hormone therapy for some time. However, consult your doctor about adjusting or stopping hormones before surgery as per their recommendations.
Medical Examinations and Evaluations: Comprehensive physical examinations, blood tests, urine tests, chest X-rays, and other necessary tests will be conducted to assess your physical readiness for surgery.

Mental Preparation:

Psychological Evaluation: Mental health evaluation by a psychiatrist is a crucial step to confirm the individual’s understanding and mental readiness for this significant change and to diagnose gender dysphoria.
Living as Male: Doctors generally recommend that individuals seeking FTM surgery live as male (Real-Life Experience) for a period to ensure that the decision to transition is truly what they desire.
Talking to Individuals Who Have Undergone Surgery: Speaking with individuals who have gone through FTM surgery can help in understanding the experience and preparing mentally.
Support from Family and Loved Ones: Encouragement and support from family and loved ones are important for both physical and mental recovery after surgery.

FTM Sex Reassignment Surgery Techniques (3 Methods)

Phalloplasty using tissue from the outer thigh (Lateral Thigh Flap Phalloplasty):

Hysterectomy (removal of the uterus) and oophorectomy (removal of the ovaries) are performed, the vagina is closed, and the urethra is repositioned to the area above the pubic bone, utilizing tissue from the vagina.
A urethra is prepared in the outer thigh area at least 4-6 months prior. Then, the surgeon will surgically transfer the prepared tissue from the outer thigh to create the penis, connecting the original urethra to the newly created one so that urine exits from the tip of the new penis.
Advantages: Can create a penis of a good size. Allows for better insertion of penile implants for erection.
Disadvantages: Requires the use of a penile implant for erection.

Phalloplasty using tissue from the inner arm (Radial Forearm Flap Phalloplasty):

Creation of the penis by transferring tissue from the inner arm using microsurgery and inserting a penile implant for erection.
Advantages: Lower risk of urethral stricture (narrowing). Easier to connect blood vessels and nerves.
Disadvantages: Requires the use of a penile implant for erection. Scars can be clearly visible on the arm. The penile tissue may be thin, requiring careful implant insertion.

Phalloplasty using tissue from the calf with bone (Fibula Free Flap Phalloplasty):

Requires preparation by implanting a urethral tube in the calf 6 months before creating the penis using tissue and bone from the calf. This involves connecting blood vessels and nerves, then connecting the urethra. Skin is then used to cover the new penis.
Advantages: The presence of bone provides natural rigidity for erection. Can create a penis of a good size. Scars are less noticeable.
Disadvantages: Requires a longer recovery period. Requires regular dilation of the urethra to prevent narrowing.

Testicle Implants:

Testicle implants are placed to replace the fat in the labia majora after the phalloplasty surgery is complete.

Post-Operative Care After FTM Sex Reassignment Surgery

Post-operative care after female-to-male sex reassignment surgery is just as important as pre-operative preparation to ensure proper wound healing, fast recovery, and a reduced risk of complications. This care includes wound management, pain management, general health care, and mental well-being.

Wound Care:

Wound Cleaning: Clean the incisions strictly according to the doctor’s instructions. Generally, this involves cleaning the wounds 1-2 times daily with an antiseptic solution provided by the doctor and covering them with clean gauze. Be careful to keep the wounds dry initially and avoid direct contact.
Drain Care: If surgical drains or a urinary catheter are placed, follow the doctor’s instructions for care, such as cleaning around the drain site, emptying drainage bags, and ensuring the drains are not pulled or kinked.
Infection Prevention: Follow the doctor’s instructions for antibiotic use and watch for signs of infection such as increased redness, swelling, pus, or fever. If these occur, seek medical attention immediately.
Care of the Tissue Donor Site: If tissue was taken from another part of the body to create the penis, such as the arm, leg, or abdomen, care for that incision site as well by keeping it clean and avoiding movements that could cause tearing.
Care After Urethra Construction: After urethra construction, a silicone tube may be placed in the arm with two openings. Patients should clean the incisions and the newly constructed urethra daily according to the surgeon’s strict instructions. (Based on information from Yanhee Hospital)

Pain Management:

Pain Medication: The doctor will prescribe pain medication to relieve post-operative pain. Take the medication as directed.
Cold Compresses: In the initial period after surgery, cold compresses may be applied to reduce swelling and pain. However, avoid applying cold compresses directly to the incisions and follow the doctor’s recommendations. (Based on information from HDmall)
Rest: Getting enough rest will help reduce pain and allow the body to recover faster.

General Health Care:

Nutrition: Eat a nutritious and balanced diet, focusing on protein to help with tissue repair. Avoid spicy foods, fermented foods, and alcoholic beverages.
Movement: Begin light physical activity as advised by your doctor to prevent complications such as blood clots. However, avoid strenuous exercise in the initial period.
Bowel Management: Maintain regular bowel movements to reduce straining that could affect the surgical incisions. (Based on information from HDmall)
Smoking Cessation: Continue to avoid smoking after surgery, as it affects wound healing.

Mental Well-being:

Psychological Support: Gender reassignment surgery is a significant life change that can affect mental well-being. Seek support from family, friends, and mental health professionals.
Follow-up Appointments: Attend all scheduled follow-up appointments with your doctor to monitor your recovery and discuss any concerns or questions.
Vaginal Dilation (for MTF patients): Regular vaginal dilation with the devices provided by your doctor is crucial to prevent vaginal stenosis. Follow the doctor’s instructions carefully. (Based on information from drvitasna.com)

Recovery Period

The recovery period varies for each individual depending on the surgical techniques used and overall health. Generally, it may involve a hospital stay of about one week and several more weeks of recovery at home. Consult your doctor about the appropriate recovery timeline for you.