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Top Surgery and Testosterone

We are often asked how testosterone impacts chest reconstruction top surgery, formerly known as FTM top surgery. However, hormone replacement therapy (HRT) is not a requirement to be eligible for top surgery with the Gender Confirmation Center (GCC). In this article, we describe how taking testosterone may influence your post op top surgery results. For patients who are undergoing HRT, we discuss our surgeon’s recommendations on testosterone regimen and lifestyle changes before your gender affirming surgery. We also briefly review the factors to consider before initiating testosterone. Keep in mind that when starting or stopping testosterone, it is best to consult with your primary care or endocrinologist to determine what regimen works best for you. 

This page contains information about testosterone, a hormone used for hormone replacement therapy (HRT). Please consult with a primary care provider or endocrinologist to learn more about starting testosterone. We do not prescribe hormones at the GCC This page is intended for informational purposes only.

Should someone be on testosterone before having chest reconstruction top surgery?

Someone can have chest reconstruction top surgery while on testosterone, before starting testosterone, or several years after starting testosterone. We recommend that patients consider taking testosterone based on what is right for them with regard to dysphoria and/or discomfort and not consider surgery too much within that decision.

For patients who want a more muscular chest after surgery, we recommend starting testosterone, engaging in an active lifestyle, and weight lifting before surgery. Although the results of building muscle mass might not be seen pre-operatively (while chest tissue remains), you will begin to see a more muscular chest 3-4 weeks after surgery once the swelling goes down. 

Should someone start or stop testosterone before having chest reconstruction top surgery?

Because emotional mood swings often accompany starting or stopping hormones, including testosterone, we recommend that patients not start or stop testosterone within three weeks of surgery. In other words, for patients already taking testosterone, we recommend that they keep taking testosterone through surgery and during recovery to help the potential emotional ups and downs around surgery.  For patients who want to start testosterone but have not yet, we recommend waiting until after recovery. Our surgeons recommend consulting with your primary care physician to discuss the proper time to start hormones and to get information about hormone doses and delivery methods.

Testosterone, top surgery, and dysphoria  

There is some evidence that once the effects of testosterone begin to take effect (lower voice, facial and chest hair, body fat redistribution, etc.), any dysphoria or incongruence or discomfort caused by chest tissue can increase. Of course, not everyone who takes testosterone experiences dysphoria or incongruence related to their chest, so for those who do, we recommend taking into account the possibility of a temporary increase in chest dysphoria or incongruence alongside the potential benefits of testosterone use. 

In summary

  • There is no medical necessity for someone to be on testosterone – or to stop testosterone – before having chest reconstruction top surgery
  • We recommend not starting or stopping testosterone use 3 weeks before surgery
  • Testosterone, in addition to weight lifting and an active lifestyle, are recommended for those desiring a more muscular chest after top surgery
  • Chest dysphoria or incongruence should be factored into the decision making around when to start testosterone
  • Please consult with your primary care physician or endocrinologist about when to start or stop testosterone, and what hormone dose or regimen would work best for you

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