A person’s general body shape is largely defined by their skeletal frame, as well as their distribution of muscle and fat. Because folks assigned female at birth (AFAB) tend to have more curves and a smaller stature, many transmen and non-binary transmasculine people desire a physical transformation to masculinize or neutralize these traits. Though it’s possible to attain a less feminine body type through various surgical and lifestyle changes, it’s important to understand the statistical differences between someone who has undergone a full estrogenic development (AFAB puberty) and someone who has gone through a full androgenic development (AMAB puberty) in order to formulate realistic goals based on how your body has formed.
Figure B is of an adult who experienced an estrogenic development, figure A is of an adult who went through an androgenic development. You can see that the bone structure of figure A is narrow. Hormone replacement therapy such as testosterone is unlikely to change the bone structure of the body and surgical modification of the pelvis comes with significant risks based on the current surgical techniques. Therefore, to obtain a more neutral or more masculine form, transmen, non-binary and gender expansive folks generally seek body contouring of the overlying soft tissues (fat).
Dr. Mosser doesn’t require patients to be on hormones in order to receive top surgery or body contouring. However, being on testosterone for a year prior to body contouring may help your results as this would allow some natural fat redistribution to occur. It’s important to note that the bony structure of the pelvis as featured in figure B is unlikely to be affected by testosterone and body contouring is attributed to the removal or redistribution of fat and does not relate to altering of the boney structure.
Prior to puberty, persons assigned female at birth and folks assigned males at birth tend to have very similar body shapes. But as the production of hormones increases during puberty, rapid physical changes usually occur. This results in the development of secondary sexual characteristics that society labels as masculine or feminine.
Testosterone is produced by everybody at different rates. These differing rates are responsible for many physical differences between estrogenic and androgenic development. Folks assigned male at birth (AMAB) can produce as much as 10 times the testosterone of the average person assigned female at birth (AFAB).
Testosterone levels affect how fat is metabolized and carried. Persons who were AFAB are more efficient in storing fat and are prone to weight in their hips, butt and thighs. Folks AMAB typically have lower percentages of body fat and are more likely to gain weight in their upper body (especially around the waist and abdomen).
Hormone replacement therapy (HRT) for testosterone can bring upon appearance through introduction of broad shoulders, an expanded chest, increased muscle mass, increased bone mass, thicker skin, more angular eyes and face, increased muscle mass, deepening of the voice, facial and body hair growth etc. Despite the positive effects of hormone therapy, changes in body fat redistribution can sometimes not be enough and cause incongruity between one’s gender identity and how the world perceives their gender. This is why many patients of Dr. Mosser’s have chosen to move forward with a gender affirming body contouring procedure.
Someone who has undergone a full estrogenic puberty uninhibited by hormone blockers have 10% higher body fat compared to people who have undergone an androgenic development. The difference in fat deposition leads to varying degrees of waist-to-hip ratio (WHR). The actual WHR for someone AFAB is 0.65 to 0.80, whereas adults AMAB are within the range of 0.85 to 0.95. Depending on the amount of time an individual lived as their assigned sex and the amount of fat they deposited, there will be a varying degree to the extent to which these soft tissue characteristics can be changed. Approaches to body contouring in transmasculine and non-binary folks should aim to obtain a WHR range between 0.85-0.95.
Below you’ll see that the androgenic body form featured in figure C has a concave/flat appearance. Body contouring of the gluteal region for transmasculine folks would aim to remove the fullness of figure D so they have an appearance more like figure C.
For folks AMAB their waistline is significantly higher than those AFAB. Lifting the waistline through liposuction of these areas can have a significant positive impact on the fit of masculine clothing. When done appropriately, contouring will decrease the hourglass silhouette featured in figure A so that the body looks more like figure B.
While no two shapes or figures are ever the same, most male body types can placed into one of the three categories below.
Perhaps the most admired male form, V-shaped males can easily shift from being incredibly lean or very muscular. They tend to have very broad shoulders, a narrow waist and narrow hips. When V-shaped males gain weight, it tends to be around the abdomen, but it can also occur on the buttocks.
Apple-shaped males tend to be shorter and rounder than those in the other body types. They carry much of their excess weight around their abdomen, calves and ankles. As a result, they’re more prone to gaining weight and have more trouble losing excess fat.
Males with a rectangular frame usually appear very muscular. They are prone to rounded, protruding chests and rectangular torsos, as well as thicker arms, thighs and calves than those in the other body types. Like apple-shaped body types, rectangular body types can gain weight easily and it’s typically distributed in the hips, buttocks, upper back and stomach.