Top Surgery and Testosterone

This page contains information about testosterone, a hormone used for hormone replacement therapy. Please consult with a primary care provider or endocrinologist to learn more about starting testosterone. You can’t be prescribed hormones at the Gender Confirmation Center. There are serious risk to starting or stopping hormones without the guidance of a physician. This page is intended for informational purposes only.

We are often asked about how testosterone impacts top surgery for transmasculine, non-binary, and gender expansive folks. Below, we describe how taking testosterone could influence your decision to have top surgery or impact your results. The answer is mostly dependent on the individual’s gender dysphoria or discomfort relating to their chest and other bodily features. 

Should someone be on testosterone before having top surgery?

Generally, we think of testosterone and top surgery as two independent variables to consider when thinking about medical transition. Someone can have chest reconstructive top surgery while on testosterone, before starting testosterone, or several years after starting testosterone. Most of the reasons to start or stop taking testosterone have to do with treatment of dysphoria or discomfort rather than any surgical implications. 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 top surgery, we recommend starting testosterone, engaging in a healthy and active lifestyle, and weight lifting before chest reconstruction 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 top surgery once the swelling goes down. 

Should someone start or stop testosterone before having 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 inevitable emotional ups and downs around surgery be that much easier. For patients who want to start testosterone but have not yet, we recommend waiting until after recovery to begin that journey. Dr. Mosser and Dr. Facque 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 discomfort caused by chest tissue can increase. Of course, not everyone who takes testosterone experiences dysphoria related to their chest, so for those who do, we recommend taking into account the possibility of a temporary increase in chest dysphoria or discomfort alongside the potential benefits of testosterone use. 

In summary

  • There is no medical necessity for someone to be on testosterone before having top surgery
  • We recommend not starting or stopping testosterone use 3 weeks before surgery
  • Testosterone, in addition to weight lifting and a healthy lifestyle, are recommended for those desiring a more muscular chest after top surgery
  • Chest dysphoria or discomfort 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