Top surgery is one of the most affirming steps many transgender men (FTM), gender nonbinary individuals (FTN), and those who are gender queer or transmasculine take in aligning their bodies with their identities. One question that can be confusing to many when considering this type of procedure is:
“Do I need to be on testosterone before getting top surgery?”
The straightforward answer to this is NO. Being on testosterone is not required before undergoing FTM or FTN top surgery.
The reason for this is that taking testosterone is completely optional and entirely separate from your eligibility for surgery including insurance coverage.
Why Testosterone Therapy Is Not Required
1. Hormones don’t significantly change breast tissue. Although testosterone can deepen the voice, increase muscle mass and redistribute fat, it does not reduce glandular breast tissue enough to change the surgical approach or need for surgery.
2. Not everyone wants the effects of testosterone. Many nonbinary or gender-expansive individuals may want top surgery but prefer not to experience voice changes, facial hair growth or other masculinizing effects. Requiring hormones would make surgery inaccessible or problematic for many people whose transition goals do not include those changes. Even some FTM individuals, for a variety of reasons, elect not to be on testosterone.
3. Top surgery results are based on technique—not hormones.
The quality of your result depends on:
- Your anatomy
- The surgical technique used
- Skin elasticity and healing
- Your desired chest shape (flat, masculine or androgynous)
Hormone therapy does not improve or worsen the final outcome when it comes to FTM or FTN top surgery.
What Surgeons Typically Require Instead
While testosterone therapy is not required, surgeons do look for a few other important criteria to ensure readiness, appropriateness and safety:
- Persistent gender dysphoria or a clear desire for chest masculinization or flattening
- The capacity to give informed consent
- Stable physical and emotional health
- A letter documenting the presence of gender dysphoria and supporting the desire for gender affirming top surgery – only if required by the surgeon, surgical facility and/ or insurance company
Clearly, none of these prerequisites include being on hormone therapy.
Does Not Being on Testosterone Change the Surgical Process or Results?
The answer to this question is no.
Individuals who have never taken testosterone can routinely achieve excellent, natural-looking and affirming chest results. The surgery, recovery timeline and long-term appearance are the same whether or not you are taking testosterone.
Some patients who are on testosterone may develop more muscle mass over time but this does not impact the quality of the top surgery outcome—it simply affects how the chest appears naturally as you build muscle.
A Personal and Individual Decision
Your gender journey is yours alone. Some people take testosterone before surgery, some start afterward, and others choose never to take hormones at all. Each of these paths is valid.
Top surgery is a highly personal step and it should be accessible regardless of whether hormone therapy fits into your transition or not.
Bottom Line
You do not need to be on hormone therapy before undergoing FTM or FTN gender-affirming top surgery.
Hormones are optional, and your ability to get surgery—and achieve great results—depends on your goals, your anatomy and informed consent – not your hormone status.
Your Consultation for FTM or FTN Top Surgery
If you are interested in pursuing gender affirming top surgery and want to schedule a consultation with me, Dr. Steven Turkeltaub, you can contact the Arizona Center for Aesthetic Plastic Surgery either by calling (480) 451-3000 or contacting us by email.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
