FTM stands for “female-to-male” and refers to a person who was assigned female at birth but identifies and lives as a man. The more common term today is “transgender man” or simply “trans man.” In the United States, roughly 730,500 adults identify as transgender men, making up about a third of the adult transgender population.
FTM is one of the older abbreviations in transgender terminology, and while many trans men still use it, others prefer language that centers who they are now rather than the direction of a transition. The term “transmasculine” is a broader umbrella that also includes nonbinary people who lean toward a masculine identity without necessarily identifying as men.
Gender Dysphoria and What It Feels Like
Many trans men experience gender dysphoria, a persistent sense that their body or the gender they were assigned at birth doesn’t match who they actually are. To meet the clinical definition, this feeling needs to have lasted at least six months and cause real distress in everyday life. It can show up in different ways: discomfort with one’s chest or other physical characteristics, a deep desire for a male body, or ongoing frustration at being perceived and treated as female.
Not every trans man experiences dysphoria with the same intensity, and some describe it less as active distress and more as a quiet, lifelong sense that something was off. The experience is personal, and there’s no single way it presents.
Social Transition
Social transition refers to the non-medical steps a trans man takes to live as himself. This often includes choosing a new name, using he/him pronouns, changing how he dresses, and asking others to refer to him as male. For many, social transition is the first step and sometimes the only one they pursue.
Chest binding is a common part of social transition. A binder is a compression garment that flattens the chest to create a more masculine silhouette. Safe binding means using a properly sized binder, not bandages or tape, which can restrict breathing or even cause broken ribs. Binders should only be worn 8 to 10 hours at a time, never overnight, and never during exercise. People with larger chests should limit wear to 6 to 8 hours. Skin underneath should be checked regularly for redness or sores, which signal the binder is too tight.
Some trans men also use soft silicone prosthetics called packers, worn in the underwear to create a more masculine appearance under clothing. These range from simple, inexpensive inserts to more realistic prosthetics that also allow standing urination.
Testosterone and Physical Changes
Hormone therapy with testosterone is the most common medical step in an FTM transition. The physical changes it produces are gradual and unfold over months to years. Voice changes often start within the first few weeks, beginning with a scratchy or hoarse feeling before the voice cracks and eventually settles into a lower register. Muscle mass and strength increase, though results depend on diet and exercise. Body hair on the chest, back, and arms grows thicker and darker, with a pattern similar to other men in the family, though full results can take five years or more.
Other changes include fat redistribution away from the hips and toward the abdomen, skin becoming oilier, menstruation stopping, and gradual growth of the clitoris. Some of these changes are reversible if testosterone is stopped (like fat distribution), while others are permanent (like voice deepening and facial hair growth).
Health Monitoring on Testosterone
Testosterone therapy requires ongoing medical oversight. During the first year, blood work is typically done every three months, then every 6 to 12 months after that. Doctors track blood pressure, cholesterol, blood sugar, and red blood cell counts, since testosterone can raise all of these. Testosterone levels in the blood are kept within the typical male range of 300 to 1,000 ng/dL to minimize risks while achieving the desired effects.
Surgical Options
Top Surgery
Top surgery, or chest masculinization, removes breast tissue to create a flat, masculine chest contour. It’s the most common gender-affirming surgery among trans men. The most widely used technique is the double incision mastectomy, which involves two horizontal cuts across the chest following the natural line of the pectoral muscles. This works well for moderate to large amounts of breast tissue. For people with very small chests, a keyhole (periareolar) approach removes tissue through a small incision along the edge of the areola, leaving minimal scarring. A newer buttonhole technique preserves the nerves connected to the nipple, maintaining sensation that other methods may reduce.
Current medical guidelines recommend at least 12 months of hormone therapy before surgical procedures for adolescents, and at least 6 months before certain surgeries for adults, though some procedures like top surgery may not require prior hormone use depending on the provider and individual circumstances.
Bottom Surgery
Bottom surgery is less commonly pursued than top surgery and involves more complex procedures. The two primary options are metoidioplasty and phalloplasty, and they differ significantly.
- Metoidioplasty uses existing genital tissue (the clitoris, which grows on testosterone) to create a smaller penis. It preserves more erogenous sensation, involves fewer surgical stages, and has a lower complication rate. The tradeoff is a smaller result that may not allow for standing urination without a modified technique or for penetrative sex.
- Phalloplasty constructs a larger penis using tissue grafted from another part of the body, usually the forearm or thigh. It allows for standing urination and penetrative sex (with a penile implant), but requires more surgical stages, carries a higher complication rate, and typically results in less erogenous sensation.
Both surgeries can include additional procedures like urethral lengthening and the creation of a scrotum with testicular implants. Many trans men choose one, both, or neither of these surgeries. There is no expectation that a trans man pursue any particular medical intervention to be “valid” in his identity.
Not Every Trans Man Transitions the Same Way
Some trans men pursue hormones and multiple surgeries. Others transition socially and stop there. Some take testosterone but skip surgery entirely. The path depends on personal goals, financial access, health considerations, and how much dysphoria someone experiences about specific parts of their body. Being a trans man is about identity, not about checking off a list of medical procedures.