FTM Surgical Journey

[journallingftmsurgery]

I will be using this blog to journal my experiences with FTM gender affirming surgery in the UK.

I am a later-life transitioner, although have always felt male.

I started testosterone in June 2022 (age 37).

Feel free to DM me with any questions.

*update* Top surgery completed 25/09/23

**update** Lower surgery (full metoidioplasty, with UL, vaginectomy, scrotoplasty, testicular implants, monsplasty, hysterectomy with salpingectomy and bilateral oophorectomy) completed 14/04/25

[journallingftmsurgery]

5 Weeks Post Op (lower surgery)

I don't feel like there has been a whole lot of progress in the last week.

The drain site is still leaking, but it has slowed down significantly, and it's more of a sticky, clear-ish, mucous-y fluid now. I can get away without having gauze in my pants all the time now.

I have noticed maybe 2 stitches coming out in the shower over the last few days, but that still leaves absolutely loads.

My lower abdomen is still very bruised/tender feeling from the hysto, and is my main source of discomfort now. Regular underwear is still too tight at the waist band.

My balls are slightly tender when I poke them, or if I'm sat down for too long. I can manage about 45 mins at a time, and that's with the donut cushion.

Walking is getting easier, but where my knees used to brush together with each stride, I'm now conscious of not having my legs that close together. I can feel my balls rubbing against each other as I move. I don't know if that is something that will continue to change, or something I will simply get used to.

I'm happy with the size of my penis (almost 2"/5cm) but it is still very much pointing downwards and kinda twisted to the left. The stitches on the underside are almost visible from the left. The meatus seems rather large, too, like maybe the join didn't heal all the way to the tip.

I'm standing to pee in the shower only, and gradually trying to point/position my stream with the hope that I will eventually be able to use a urinal, but I'm not in any rush.

Jerking off is very satisfying, and I hope could be stimulating blood flow to the area and encouraging faster healing, although I'm only doing it once a day.

I can sort of sleep on my side now, but I have to angle my legs so I'm not crushing my balls.

[journallingftmsurgery]

1 Month Post Op (lower surgery)

I can now do most day to day activities, albeit somewhat more slowly than normal. I also drove for the first time a couple of days ago, and it was much better than my first post-op drive after top surgery.

The sutures have started falling out; I have 2 left on my monsplasty site, all 4 of the hysto ones are still there, and quite a few *under* me (vaginectomy site, between my balls, and the underside of my penis), but I've definitely seen one come away in the shower, and 2 more just now when I was changing my gauze.

The drain site is still bleeding, but it's only a tiny bit now. I wouldn't feel confident going without gauze, yet.

In terms of discomfort, I am still a little bloated/swollen from the hysto, and it tends to get more uncomfortable as the day goes on. Everything feels too tight across my lower abdomen. And I have been painfully gassy today, but that's new, so it could be diet related, rather than surgery related.

Left testicle is still quite tender - there's a hard little lump under the skin, right at the end of the implant. I think it's a suture tethering the implant to the bottom of the scrotum. I'm not loving how rigid the left one feels. Especially as both balls are right between my thighs, and not loose enough to be cupped and manoeuvred forward so I can close my legs comfortably.

The SP catheter site sealed up in about three days, but I kept gauze over it for a few additional days just to protect it. It is... weird. When I piss, the area where the catheter went in is sort of sucked in. To the point it looks like a second (innie) bellybutton. It is the strangest clenching sensation. I think there could be internal scar tissue connecting my bladder to the abdominal wall, so as the bladder contracts to empty, it's pulling the wall of my abdomen inwards. Once the external scab is gone, I'll start some scar massage, and see if that helps.

I have attempted to stp in the shower. Penis is very much pointing down, and I'm not confident enough yet to pull him up. He is also pointing to the left - I think that's because of some swelling on the right. Presently, my stream is landing maybe 20cm in front of my left foot, and the last dribble runs down between my balls. So I don't think I'm urinal-ready just yet.

I have been able to jerk off, finally. Getting hard is fun and validating. I used my trusty bullet vibe to finish off, and it felt spectacular. Not sure if it was better than pre-op, or just an epic relief after an entire month of abstinence.

Next milestones will be: drain site to stop bleeding, sutures fall out, abdominal swelling/bloating to go away, tenderness in balls to go away.

I am also very excited about being able to run and lift again in another 3.5 weeks, and plan to gradually return to work in just over a week.

[journallingftmsurgery]

3 Weeks Post Op (lower surgery)

It has been a long and busy week, and I'll try to remember all the details.

On day 15 I flew home from Serbia. The total journey time from door to door was 9 hours, 2 car rides, and 2 flights. I did it solo, contrary to advice, because I had no other choice.

It was *not* fun, but I made it because, once again, I had no other choice.

Sitting in cars and planes wasn't too bad, as long as I was able to lean back. If attempting it yourself, just make sure you have whatever snacks etc in your lap, because leaning forward to pick up your bag is not particularly pleasant.

I did have friends waiting to collect me from the airport once I'd landed in the UK, but I don't think any of us realised that the carpark was (or maybe felt like) a half mile uphill walk from the terminal.

I struggled.

I must have looked like absolute shite, because the moment they saw me they came rushing over, and I all but collapsed (cleverly disguised it as a hug) into my friend's arms.

Being home felt amazing.

I took a rest day, then started trying to get a little walk in each day.

On day 19 I did my voiding trial.

This was at home, and I just reported my results to the team via WhatsApp. I left my SP catheter plugged all day, and went to the toilet as normal.

I had no trouble at all peeing, although it stung a little, and at the end of the stream my bladder seemed to clench around the SP tube in my abdomen, which was an unsettling sensation, although I would quite describe it as pain.

Because I was able to empty my bladder, I went to A&E on day 20 and requested they remove the SP catheter.

This was met with a little resistance, but I was firm, and after calling a urologist from the next town over, the practice nurse was cleared to pull it.

Again, not a pleasant sensation, but not exactly painful. And it oozed, although I couldn't personally bring myself to look. I was given a stack of gauze and some tape, and told to change the dressing daily.

I left the hospital beaming.

The walk home (Google maps said 29 minutes, I'd normally do it in 23, took 55) was still a bit uncomfortable - there is a hole in my abdomen, but I was so damn happy to have that tube gone.

Day 21/the 3 weeks mark, I realised the taped gauze wasn't going to be practical in the shower. I had bought some waterproof plasters for showering, but they're quite small, and won't take a whole lot of exudate. I figured I'd put one on for the shower, then take it off and replace with gauze afterwards.

Taking the gauze off was nerve-wracking because I had no idea what this hole was going to look like. And to make matters worse, my abdomen is still slightly swollen, and the hole is sort of beneath the swelling, so I can't see it when I look down. I ended up using a mirror to guide myself.

Thick yellowish-white, sticky-looking gunk oozed out. I fought the urge to throw up. I gently wiped with antibac wipes, then carefully applied the plaster, and enjoyed my first tube-free shower.

After the shower, I reversed the dressing process.

I still feel the tugging sensation when I walk, and am most comfortable if I hold the wound site stable while moving around. I'm hopeful that it heals quickly, and I will be able to walk a little faster by the end of the week.

In terms of my actual junk (the catheter was taking up so much headspace, I've barely thought about anything else), sitting up straight is still a no-no. Even with my donut cushion there's too much pressure.

My balls are very much *directly* between my thighs, and feel quite tight still. They feel bruised/sore to the touch, although they look great. My left has descended perfectly, and I expect the right one to join him in time.

My penis is still wedged between them, swollen, and pointing down and to the left. When I pee, the stream seems to go whichever way it chooses, but usually it's a mess. I'm not even going to attempt to stp any time soon, unless the urge strikes me in the shower.

I'm planning to wait until the stitches on the underside of the phallus have fallen out, and I can start manipulating him a bit more.

The vaginectomy drain site is still bleeding, but I have been told that is normal. And I think some of the stitches have started disappearing from the monsplasty site.

It has certainly been a rollercoaster so far.

[journallingftmsurgery]

8 Days Post Op (metoidioplasty)

My updates have been very sporadic, but that's actually quite reflective of how I've been feeling.

I had the Foley catheter out yesterday - nowhere near as painful as I was expecting - and that has been a huge weight off my dick mind.

The suprapubic catheter is uncomfortable - the incision is sore, but not infected, and I have a serious psychological hang up with it. Hopefully it goes in 13 days. I already know the new urethra works, as I've been (not deliberately) pissing through it every time I poop.

Pooping has also been such a hassle.

After the epic dump on the night before the op (dulcolax suppositories - I will absolutely be using them again for play prep), I then didn't go again for 5 days. And it wasn't some mega-poop then; more like a double-shot of lumpy gravy.

And for the last few days it's been the same, but I'm going every few hours, and the liquid-y consistency has threatened to leak between trips to the toilet.

Apparently it's okay that it's not solid again yet, even though my diet has (almost) returned to normal, as I'm still on antibiotics and have likely nuked my carefully cultivated guy microbiome 😭.

I am trying to repair the damage with high fiber, probiotics and prebiotics, but maybe it's for the best that I don't have to drop a monster shit just yet, given the wounds still healing in that area.

Due to swelling, I can't see how well the incisions underneath me are healing, but the only bleeding I still have is light, and from the vaginectomy drain site. I have read reports of folk still bleeding from there for up to 8 weeks, so the little bit of spotting I'm getting is not too bad at all.

My gut is still bloated. Which is annoying as much as it is uncomfortable. Again, psychologically, not having a flat stomach hits my "stop eating!" emergency button, and I have to work to ignore it.

Internet research again throws up 8 weeks as a maximum time frame for post-hysterectomy bloating to go down.

I have to keep reminding myself; it's only been 8 days. I am doing amazingly. My body is tough, and my mind is tougher.

I can do this.

[journallingftmsurgery]

48 hours post op - lower surgery

Not gonna lie - I am uncomfortable right now.

The op sites aren't too bad, but my lower back is killing me. Lying down isn't comfy when you can't switch positions.

I have been assured that everything looks good down there, but I haven't looked for myself yet.

I would love the IV things to be removed from my arms, especially as I'm no longer getting fluids through them, but I suspect they'll want to keep giving me antibiotics through them, and pain meds when necessary.

Most of the surgery-related discomfort is from the hysto. It feels like cramping/bloating/achy muscles.

I've had a few twinges from the genital region - a sharp sensation at the vaginectomy site, made worse by the involuntary clenching of the muscle in response. And there's a kind of dry/irritated feeling every now and then from what I think is the tip of the penis, where the urethral catheter comes out.

I have briefly been out of bed a couple of times, and it was a relief to be on my feet. I would like to get up some more - to wash etc - but don't want to attempt it without the nurse.

No bowel movement yet. I think walking might help that, too. I'm simultaneously dreading it, but also keen to get it out of the way.

[journallingftmsurgery]

1 Day Post Op (lower surgery)

That was definitely more intense than top surgery. Potentially because I had multiple procedures at once (I was too impatient to spread them out).

The night before surgery I was given antibiotics (IV) and an anticoagulant shot. I was also instructed to take 2 suppositories an hour apart, to clean out the bowels.

In the morning I met the surgeon and confirmed the procedure. And met with the cardiologist to confirm I was fit for it.

On waking from the anaesthesia I was *freezing*, literally shaking with the cold. But I had been forewarned about that. My concern was the tensing of my abdominal muscles around the healing hysterectomy and suprapubic catheter, while I was shaking.

I spent the day and night drifting in and out of sleep. I was a little uncomfortable down there, but not in agony. The nurses put something in the drip for pain (no idea what, and I can't be bothered to ask), so I'm confident it's being managed.

I have just had my dressings changed - I was nervous that it would hurt, but it didn't. And managed to get out of bed (with help from the nurse) to clean my teeth. Now I have some biscuits and tea. I have barely had one glass of water in a day and a half, but I'm not dehydrated because I'm getting fluids through the IV drip.

Hopefully there's some sugar in there, too, although if there isn't, it might explain why I still feel groggy.

[journallingftmsurgery]

Lower Surgery - One Day to Go

I have been a bit hesitant to post much of the lead up to this one, because it's still hard to believe it's actually happening.

I arrived in Belgrade from the UK a couple of days ago, and had bloods taken for pre-op checks. Then I was driven to the apartment (about 15-20 minutes from the hospital).

The apartment is great - really big, and close to local amenities. I have been able to go out and get a load of food in (I've gone for easy options: instant porridge, soup, fruit pouches, protein shakes, as I'm doing this whole thing solo). There is also a nice park nearby for walking, and a big church(?) type building which is really pretty.

My op is scheduled for tomorrow morning, but they've asked me to go in this evening for some prep. Before I go in I have to have a very thorough shave. This seems to vary from surgeon to surgeon, as I know some of them don't like to risk nicks/cuts from shaving that could potentially be an infection risk.

The surgery itself is an all-in-one job: hysterectomy with bilateral oophorectomy, metoidioplasty with urethral lengthening, vaginectomy, scrotoplasty with implants. ...I would have liked monsplasty to be included, but never got around to discussing it, so I might ask when I see the surgeon later.

It is a *huge* op, and I am well aware that the recovery is going to be a bitch, but I have a real talent for pushing through pain/stress to get to the things I want.

[journallingftmsurgery]

Surgery is supposed to be three weeks today.

And I just keep coming up against roadblocks.

1. Letter of recommendation - as dumb as it sounds, I didn't realise I needed one. I'm paying (HAVE ALREADY PAID) cash, I'm doing it out of the country, and I booked it 9 months ago without the letter. But this week I was asked for the letter, and told the procedure could not go ahead without it.

Neither of the specialists who did my top surgery recommendation letters are available at short notice, and my endocrinologist says he isn't qualified to provide one.

I have found a psychiatrist online who may be able to help, but it's going to set me back another £300 and she's only available during the working day, so I'm going to have to miss a day of work for an appointment, costing me £200 in lost wages.

Fingers crossed, I get my letter in time (at a total cost of £500).

2. After a complete clean bill of sexual health last summer, I have picked up an STI in the last week and a half. I'm furious. He must have known he was a carrier, but never said anything. I don't even do penetrative.

So now I'm on a high dose of antivirals, in the desperate hope that my junk is operable in 3 weeks. And I will continue with suppressive antivirals until healing is complete (IF my surgeon is even still happy to operate...).

I have no idea how to bring it up with him.

So things are ridiculously stressful. I wish I could just relax and continue being excited for the op, but instead I'm freaking out about it being cancelled.

Wish me luck.

[journallingftmsurgery]

No real update to add yet, just a countdown:

8 weeks to surgery!

[journallingftmsurgery]

The exciting news this week is that I have paid, in full, for my lower surgery.

I had been putting it off as long as possible, as the cash was earning a decent interest rate. I was also naturally anxious about transferring such a large sum of money overseas...

Over summer I attempted to follow as many of the instructions from the anaesthetist as possible; I got tested for all the STDs, and sent over *some* of the blood test results requested.

The team wanted a letter from my GP stating that I was fit for surgery, however, my GP refused, on the basis of not wanting to be held responsible if something went wrong. Fortunately the anaesthetist said he has worked with the NHS before, and knows how awkward they can be when they want to.

To get around this issue, I will need to arrive in Serbia a few days in advance of the surgery, so I can undergo pre-op assessment there.

I cannot begin to describe how excited I am about all of this. It is only just over four months away now. I know there is so much that can go wrong, but besides planning contingencies, it's out of my hands. I'm running on the power of positive thinking.

Watch this space.

[journallingftmsurgery]

Metoidioplasty

Exciting times!

I have been in contact with Miroslav Djordjevic at the Belgrade Center for Genital Reconstructive Surgery.

We have provisionally booked the date 14th April 2025, subject to payment and general terms (letter of recommendation etc).

I chose Miro for the results I'd seen online, and also because he offers an all-in-one surgery: hysterectomy with bilateral oophorectomy, vaginectomy, metoidioplasty with urethral lengthening (UL), and testicular implants. There is even an option to have top surgery at the same time!

The compromise is that the center is in Belgrade, in Serbia, and I will need to stay there for two weeks post op, to monitor recovery. I will then have to fly home with a suprapubic catheter in place, and find a local doctor willing to remove it at a later date.

I live in the UK, where we have an extreme shortage of options for lower surgery: it technically *is* available on the NHS, but I imagine I will be drawing my pension before I get anywhere near the top of that waiting list.

Due to the shortage of UK-based surgeons, the private waiting lists are almost as long - and the cost significantly higher.

I have currently been quoted €16000 (approx £13650) for the whole procedure, in Serbia. Which is extremely reasonable. However, I am prepared for that cost to increase. For example, I highly doubt that is going to include my accommodation, or food for two weeks, and I seem to think I've read something about tax, too.

Flights to and from Birmingham airport only comes to about £200.

My other concern is that I don't have anyone accompanying me. Loneliness and boredom don't worry me as much as my physical incapacity and potential lack of ability to feed myself...

Still; absolutely beside myself with excitement now!

[earlofnewshire]

A uniquely transmasc experience I think is being a kid and "wanting cancer" because the only way you know of people getting rid of their boobs is breast cancer patients having them removed as part of treatment. And obviously you don't actually want to be sick but the idea of not having to live the rest of your life with tits is so euphoric that the idea of potentially getting cancer seems exciting. And then of course you learn about queer communities and transness and top surgery and you stop praying for sickness every night, but it really highlights how fucked up a lot of our childhoods were because no one let us know about these communities we belong to. If gender affirming care wasn't attacked and stigmatized, if kids were actually allowed to know about these things, a lot of us would've spent a lot less time hoping for disease and a lot more time just,, enjoying life as best we can while we wait to get the care we need.

[journallingftmsurgery]

This reminds me of the light-bulb moment I had when Angelina Jolie had her preventative mastectomy. Everyone (with breasts) on my maternal side, over the age of 40, has had breast cancer.

The stats are actually HIGHER than the official stats associated with BRCA etc.

I smugly assumed this meant I would be eligible for the prophylactic surgery for free on the NHS.

But no. All they would offer me was counselling, and an assurance that breast cancer is very treatable these days.

My mother had died of breast cancer quite recently when they told me this.

It was frustrating to hear folk praise Jolie for her bravery, when I was begging for the same procedure and being told no.

Oh well, at least it did get done in the end.

And I've personally saved the NHS however much it costs to treat a patient for breast cancer.

[journallingftmsurgery]

10 Months Post Op

I'm currently on my first holiday post op, and loving the freedom.

My scars ARE noticeable. I am at peace with that. But I have not caught anyone staring, yet.

To try to disguise them a bit, I had a spray tan before leaving the UK, and I'm sporting my transfer tattoo nipples. But I think strutting around confidently is working for me just as well.

Before anyone panics; I am slathering on the SPF50 to protect the scars.

[journallingftmsurgery]

Nipples!

After some less than impressive silicon stick-on nipples, I ordered some transfer tattoos.

The positioning could have been better (if I was more patient) but the transfers themselves look great!

The website I ordered from (www.tattooforaweek.com) reckons they should last... A week. I will see how it goes, but I'm running tomorrow, so I don't hold them to that promise.

In terms of the options, I went with Light Tan in "small".

[journallingftmsurgery]

6 months post op

Wow, how has it been 6 months already?

I feel like any swelling has probably gone down as much as it's ever going to, and any wobbly pockets left will be fat that I need to get rid of the old fashioned way.

I am increasing my workouts gradually (might need to pick up the pace) and seeing some pectoral definition starting to develop. I still have hollow areas above and below my pecs, but hopefully they will fill out with muscle in time.

My T dose has been increased recently, so it's possible that will boost muscle growth, and maybe also kickstart some chest hair.

Ahead of my holiday in 4 months I do plan to get a spray tan, which might camouflage the scars to a degree, and depending on Mr Sterne's advice when I see him in May, I might even get the nipples tattooed on.

Is it weird that I don't know where they go, exactly? 😆 I tried to stick some silicon ones on but they looked ridiculous (skin tone was miles off, and they were too big, despite me ordering the smallest size), and no matter where I put them, they looked *wrong*.

I've tried looking at pictures of chests online to get an idea where nipples are meant to go, but I still can't make it make sense. I figured the tattooist will have done enough that she will know where to put them.

[journallingftmsurgery]

5 Months Post Op

I've been back through this blog, and I'm trying to see if there's any further progress. I'm not sure.

I did really well with the massage for a while, but once again it's kind of trailed off.

Here is where we are at:

And I am quite happy with this picture.

I have been consistently working on my arms, shoulders, and chest muscles, in an effort to build the shape I want, as that wasn't a surgical option (as part of the risk reduction for BC, the surgeon took all the tissue, so no masculinisation was done on the operating table).

However, that is but one pose.

From the sides, the lumpy-bumpiness is a little more prevalent:

Once I'm fully employed again, I think I may join a gym and take advantage of a PT, to see if there is some way I can fill in the sunken areas with muscle.

The scars look pretty good, too:

I imagine they will continue to fade with time.

The mark near my hand is where I was cauterized with the diathermy after they hit a particularly insistent blood vessel.

There is still a lot of temperature-numbness, and it feels a little tight when I rotate my arms, but that will probably pass, in time.

I have a holiday booked for 5 months from now, and am keeping optimistic about my ability to swim and sunbathe shirtless.