Want to have a mastectomy! Should I have surgery first or take hormones first? Which is better?

Chest removal surgery in individuals transitioning from female to male (transmen): Should the chest be operated on first or should hormone therapy be started first? In terms of treatment outcomes, the results are generally the same. However, due to differences arising from other overall factors and the sequence of steps between surgery first or hormone therapy first, it ultimately depends on the satisfaction of the person undergoing gender transition.

Chest Surgery First VS Hormone Therapy First: What Are the Differences?

• Having chest surgery before hormone therapy makes the person appear more masculine because there is no chest, but the voice, facial structure, hair, beard, or skin will still be feminine. When hormone therapy begins, the voice will start to deepen, facial structure, beard, and hair will develop, making the appearance clearly masculine.
• Starting hormone therapy before chest surgery causes the voice to deepen, beard to grow, and facial structure to change, making the person look masculine even though the chest is still present! When preparing for chest surgery, hormone therapy must be stopped, and the duration of stopping varies for each person. This may cause some to have their menstrual cycle return or revert to a more feminine appearance (this depends on the individual and does not happen to everyone).

Is it true that hormone therapy first makes the chest smaller?

The breast tissue remains the same, but the chest base widens (chest expands due to male hormones). If the person is thin, the chest is small, and when building muscle, the chest will look more muscular and masculine. However, if the person is larger with a big chest and does not exercise, even with hormone therapy, the chest will remain large and will not become smaller.

Will chest muscles disappear if you build muscle before chest surgery?

During surgery, the doctor will remove the chest muscles as well, causing the chest to shrink and the muscles to no longer be as before surgery. If anyone is planning surgery but fears losing the chest muscles they have worked hard to build, it is recommended to consult the doctor about whether the chest muscles can be preserved to avoid regretting the loss of the muscles.

Is it possible to take hormones without chest surgery, or have chest surgery without hormone therapy?

Choosing to do only one depends on the individual’s satisfaction. If you are okay with having a deepened voice, beard growth, and a masculine facial structure but still have a chest, hormone therapy alone is not a problem. However, it is recommended to undergo breast cancer screening at least once a year to prevent breast cancer.

For those who want chest surgery but do not want hormone therapy due to concerns about complications associated with hormone therapy, such as thick or sticky blood, blood clots, high blood lipids, osteoporosis or brittle bones, or risks affecting the heart, high blood pressure, diabetes, kidney, liver, or cerebrovascular disease, you can choose according to your own preference.