All surgery is optional. You should not feel that you have to have surgery to validate your transition from F to M. You should have surgery because you want to have surgery and for no other reason.

Top surgery
This refers to a double mastectomy to remove the female breasts and plastic surgery to build a male chest. The two phases of the operation are done in one procedure under general anaesthetic. Hudson’s Guide has a great section on chest surgery methods and their advantages and disadvantages.

When considering top surgery, manage your expectations. You will have scarring, whichever method you choose, you may need revisions post-surgery, and your final chest is unlikely to look like a natural male chest close up. However, with gym work to improve the tone of your pecs, most post-op transmen would pass on the beach at St Ouen’s.

There are no surgeons available on the island to undertake this procedure so you will need to go to the UK or abroad if you want chest surgery. If you are being treated through the NHS, you will be offered a list of approved surgeons to choose from. If you wish to go privately, you can choose from surgeons in private practice all over the world. However, you will need to research the best person for your needs and your budget.

Do your research. Look at the numerous YouTube videos uploaded by transmen showing pre and post-surgery photos. Compare the pre-op photos with your own body shape. It is no good admiring the chest of a transman who started off as a B cup if you are a D cup! If the post-op results look good to you, send a comment to the transman who posted the video asking who his surgeon was. Most transmen are happy (and flattered) to share this information.

Bottom surgery
This comes in two parts.

Hysterectomy and oophorectomy
This refers to the removal of the uterus and ovaries respectively. After taking testosterone for a while, some transmen may find that they have to have one or both of these procedures for medical reasons. Hudson’s Guide explains the reasons for this surgery and the surgical options available.

Jersey has the necessary surgeons capable of performing a this surgery through the health service. If you have island health insurance, you may also find that this is the only part of your transition it will cover, especially if you have to have the operation for medical reasons, such as the development of cysts. However, you may wish to go privately in order to choose the surgical method used by your surgeon.

Genital reconstruction surgery (GRS)
The surgery to contruct a penis and testes is the surgery that majority of transmen elect to do without. The results still ask transmen to trade-off sexual function and visual appearance, there can be complications, it is by far the most costly and time-consuming of trans surgeries, and can involve numerous surgical procedures. Details of the various options currently available to transmen can be found on Hudson’s Guide or can be downloaded here (warning: this download contains graphic photographs of operation progress and results).

You will not be surprised to learn that there are no surgeons with the required skills to perform GRS in the island. You are therefore looking at travel costs again and, because of the complexity of the surgery, several trips to the UK or abroad may be needed.

The same advice applies to GRS as for top surgery: manage your expectations and do your research thoroughly.