There is no single operation from female to male. The phrase covers up to five separate procedures: top surgery, hysterectomy, metoidioplasty, phalloplasty and body contouring. Every one is optional. Most people have top surgery first; genital surgery, if wanted, comes later and in stages, and NHS England asks for 12 continuous months of hormone therapy before it.
Key takeaways
- Each operation from female to male is a separate decision; no guideline requires you to have them all.
- Top surgery is usually the first operation from female to male, and NHS England's criteria do not require hormones for it.
- NHS England asks for two referral letters and 12 months of hormones before genital surgery.
- WPATH suggests at least 6 months of hormone therapy before removal of the ovaries.
Table of Contents
- What an operation from female to male covers
- Which operation from female to male is optional
- Order of each operation from female to male
- Top surgery: the first operation from female to male
- Hysterectomy: where it fits
- Metoidioplasty or phalloplasty: the staged part
- Body contouring: usually last
- Spacing and a realistic timeline
1. What an Operation From Female to Male Covers
An operation from female to male can mean any of five procedures. The NHS groups them as removing the breasts and chest reconstruction, removing the womb, ovaries and fallopian tubes, and construction of a penis, scrotum and testicles.
Each operation from female to male at a glance
- Top surgery: removes breast tissue and reshapes a flat chest.
- Hysterectomy: removes the womb, with or without the ovaries and tubes.
- Metoidioplasty: forms a small penis from tissue enlarged by testosterone.
- Phalloplasty: builds a larger penis from a skin flap.
- Body contouring: liposuction, fat transfer or implants to adjust proportions.
Where to read about each procedure
This article maps the sequence only. For what each operation from female to male involves, see Female to Male Gender Surgery: A Complete, Patient-First Guide.
2. Which Operation From Female to Male Is Optional?
All of them are optional. WPATH's Standards of Care, Version 8 (SOC 8) describe gender-affirming care as individual, and many trans men and non-binary people stop after one operation from female to male, most often top surgery.
Deciding what you need
Ask which part of your body causes distress day to day, and what recovery time and risk you accept. Nobody needs a second operation from female to male to "complete" a transition.
3. The Usual Order of Each Operation From Female to Male
The usual order is top surgery, then hysterectomy, then metoidioplasty or phalloplasty, with body contouring last. No guideline fixes which operation from female to male comes first; the order follows from eligibility rules and healing.
| Usual step | Operation from female to male | Earliest point in the guidelines | Spacing |
|---|---|---|---|
| 1 | Top surgery | No hormone requirement; one letter (NHS England) | Can be the only step |
| 2 | Hysterectomy, with or without ovaries | 6 months of hormones suggested (WPATH) | After the chest has healed, or with step 3 |
| 3 | Metoidioplasty or phalloplasty | 12 months of hormones and of living in role; two letters (NHS England) | Often several stages, months apart |
| 4 | Prostheses and later stages | Set by the surgeon | Months after step 3 |
| 5 | Body contouring | No fixed rule | Usually last |
Can one operation from female to male be combined with another?
Sometimes. NHS England's specification allows surgery to be combined when you meet the criteria for each procedure, the surgeon judges it appropriate and you prefer it.
4. Top Surgery: Usually the First Operation From Female to Male
Top surgery is usually first because, of every operation from female to male, its entry criteria are lightest. NHS England's criteria ask for one referral letter and state that hormone therapy is not a prerequisite. Eligibility is explained in our guide to gender affirming top surgery.
Time to allow
The procedure typically takes 2–4 hours, and patients travelling to Istanbul usually stay 7–10 days. Most surgeons want the chest fully healed before another operation from female to male; ask yours for the interval in writing.
5. Hysterectomy as an Operation From Female to Male
Hysterectomy is usually the second operation from female to male, either on its own or in the same sitting as genital surgery. SOC 8 suggests considering a minimum of 6 months of hormone therapy before the ovaries are removed, unless hormones are not clinically indicated.
How the NHS handles it
NHS England's specialised service commissions hysterectomy and removal of the ovaries only when they are performed together with genital surgery. Discuss fertility before this operation from female to male, because removing both ovaries ends the option of collecting your own eggs later.
6. Metoidioplasty or Phalloplasty: The Staged Operation From Female to Male
Genital surgery is the longest operation from female to male to plan: it comes after at least a year on hormones in the NHS pathway and is commonly split into stages. NHS England's criteria ask for 12 continuous months of hormone therapy, unless you cannot or do not wish to take hormones, and 12 continuous months living in a congruent gender role.
How testosterone affects the choice
SOC 8 notes that metoidioplasty works with the growth testosterone produces, so a period of hormone therapy may be necessary. Phalloplasty has no minimum testosterone period as such. Urethral lengthening is optional with either and, according to SOC 8, carries a greatly increased complication rate.
Why stages are spaced out
Each stage of this operation from female to male needs healing time before the next, and implants are placed after earlier stages have settled. NHS England says a surgeon recommending a multi-stage procedure should explain why. SOC 8 suggests lifelong urological follow-up afterwards.
7. Body Contouring: Usually the Last Operation From Female to Male
Body contouring is usually left until last because testosterone and time change fat distribution without surgery. SOC 8 lists liposuction, lipofilling and implants as contouring procedures. Our FTM body contouring guide describes the options.
When contouring is done earlier
Liposuction of the sides of the chest is often part of top surgery itself. Separate hip or waist contouring is a personal choice and never a requirement for any other operation from female to male.
8. Spacing and a Realistic Timeline for Each Operation From Female to Male
Plan in years, not months, if you want more than one operation from female to male. A sequence that includes genital surgery cannot realistically finish in under a year, and staged procedures plus waiting lists commonly stretch it across several years.
Timeline checklist before you book an operation from female to male
- Which letters each operation from female to male needs: one for chest surgery, two for genital surgery on the NHS
- How long you have been on hormones, if you take them
- The healing interval your surgeon wants between operations
- Whether hair removal is needed first; SOC 8 says it generally is before external genital procedures
Where Neda Agency fits
Neda Agency is a coordinator, not a clinic. We arrange top surgery, the most common operation from female to male, with board-certified plastic surgeons in accredited Istanbul hospitals. For staged genital surgery, a specialist team near home is often the better choice, because follow-up lasts for years. Our female to male surgeries page lists what we coordinate.
Further Reading
More on each operation from female to male on our blog:
- The Ultimate Guide to Transgender Surgery Woman to Man
- Comprehensive Guide to Gender Affirmation Surgery
- Gender Surgery UK
- FTM Surgery Turkey
Frequently Asked Questions
What is the first operation from female to male?
The first operation from female to male is usually top surgery. NHS England's criteria ask for one referral letter and do not require hormone therapy, so chest surgery is usually the easiest procedure to access.
Do I need every operation from female to male?
No. Every operation from female to male is optional. Top surgery, hysterectomy, metoidioplasty, phalloplasty and body contouring are separate decisions. Choose according to which parts of your body cause distress and how much recovery time and risk you accept.
How long does it take to complete each operation from female to male?
Top surgery alone can be completed soon after an assessment. A sequence with every operation from female to male takes years, because NHS England asks for 12 months of hormone therapy before genital surgery and genital procedures are commonly staged.
Is hysterectomy required before another operation from female to male?
Hysterectomy is not required before top surgery. Before genital surgery, practice varies by surgeon and technique. NHS England commissions hysterectomy only together with genital surgery, and WPATH suggests at least 6 months of hormone therapy before the ovaries are removed.
Can more than one operation from female to male be done at once?
Sometimes. NHS England allows one operation from female to male to be combined with another when you meet the criteria for each, the surgeon considers it appropriate and you prefer it. Combining makes one recovery longer, so your surgeon decides.
Sources
- NHS: Gender dysphoria, treatment
- NHS England: Gender Identity Services for Adults (Surgical Interventions)
- WPATH Standards of Care, Version 8 (2022)
Medical note
This article gives general information and is not a substitute for a personal consultation. Sequences and intervals are decided by your surgical team, and prices are indicative.
Start With One Clear Step
If top surgery is your first operation from female to male, tell Neda Agency your dates and questions, and we will set out the timing, the documents and the cost in writing. Contact us.
Sources and further reading
- WPATH Standards of Care, Version 8: international clinical guidance for gender-affirming care.
- NHS: Gender dysphoria and incongruence: how assessment and treatment work in the UK.
- NHS: Having surgery abroad: what to check before you travel for treatment.
- HealthTürkiye: the official health tourism portal of the Republic of Türkiye Ministry of Health.