by Tucker Lieberman

Created on: July 09, 2006   Last Updated: January 19, 2009

Hormonal and surgical treatment usually enables people who were born female to appear convincingly male and to live as normal men.

Testosterone injections administered twice a month will cause the female voice to drop into a male register. It will promote facial hair, body hair, and male-pattern baldness. Fat is generally redistributed from the thighs to the abdomen, and muscle is more easily developed. Some people notice changes in energy levels, appetite, cognition, or emotional response. The effect of testosterone on any given individual is partly influenced by genetics. Young people tend to undergo these changes more rapidly than old people. Testosterone puts females at a cardiac health risk similar to that of males; patients should also be monitored for elevated cholesterol or liver function.

Testosterone causes cessation of menstruation and infertility which will gradually become irreversible. Many transsexual men have their atrophied ovaries and uteruses removed. Like those of typical females, the reproductive organs of the female-to-male transsexual are susceptible to cancer and other maladies as long as they remain in the body.

After the commencement of lifelong hormone replacement therapy, the next step is typically a bilateral or double mastectomy-that is, the surgical removal of both breasts. A cosmetic surgeon will remove the breast tissue and reshape the skin and nipples to have a male appearance. Surgical technique varies based on the patient's body and the surgeon's preference, but scarring is usually minimal.

Testosterone replacement therapy and male chest reconstructive surgery are usually sufficient for a female-to-male transsexual to live successfully as a man. Some also desire genital surgery.

The clitoris, already enlarged from testosterone, may be further extended in a surgical procedure called a "metaoidioplasty". A more involved procedure called a "phalloplasty" can create a normal-sized penis from a tissue graft taken from the patient's arm or thigh. Optional urethral lengthening enables the patient to urinate through the new organ. Testicular implants may be placed in the patient's labia. The vagina may be removed by first performing a full hysterectomy and then denuding the inner vaginal walls of skin so that the orifice closes when it heals.

Most doctors in the United States will not provide hormonal or surgical treatment to transsexuals without the written recommendation of a mental health professional. Nearly all medical insurance companies refuse to cover the cost of sex-reassignment procedures.

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