FTM SRS Surgery: Options and Recovery

FTM SRS surgery is an umbrella term for individualized genital gender-affirming procedures for trans men and transmasculine people. Options, recovery time, sensation, urinary function and long-term results depend on the selected surgery, overall health and personal goals.

Understanding FTM SRS Surgery

FTM SRS surgery is a term commonly used for genital gender-affirming surgery for trans men and transmasculine people. It is not a single procedure: surgery can be tailored to create external genital anatomy that better aligns with a person’s identity, comfort and practical goals. Many clinicians use the terms gender-affirming genital surgery or masculinizing genital surgery, while some people continue to use SRS or gender reassignment surgery.

The two main reconstructive pathways are metoidioplasty and phalloplasty. Metoidioplasty uses existing genital tissue, often after enlargement associated with testosterone therapy, to create a smaller phallus. Phalloplasty creates a phallus using tissue from another area of the body, such as the forearm, thigh or abdomen, depending on the surgical approach and the person’s anatomy.

Some people choose genital surgery to reduce gender dysphoria, improve body comfort, support urinary goals or improve sexual well-being. Others do not want genital surgery, or choose only selected procedures. There is no single medically correct pathway, and surgery is only one possible part of gender-affirming care.

Candidacy, Goals and Surgical Planning

Suitability for FTM SRS surgery is determined through an individualized assessment by an experienced multidisciplinary team. Most programs provide genital surgery to adults, while eligibility requirements can differ by country, hospital policy and local regulations. The central focus is informed decision-making, physical readiness and a clear understanding of the possible benefits, limitations and recovery needs.

Preoperative assessment usually reviews medical history, current medicines, hormone treatment, prior surgery, smoking or nicotine use, blood-clot risk and conditions that may affect healing, such as diabetes. Mental health support can be helpful before and after surgery, particularly when a person has anxiety, depression or limited practical support, but being transgender is not itself a mental health condition. Any coexisting health concerns should be appropriately managed before a major operation.

Planning discussions cover preferred appearance, standing urination, preservation of sexual sensation, interest in penetrative sex, donor-site scars and willingness to consider staged surgery. Fertility preservation should be discussed before removal of the ovaries or uterus if future genetic parenthood may be important. Testosterone is commonly relevant for metoidioplasty, but it is not universally required for every form of genital reconstruction.

How the Procedure Works: Step by Step

Before surgery, the team confirms the operative plan, performs necessary blood tests and explains fasting, medication changes and discharge arrangements. The procedure is performed under general anesthesia, so the person is asleep and does not feel the operation. The length of surgery and hospital stay vary substantially according to the procedures being combined and whether microsurgical reconstruction is needed.

In metoidioplasty, the surgeon releases and reshapes hormonally enlarged clitoral tissue to create a phallus while preserving its nerves and blood supply. Some people also have urethral lengthening, which may allow urination while standing after healing, although this outcome cannot be guaranteed. Scrotoplasty can use labial tissue to create a scrotum, and testicular implants may be placed at the same time or later.

In phalloplasty, a flap of skin and tissue is used to construct a phallus. Depending on the technique, the surgeon may connect very small blood vessels using microsurgery and connect nerves to support the return of sensation over time. Urethral lengthening, scrotoplasty and vaginectomy may be included, but these are individual choices rather than universal steps.

Hysterectomy and removal of the ovaries may be performed before, during or separately from genital reconstruction when clinically appropriate and desired. Erectile implants, which can provide rigidity for penetrative sex, are usually considered only after tissues have healed fully. A catheter is often used after procedures involving urethral reconstruction, and it should remain in place until the surgical team confirms that it is safe to remove.

Recovery Timeline and Aftercare

Recovery begins in hospital, where staff monitor pain, circulation, wounds, mobility and urinary drainage. After phalloplasty, close monitoring of the reconstructed tissue is especially important in the first days because blood flow must remain healthy. Swelling, bruising, fatigue and temporary limits on movement are expected, but the care team provides specific instructions for wound care, bathing, catheter care and medicines.

Initial healing commonly takes several weeks. People are usually advised to avoid strenuous exercise, heavy lifting, cycling and sexual activity until their surgeon confirms that healing is adequate. Returning to desk-based work may be possible after several weeks for some people, but longer time away can be needed after complex reconstruction, physically demanding work or complications.

Recovery after metoidioplasty may be shorter than after phalloplasty, although urethral healing can still require careful follow-up. After phalloplasty, healing of both the genital area and the donor site can take months, and later stages or revisions may extend the overall process to a year or more. Follow-up appointments are essential for checking urinary function, wound healing, scars, sensation and emotional well-being.

Benefits, Limitations and Possible Risks

For many people, FTM SRS surgery can improve comfort with their body and reduce distress related to incongruent anatomy. Depending on the procedure, potential functional benefits may include a more masculine genital appearance, the possibility of standing to urinate and preservation of erotic sensation. Results are personal, and the best choice depends on which outcomes matter most to the individual.

All major surgery carries risks such as bleeding, infection, blood clots, anesthesia-related complications, scarring and delayed wound healing. Genital reconstruction can also involve specific risks, including a urinary fistula, where urine leaks through an unintended opening, or a urethral stricture, where scar tissue narrows the urine channel. Donor-site scarring, changes in sensation, tissue blood-flow problems and concerns about appearance or size can also occur.

Some complications resolve with monitoring, wound care or temporary catheter use, while others may need a further procedure. Nicotine avoidance, management of long-term health conditions, careful adherence to aftercare instructions and regular follow-up can support safer healing. A surgeon should explain the risks associated with the exact technique being considered, rather than relying on general expectations alone.

Questions People Commonly Ask About SRS Surgery

How long does it take to recover from SRS surgery?

Initial recovery generally takes several weeks, but the full timeline depends on the procedure. Metoidioplasty may allow a return to many daily activities sooner than phalloplasty, while phalloplasty often requires a longer recovery because both genital and donor-site tissues need to heal. If urethral reconstruction, implants or later surgical stages are planned, the overall treatment process may extend over months or longer.

What is the success rate of SRS surgery?

There is no single success rate for SRS surgery because studies and individuals define success differently. Healing without major complications, the ability to urinate while standing, retained sensation, appearance, sexual function and satisfaction with gender affirmation are all separate outcomes. Revision surgery can be part of planned care or may be needed to address a complication, especially after complex phalloplasty.

Can you still climax after gender reassignment surgery?

Many people can still experience sexual pleasure and orgasm after gender-affirming genital surgery, particularly when nerve-rich clitoral tissue is preserved. Sensation can feel different during early healing and may continue to develop over many months, especially after nerve connections in phalloplasty. Individual sexual response varies, so a surgeon should discuss how the chosen technique may affect sensation and sexual goals.

Is SRS surgery painful?

The operation itself is not painful because it is performed under general anesthesia. Pain, swelling and discomfort are expected during the early postoperative period, but these are managed with an individualized pain-control plan and supportive care. Pain that suddenly worsens, is not controlled by prescribed treatment or occurs with fever, marked swelling or skin-color changes should be reported promptly.

When to Seek Medical Care

People should contact their surgical team promptly for increasing redness, warmth, drainage or separation around a wound; fever or chills; worsening swelling; persistent vomiting; a catheter that is blocked or not draining; difficulty passing urine after catheter removal; or a new urine leak. They should not attempt to remove, reposition or flush a catheter unless the team has specifically taught them to do so.

Urgent medical assessment is needed for heavy bleeding, chest pain, shortness of breath, fainting, sudden leg swelling, severe uncontrolled pain or a rapid change in the color, temperature or swelling of reconstructed tissue. Ongoing care can include urology, plastic and reconstructive surgery, nursing, mental health and sexual-health support. For international patients, Acıbadem Health Point’s multidisciplinary specialists and JCI-accredited hospitals provide individualized assessment and treatment planning for gender-affirming surgical care.

Frequently asked questions