Your Guide to Top Surgery Without Testosterone: Real Results, Experiences, and What to Expect

Medically reviewed by Jennifer Richman on November 26, 2024.

Understanding Top Surgery

Definition and Purpose

Top surgery, also known as chest reconstruction is a gender-affirming procedure that alters the appearance of the chest to align with an individual’s gender identity. This can mean increasing or decreasing chest volume depending on your goals. In this guide, we will be discussing top surgery techniques that reduce the size of the chest. While many transgender people seek top surgery alongside testosterone replacement therapy (TRT), many others undergo top surgery without actively being on testosterone. Undergoing TRT does not make a person more or less transmasculine, and it is not necessary for top surgery. The motivations behind seeking TRT and top surgery can be separate as they affect one’s self image and body in different ways

Why Choose Top Surgery Without Testosterone?

Undergoing top surgery without testosterone is a valid choice for many transmasculine and nonbinary patients. Patients may cease receiving TRT for reasons ranging from contentment from the effects of T, medical need or lack of access. Additionally, many transmasculine and nonbinary people do not wish to undergo testosterone replacement therapy. Not every transmasculine and nonbinary person wants to experience the effects of testosterone on their body, but many wish to alter the appearance of their chest. Others may microdose testosterone to achieve more gradual or subtle effects from testosterone. Patients may wish to alter the appearance of their chest without experiencing the effects from testosterone. Ultimately, the choice to undergo top surgery is separate from the choice to undergo testosterone replacement therapy. Consider what effects from top surgery elicit feelings of joy and will align your body with your self identity.

Top Surgery Methods

Top surgery methods are diverse in final appearance, chest sensitivity, and scarring. Common methods that flatten the appearance of the chest are double incision, periareolar and keyhole. Other patients seek out techniques that leave behind some volume in the chest such as buttonhole or inverted T anchor. You can choose to preserve your nipples, receive nipple grafts (to have greater control over their dimensions and position on the chest) or opt for no nipples. Patients can use medical tattooing to create nipples after surgery. 

Testosterone and Surgical Outcomes

Testosterone Effects

Generally, testosterone will not change the effects or outcome of top surgery. Pre-op Testosterone may help some in the process of defining upper chest muscle, but is not crucial for developing these muscles. If you undergo HRT after top surgery, you may notice changes in fat distribution, with less fat around your hips and more fat around the waist. This may change your overall body contour. These are not guarantees on testosterone and low-dose testosterone may produce subtler or slower results. For more information on the bodily changes that gender-affirming testosterone hormone therapy brings, click here. 

Results and Post-op Considerations

Your results and recovery from top surgery will not be different without testosterone. You can still expect to experience a standard top surgery recovery. For some, testosterone helps with developing strengthening chest wall muscles, but it is still possible to achieve a more contoured chest without testosterone. Some patients report that training their pectoral muscles after top surgery helps resolve aesthetic concerns about dog ears or wanting to fill-out the appearance of their chest.

Eligibility

At the GCC, HRT or TRT is not required for surgery. While many insurance companies do not require HRT for coverage, some may have HRT requirements. It may be possible to appeal this and our insurance advocacy team will work with you to get insurance approval. A more common requirement for top surgery is a letter from a mental health professional. If the GCC is out of network for your insurance plan, you may also need a referral letter. 

Body Image and Self-Perception Post-Surgery

Peer reviewed studies indicate that top surgery is overwhelmingly positive for patients’ self image. There are many patients who undergo top surgery without testosterone replacement therapy and feel it has aligned their body image with their self identity. 

Choosing a Surgeon

Scheduling a Consultation 

A crucial step in accessing top surgery is requesting a consultation. A consultation with a board certified surgeon will help you communicate your unique goals, questions and medical history. At the GCC, we offer free consultations both virtually and in-person.

Key Questions to Ask

If you are considering top surgery without testosterone it is important to ask about policies, requirements and experience. While at the GCC, we do not require HRT prior to top surgery, some top surgeons still require HRT. You should not undergo HRT exclusively to access top surgery, and we recognize that there should not be unnecessary barriers to accessing the benefits of top surgery.

Preparing for Top Surgery Without Testosterone

Physical Preparation

Regardless of whether or not you are on testosterone, it can help to do upper body exercise to build strength in your chest wall. This can help accentuate your pectoral muscles if you are looking for a contoured chest. Other considerations to make while preparing for top surgery include avoiding smoking and drinking, and eating a balanced diet. 

Emotional Preparation

There can be many emotions involved in the process of getting top surgery. As a result, we suggest not beginning testosterone replacement therapy within three weeks of your surgery date. While testosterone will not impact your surgery, it can be a complicated process that can be difficult to manage alongside surgery. We recommend that patients be prepared and aware of emotional reactions after top surgery.

Logistical Considerations

Top surgery is generally an outpatient procedure, and you can return home the day off. However, you cannot drive yourself home, and it will be helpful to have someone help you with chores and other important tasks. You can expect to return to work within one to two weeks, but full recovery can take up to six weeks.

FAQ

Can you get top surgery without testosterone?

At GCC, we do not view testosterone as a prerequisite for top surgery. It is a more outdated requirement and assumes that all top surgery patients are looking for top surgery in tandem with testosterone in their transition. Other surgeons and practices may have different requirements. 

Will insurance cover top surgery if you are not on testosterone?

Insurance will generally cover top surgery if you do not receive testosterone, but some may still require HRT. You may need a letter from a mental health professional or a referral letter. If you are denied, it is possible to appeal this decision. Our insurance advocacy team has had a 90% success rate in obtaining insurance approvals for our patients and will work with you to receive insurance coverage. 

Will testosterone alter my top surgery results?

Testosterone will not alter your top surgery results. If you choose to go on testosterone after top surgery, your results will not change.

Will I experience regrowth in my chest if I am not on testosterone?

Most of your breast tissue is removed during top surgery. As a result, patients do not experience regrowth in their chest. For patients who undergo a reduction, regrowth in the chest is also unlikely. There are inconsistent cases of tissue regrowth for patients who become pregnant.