MTF Before and After

Medically reviewed by Jennifer Richman on October 21, 2024.

Understanding MTF Transition

The “MTF” or “Male” to “Female” is an antiquated term that refers to people assigned male at birth who identify as women or transfeminine. More specifically, this term references the various legal, social and/or medical steps that transfeminine individuals can take as a part of their transition. In this article, we discuss the before and after effects of various feminizing medical interventions like gender-affirming hormone replacement therapy (HRT), bottom surgery, breast augmentation, facial surgery and body contouring.

When we say that the term “MTF” is antiquated, we do not deny that there are patients who feel that it accurately describes their experience. Terms such as “trans women” and “transfeminine” are more widely accepted. This is because many transfeminine people consider that they were never men, but rather, have always been women. Transition, then, does not turn men into women, but rather, allows trans femmes to feel greater gender congruence with their bodies, names, pronouns and more.

Physical Changes in MTF Transition

Feminizing HRT and surgeries such as MTF bottom surgery, breast augmentation and facial feminization surgery (FFS) are some of the many medical interventions that trans women and femmes can choose from to feel greater gender congruence with their bodies. We find it important to remind our patients that there is no one way to look like a woman. Likewise, to live as a trans woman or femme, you do not need to undergo any medical interventions. Rather, what is medically necessary is different for every person.

Here is a table that discusses the effects of different hormones on the body:

Feminizing HRT Overview

Feminizing HRT Before & After Timeline

Below we discuss how long patients tend to have to wait on a full dosage of feminizing HRT to see different effects. For more information on the timeline, click here. Please note that the following ranges may vary depending on the person, type of anti-androgen or testosterone blockers you take, the way your hormones are administered and other factors.

• Redistribution of body fat: begins around 3-6 months, can take 2-5 years to reach maximum effect

• Breast development: begins around 3-6 months, can take 2-3 years to reach maximum effect

• Changes to skin (softness increases, oiliness and sweat decreases): begins around 3-6 months, can take 2-5 years to reach maximum effect

• Stopping hair loss (aka. male pattern baldness): begins around 1-3 months, can take 1-2 years to reach maximum effect, will not reverse current hair loss

• Decrease of body hair (grows more slowly, thins out): begins around 6-12 months, can take 2-5 years to reach maximum effect
• Decreased spontaneous erections: begins around 1-3 months, can take 6-12 months to reach maximum effect

If you are interested in experiencing slower changes than what are listed below, microdosing estrogen and/or anti-androgens (aka. Testosterone blockers) might be a good option for you. Generally speaking, every patient taking gender-affirming HRT starts with micro or smaller dosages before titrating up to a higher dosage. However, some patients maintain a microdose to experience slower changes, for economic reasons (to ration out hormones for their cost) and/or medical reasons.

MTF Surgical Procedures

Trans feminine patients often choose from the following surgical procedures. Remember, procedures that may be medically necessary gender-affirming interventions for some patients may not be for others. Every trans and non-binary patient’s gender-affirmation needs are unique to them. If you are interested in undergoing feminizing gender-affirming surgery, click here to request your free consultation today.

• Breast Augmentation: In order to change the shape, size, or fullness of their breasts, some of our patients pursue breast augmentation. This may involve using implants or fat grafts to enlarge or construct breasts. Some of the time, the incisions for these procedures may affect nipple sensitivity and mammary development and function.
• Facial Feminization Surgery (FFS): Some of our patients pursue FFS, a set of procedures that allow you to reverse the effects of a testosterone dominant first-puberty. These include adjustments to the hairline, nose, brow bone, brow, cheeks, lips, chin, Adam’s apple, and jaw.
• Bottom Surgery: Genital reconstruction surgeries such as Vaginoplasty or Vulvoplasty are bottom surgeries that relieve gender dysphoria for trans women and femmes. These surgeries have different specifications for post-operative care and maintenance.
• Body Contouring: Body contouring procedures such as liposuction, fat grafting, and/or skin excision can adjust fat distributions in the upper and lower body when our patients want to reshape their bodily contour. Other surgeries such as the Brazilian Butt Lift and hip dip fat transfer can add fullness to the hips and buttocks.
• Vocal Feminization Surgery: There are a wide variety of techniques available that can raise the pitch of the voice through modifying the vocal cords and/or larynx. Patients who undergo this surgery will need to undergo vocal or speech therapy for the recovery process and may need vocal therapy to help them adjust aspects of their voice that go beyond pitch, like tone and resonance. While we do not offer this procedure, you can read more about it from a trusted provider in San Francisco here.

While this brief overview of the physical procedures and their effects for gender-affirming medical care help our trans feminine patients achieve gender euphoria, there are also diverse emotional and mental health benefits and challenges in this process.

MTF Before and After Photos

Breast Augmentation Before & After:

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FFS Before & After:

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Body Contouring Before & After:

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Bottom Surgery Before & After

On this page viewers can find pictures of some of Dr. Ley’s vaginoplasty and labiaplasty results. Viewer discretion is advised.

Emotional and Mental Impact of MTF Transition

• Before and After Emotional Changes
  • Anxiety, anticipation, joy, self-doubt, shock, confusion are all normal parts of the journey to gender affirmation. No emotional reaction is incorrect as patients go through medical interventions to change their body. After surgery, many patients even report experiencing temporary lapses of depression and regret while they are in the most taxing phase of recovery. However, our patients report increased self-confidence and greater gender euphoria as they heal from surgery.
• Improved Mental Health
  • Overall, our anecdotal experiences with patients alongside several, peer reviewed studies demonstrate that gender-affirming surgical care greatly increases quality of life measurements like self-esteem, self-confidence, improved body image and more. Many patients feel alleviation of symptoms like depression and anxiety that were rooted in gender dysphoria.
• Potential Challenges
  • Some individuals may experience difficulties with different parts of the hormonal and surgical gender affirming process. It is important to discuss with your endocrinologist and/or surgeon your medical history to see if you can anticipate any challenges.

Support Resources for MTF Individuals

There can be complicated emotions that emerge throughout your gender affirmation process. The social and legal aspects of these complications are important to discuss and understand so you can seek support.

Social and Legal Transition:

• While many transgender people change their legal name and/or gender marker on documentation such as birth certificates, licenses, passports, and more, these can be difficult processes.
• Trans Law Center provides a quick guide for federal identity documents (US only).
• The California Courts Self-Help Guide outlines the process of gender marker and legal name changes in California.
• The National Center for Transgender Equality is another organization that provides info for legal name and gender marker change for each state (US only).

Mental Health Support

For some patients, it can be difficult to find a gender-competent mental health professional to support them through gender transition, or more specifically, to get a support letter for surgery. Though it may take time, finding someone you are comfortable with is worth the effort. Patients can consult the list of WPATH members or the directory of the Gender Affirmative Letter Access Project (GALAP) to find a gender-competent, licensed mental health provider. Additionally, there are multiple online therapist directories that can filter for experience working with transgender individuals, the types of insurance they take, and their current availability.