Patients do not need to undergo testosterone hormone replacement therapy (HRT) to have a metoidioplasty with the GCC (Gender Confirmation Center). Patients who are taking testosterone HRT are recommended to wait 1-2 years after beginning treatment to maximize their chances of bottom growth. That said, the natal erectile tissue (sometimes called a penis or clitoris) does not always grow as a result of exposure to testosterone. Bottom growth is also not a requirement to undergo this surgery with us.