FTM Transgender - What are the Effects of Hormones on Breasts?

Testosterone therapy in transgender men results in several masculinizing changes, including a reduction in breast size due to the shrinkage of glandular and fatty tissue. However, testosterone does not significantly affect breast skin, so while the tissue may become smaller and firmer, the skin often remains loose or saggy. This can result in a deflated appearance, particularly for individuals with larger breasts, as the skin doesn’t tighten to match the reduced volume. Additionally, testosterone increases muscle mass, contributing to a more masculine chest contour, and stimulates the growth of body and chest hair, further enhancing a male appearance.
While testosterone can produce some breast changes, it is generally not enough to fully achieve a masculine chest for individuals with larger breasts, as the skin may remain excessive or saggy. Most individuals with significant breast tissue or skin laxity will require top surgery, such as double incision or keyhole surgical approach, to remove excess tissue and skin and create a flatter, more defined chest. The effects of testosterone take time, often requiring months to a year for noticeable changes, and results can vary depending on factors like skin elasticity and initial breast size. In most cases, a combination of hormone therapy and top surgery is the most effective approach for achieving a masculine chest. I will mention that in my practice, we do not have a requirement for hormones to have surgery, but any CHANGES (starting/stopping) should be done 3-6 months before or after the planned procedure, and not peri-operatively to avoid fluctuations.
It is important to consult with a qualified gender-affirming breast surgeon who can customize your surgical plan with the best technique based on your individual anatomy and goals. Be sure to ask about experience and options for surgical techniques (such as incisions, liposuction, nipple reinnervation).
Krishna Vyas, MD, PhD, MHS
Harvard, Hopkins, & Mayo Clinic Trained
Aesthetic Plastic Surgeon
New York, New York

FTM Top Surgery can leave noticeable scars on the chest. Our office
specializes in Hidef Scar Protocols to help correct scars from FTM Top
Surgery; including Vbeam laser, fractional RF and Laser, scar modulation
RF, topical scar protocols that do not require surgery, and scar
subcision or excision. 
Best, 
Dr. Karamanoukian
Realself100 Surgeon

Many companies will require one year of HRT (Hormone replacement therapy). The #benefits of HRT for every patient, however, do include heavier #chest #muscles and more chest #hair; which can cover some incisions while you are healing. #HRT may be a strong consideration for most patients. WPATH (World Professional Association for Transgender Health) provides the best current standards of care for physicians to assist in the care of #transgender, #transsexual and #nonconforming patients.Hormone therapy for top surgery is not required unless you’re seeking coverage through #insurance. There are a number of states that now prohibit discrimination and legally require #insurance companies to provide transgender health coverage. If you live in a state where surgery coverage is not mandated by law, you still might be able to get your top surgery covered via student health insurance. To get #Top Surgery covered by insurance there are a number of requirements. Here are some of the obstacles you may face:1. Meeting the insurance company's basic criteria: legal adult status, Gender Dysphoria diagnosis, support letters from qualified mental health practitioners, your primary care provider and your surgeon.2. Having to pay out-of-pocket for surgery, then getting a reimbursement from the insurance company.3. Having to be evaluated by a board of in-network doctors.4. Finding in-network surgeons who have Top Surgery experience.Keep in mind, that coverage varies between health insurance companies, states, and plans. Read your policy completely, not only the summary, and look for the #exclusions and limitations section. Finally, call your insurance company's member services department, or, contact a #benefits representative and ask the following:• Is my selected surgeon a provider with my specific plan? (Make sure that you provide the representative with your surgeon's NPI number.)• If my surgeon is NOT a provider, does my plan have out of network benefits?• Does my plan cover gender confirmation Top Surgery?• How much is my deductible?Being each person varies, it’s important to be realistic about your goals and what is achievable. It's best to consult with your board-certified plastic surgeon about your concerns and to confirm if FTM Top is in your best interest.

Testosterone will have many masculinizing effects. This includes shrinkage of glandular breast tissue. Unfortunately, it will not shrink the skin to any noticeable degree. This will leave your breast looking like deflated pancakes.  You will need surgery in order to address this. If you have health insurance, you should check with your plan to see if they will cover the procedure.  If not, just start slowly saving so that you can get the results you want.  While it may take a little longer than you want it to, it will happen. 

Testosterone may have an effect on decreasing breast volume, however it will not decrease the amount of skin (which for D cup breasts is quite significant), so top surgery will most likely still be necessary in order to truly achieve a masculine chest contour.  We have had favorable experiences recently with insurance coverage for this procedure.In order to get a qualified, expert opinion on your surgical options and expectations visit a plastic surgeon certified by the American Board of Plastic Surgery.



Best of luck,

Keith M. Blechman, MD

New York, NY

I appreciate your question.The 2 major methods are double incision mastectomy with nipple grafting and keyhole.It depends on the size of your breasts as to which method would be best for you and the ability to maintain nipple sensationThe decrease in estrogen will shrink your breasts but ultimately you may still need surgery The best way to assess and give true advice would be an in-person exam.Please see a board-certified plastic surgeon that specializes in aesthetic and restorative breast surgery.best of luck!Dr Schwartz

Hello. Although hormones do reduce the glandular component of the female breast and increase the presence of chest and body hair, reduction may not be as much as you desire. Mastectomy with the double breast crease incision and nipple graft would be the best option. I suggest consulting various physicians that are EXPERIENCED in this type of surgery to see who is within your budget, but will provide an excellent result. 

Top surgery is really the most definitive way to address your D cup breasts.  There are ways to finance the operation.  Hormone therapy may have some effect on your breasts, and if it is part of your plan otherwise, it will benefit you to start before surgery.  I would not expect the type of resolution that you are looking for without surgery however.

I agree with Dr. Greenwald, your D cup breasts will need surgery eventually to tailor the excess skin.  Hormone therapy is not going to provide adequate skin reduction by itself. 

Hi, Thanks for your question. In my experience I've only had one patient who has had a significant deflation of their breast tissue after commencing Testosterone. This patient still had excess skin as it had not deflated in line with the parenchyma. You may have more uptake if your skin is youthful and elastic.
Testosterone will effect other changes in your body, such as increased muscle mass and body hair growth. 
My honest opinion is that it won't change your breasts that much. Top surgery is not just about removing the breasts, it aims to masculinize the chest- and the best visual clue for a male chest is a well developed pectoral muscle. You will need surgery at some stage, but Testosterone will help you bulk up your muscle for a better result.
As you are likely aware, there are risks in taking Testosterone, and you should discuss all the implications with your endocrinologist.