Breast Augmentation for 40 year old male. No HRT

Thank you for your question. Yes, it is realistic to find a surgeon in the U.S. who will perform breast augmentation as a gender-affirming or aesthetic procedure for a male patient, even if you are not HRT. Surgeons base their decisions on your overall health, skin and tissue characteristics, and aesthetic goals. Some surgeons may ask for a letter of support from a mental health provider if the procedure is part of gender affirmation. However, this is often not a barrier, especially for smaller implants (e.g., A cup). Focus on finding a surgeon experienced in gender-affirming or aesthetic surgeries who respects your goals and provides a tailored, supportive approach. Be prepared for a standard health assessment, including a physical exam, lab tests, and potentially imaging if needed. Share your desired outcome (e.g., small A cup, subtle femininity) and provide reference photos if possible.

We do perform gender confirming breast surgery on adults including breast augmentation for transgender women and breast reduction for transgender men. We definitely prefer an evaluation with a gender affirming medical and/or mental health specialist before proceeding with surgery. We do offer free virtual consultations.

Yes, it is possible to find a specialist in the U.S. who can perform gender-affirming breast augmentation. Hormone Replacement Therapy (HRT) is not a requirement for chest/breast surgery, but if you are planning to start or stop hormone therapy, it is best to wait at least 6 months prior to scheduling surgery, as the hormone changes the breast anatomy, size, and shape.
Regarding the need for a mental health counselor’s approval, the requirements can vary depending on the surgeon or clinic. Some may require a letter or confirmation from a mental health professional, especially if you're seeking gender-affirming surgery for gender dysphoria.
It’s important to find a surgeon with experience in gender-affirming surgeries, especially those with experience in male-to-female breast augmentation. You can search for a plastic surgeon who specializes in transgender care and breast surgery (use resources such as WPATH or medical or LGBTQIA+ organizations).
Krishna Vyas, MD, PhD, MHSHarvard, Hopkins, & Mayo Clinic Trained Aesthetic Plastic SurgeonNew York, New York

You will need an evaluation and recommendation by a professional. It's generally best to be on hormones for a while prior to Augmentation since it makes the pockets softer and with better soft tissue coverage. We do a lot of these procedures.

First, I don't think you should fear being rejected by a Plastic surgeon, I do think you should seek consultation before embarking on breast augmentation and possibly consider HRT. But breast augmentation could certainly be an option to appear more feminine. And I would suggest small implants. Good luck!