If any kind of FTM transsexual surgery is in your plans, it’s likely that you’ve thought about surgery scars: their placement and visibility, and for many, the ways in which they can be reduced. Some guys are proud of their scars and wear them as badges of honor, but if you’re looking for information about the best ways to treat scars and reduce their appearance, you’ll find lots of ideas in this comprehensive guide.

TABLE OF CONTENTS

A) What Are Scars?

To determine the best methods for treating surgery scars we first need to understand what they are. Simply stated, scars are areas of fibrous skin that replace normal skin after injury. Skin injury can include wounds, burns, acne and surgery. Scar formation is a natural part of the healing process. When your skin is injured, skin cells rich in collagen (protein) multiply to replace the injured skin. The collagen contains fibers that strengthen the layer of skin below the surface, adding thickness to the healing skin, and it’s this thickness that causes scarring. How the scar heals is dependent on the severity and location of the injury, age, hereditary factors, and skin color.

There are several different types of scars:

• Hypertrophic Scars: These are typically redder in appearance, and lightly raised and thickened.
• Keloid Scars: These scars are the result of an overproduction of new scar tissue. They usually appear after surgery, but can also be caused by inflammation from pimple, burns, or piercings. Although harmless, keloid scars tend to be itchy, tender, or even painful to the touch, and they can spread beyond the original wound site. Additionally, keloids can continue to grow slowly for years. They are more common in darker skinned individuals and tend to be hereditary.
• Atrophic Scars: These scars are recessed and occur when fat and muscle under the wounded skin is damaged or lost. Acne can leave recessed scars.
• Contracture Scars: These scars have a pulled taught appearance caused by skin contraction during healing. Deep contracture scars can restrict movement if the underlying muscles and nerves are affected. They are often the result of burn injuries.

One way of treating scars is to… not treat them at all! You’ll need to be patient, as the healing process is slow. If you’d like to support your body’s healing capabilities, or speed the healing process along, continue reading to learn more about what both conventional and alternative medicine have to offer for treating surgery scars.

B) Preoperative Care

1. Choosing a Surgery Procedure

FTM transsexual surgery procedures vary, and scar size and placement is often a consideration when choosing a procedure. For example:

2. Nutrition and Scar Healing

Certain foods, vitamins and mineral supplements are known to help promote wound healing and even reduce the development of scar tissue. To prepare for surgery, stick to a healthy, well-balanced diet, and quit smoking. You’ll be well on your way to optimal healing.

Protein: Proteins provide the body with the building blocks to repair and rebuild, and they also help fight infection. Because protein deficiency can delay wound healing, eating a diet rich in lean protein before surgery can help promote good scar healing when you’re post-op.

Zinc: Similarly, zinc deficiencies have been linked to slow wound healing. Additionally, surgical trauma can actually decrease your zinc levels. Zinc plays an important role in the collagen matrix, it promotes new skin formation and helps fight infection. Consider increasing your daily zinc intake via zinc-rich foods or a zinc supplement.

Vitamin C: Studies have shown that wound healing can be significantly accelerated by taking vitamin C in doses larger than the recommended daily allowance (RDA).

Other vitamins and minerals that reportedly promote skin healing include: bromelain (pineapple), grape seed extract, vitamin A, glucosamine, hyaluronic acid, and collagen supplements.

Important Note: There are numerous supplements that should be discontinued in advance of surgery, particularly anti-coagulants like garlic, ginger and ginseng. Nothing above appears in the list of Medications to Avoid Before and After Surgery that my surgeon provided me with, however you are advised to speak with your surgeon to confirm that any supplements you add to your regimen prior to surgery are not problematic in this regard.

3. Preoperative Massage

Massage has applications both pre- and post-operatively. Manual Lymph Drainage (MLD) massage prepares and helps tissues to be in the best possible state before surgery. Even just two preoperative sessions can significantly improve wound healing and scar appearance. (Read more about post-operative massage below.)

C) Post-Operative Scar Care

Your path to good healing starts immediately in the recovery room, with rest. During your recovery, you’ll have to wait for incisions to close before moving on to topical scar treatment, but in the meantime the same nutritional principles of wound healing apply. Depending on the type of surgery you had, your food intake may be limited but strive to eat a healthy, balanced diet within those limitations. Once your incisions have closed…

1. Post-operative Massage

Kristin Wilson-Key has been practicing massage and bodywork for over 25 years and has a specialization in post-operative chest and breast care. When asked about post-op massage in relation to scar tissue, Kristin offered the following comments:

A person can begin “working” the tissue very gently as soon as stitches are removed [or fully dissolve]. The work is to gently smooth the tissue along the incision line, in the direction of the scar, to get the tissue to form next to — instead of across — the incision. This helps the tissue be more mobile. The scar will also heal in a thinner line with less redness. After a month or so, one can begin to go across the incision, sideways, and diagonally, with a little more pressure.

The other important thing to do is to begin to lift the scar up from the underlying tissue, so that it does not adhere to it. This is very important for mobility. I like to get the scar to a point of being able to pick it up and roll it between my fingers. This type of work is done months into the healing process, depending on the scar’s sensitivity. It must be done gently at first and then quite aggressively later, especially if it’s an older scar. [Note: Stop if you feel any discomfort or tenderness.]

The massage work also helps with sensitivity. If a person never touches or handles a scar, the nerves can remain too sensitive or altered. Additionally, touching the scar while it is still forming helps the person heal, physically and emotionally. I think this is very important.

2. Traditional Chinese Medicine and Scar Healing

Acupressure and acupuncture are treatment modalities from the TCM tradition that can help reduce scar tissue. Acupressure is a form of massage that stimulates energy points on your body to boost maximum energy flow. Acupressure breaks up scar tissue and restores energy flow to the site of the skin injury, and is especially effective when combined with a topical scar healing oil or salve. This video demonstrates the acupressure technique for healing scars.

To treat scars with acupuncture, tiny specialized needles are inserted superficially into the skin at various points along the scar. This creates a healing, inflammatory response: dead cells and scar tissue are broken down by the body, blood flow to the area is increased, the lymphatic system is stimulated, and dead cells can be excreted. For a detailed summary of acupuncture methods to treat scars, see this excellent article from Acupunture Today: A Simplified Approach to the Treatment of Scars with Oriental Medicine.

3. Topical Scar Treatments

To Use or Not To Use? The Debate About Vitamin E and Scar Healing

Vitamin E has been used in the treatment of a variety of skin conditions. Anecdotal reports claim that it speeds wound healing and improves the cosmetic appearance of scars, and many doctors recommend topical vitamin E for surgery scar treatment. However, an oft-quoted study into the effect of vitamin E on scars revealed a starkly different picture:

• Vitamin E did not improve the appearance of scars.
• Vitamin E either had no effect on, or actually worsened, the cosmetic appearance of scars in 90% of study participants.
• 33% of study participants developed dermatitis.

Is it possible that the positive results claimed about vitamin E have more to do with scar hydration than with any dermatological effect of vitamin E?

With the high risk of dermatitis it may be best to avoid using vitamin E on your scars. If you already know you’re allergic to topical vitamin E, be sure to note which scar treatment products include vitamin E, such as:

• Cocoa and Shea Butter
• Kukui Nut Oil
• Bio-Oil
• Stretch Renew Cream
• Scarguard
• See-No-Scar Solution by Mama Mio
• SCAREX
• Verseo Scar Gone

Natural Products For Scar Healing

There are numerous natural oils, plants and products that can be used to help improve the appearance of surgery scars. Look for these at your local health food store or natural pharmacy, or buy online.

Allium Bulb Extract: There’s conflicting evidence of the effectiveness of allium (aka allicin, onion) in the treatment of scars. Nevertheless, onion extract has found its way into a number of scar treatment products, including Derma E Scar Gel and the popular Mederma Scar Gel.

Arnica Cream or Gel: Applied topically, Arnica creams and gels are used to relieve pain and inflammation and promote scar healing. Avoid gels that include alcohol, which has a drying effect on skin — the opposite of what you want to do to scar tissue. You can sometimes find topical arnica formulated with calendula and silicone, both of which can also improve scar healing.

Castor Oil: Castor oil can soften and smooth out some of the fibrous tissue of a scar, improving its appearance and making it less noticeable. Gently massage into scars to promote circulation and healing. Castor oil also makes a good base for homemade herbal scar massage oils.

Calendula Gel or Cream: Applying calendula gel or cream to a scar twice a day can reduce inflammation and increases healing in new scars.

Cocoa & Shea Butter: Both cocoa and shea cocoa butter contain high concentrations of vitamin E, omega-3 fatty acids and antioxidants. Shea butter also stimulates collagen production in the skin and thus may be better suited to treating atrophic scars. While there’s lots of anecdotal information about the effectiveness of these fat extracts, refer to the above information about vitamin E.

Horsetail Grass: Long-valued by both European and Chinese herbalists, horsetail grass can be used topically on scars. The plant’s stems have the richest concentration of silica and silicic acids found in the plant kingdom, making horsetail grass extract a wise inclusion in a homemade scar massage oil.

Mustard Seed Oil – Homeopathic: Mustard seed oil (Thiosinaminum) ointments and homeopathic formulations are used to improve the appearance of scars. Look for a minimum 1X or 10% mustard seed oil concentration.

Kukui Nut Oil: Also known as Candlenut oil, Hawaiian Kukui nut oil is high in vitamins C, D, and E, as well as skin-protecting antioxidants. It stimulates collagen, and has the ability to “lock in” moisture in a manner similar to silicone. Refer to the above information about vitamin E.

Rosehip Seed Oil: Rosehip Seed Oil is well-known for its outstanding skin regeneration properties and its ability to minimize scar tissue. To create a homemade scar treatment oil, mix 1 ounce each of rosehip seed oil and essential oils of rose and everlasting.

Scar Control – Organic Homeopathic: Scar Control is formulated to treat scars and keloids, reduce and help eliminate scar tissue and discoloration of surrounding skin, improve elasticity of skin tissue, and promote healthy and balanced skin tone. Ingredients: Calendula Officinalis 6X HPUS (promotes healthy skin and healing); Silicea 6X HPUS (for painful scars, keloids), Thiosinaminum 8C HPUS (mustard seed, for dissolving scar tissue); Corsican Helichrysum; Chilean Rosa Moschata; Mediterranean Rosmarinus Verbanone; French Lavandula Super*; American Sesamum Indicum. $25.95 11 ml. (*See Scar Care Products to Avoid for more information about lavender.)

Seaweed Extract: With reported skin healing properties, seaweed extract has found its way into a number of scar treatment products, such as Scar Esthetique Scar Crème, and makes a good addition to homemade scar massage oils.

Tamanu Oil: Tamanu Oil is among the most healing of the carrier oils for skin (along with Rosehip seed oil.) This study confirmed Tamanu oil’s ability to improve the appearance of scars, with “significant improvement” in as little as 6 weeks. It’s recommended in blends at 10-20% total concentration to receive its healing effects. Tamanu oil makes an excellent base for a homemade scar massage oil.

Vitamin A: Oral vitamin A has been shown to improve the appearance of keloid scars, and topical application of retinoic acid to hypertrophic and keloid scars has also shown success. However, vitamin A treatment can cause hypervitaminosis and teratogenicity, which limit its use.

Vitamin B5: Also called Panthenol, vitamin B5 is included in several scar healing products for its ability to moisturize, aid in tissue repair and increase cell regeneration. (Vegans take note: B5 is sometimes animal-derived.)

Botanical-Based Scar Healing Products

• Bio-Oil – This is a popular scar treatment product that’s formulated with plant extracts and vitamins suspended in an oil base. Its primary ingredients are oils of calendula, lavender*, rosemary and chamomile, along with vitamins A and E. Note that Bio-Oil also includes fragrance and artificial color. $9.59 60 ml / 2 fl. oz. (*See Scar Care Products to Avoid for more information about lavender.)
• Derma E Scar Gel – Includes allicin, the active compound in garlic and onions, as well as panthenol (B5) and allantoin, which breaks down scar tissue and encourages tissue growth. $19.95 56 gm / 2 oz
• Mederma Scar Gel – Mederma claims to be the “#1 doctor-recommended” product for scars. It contains a proprietary botanical extract made from onion and allantoin. $29.49 50 gm / 1.76 oz.
• Stretch Renew Cream – Contains emu oil, aloe vera, collagen, elastin and vitamin E. $89.95 2 oz jar.

Silicone Scar Treatment

Silicone scar treatment is clinically proven to be effective, easy to use, and low risk. Silicone is made from combining silicon and oxygen atoms. It creates a protective barrier over a scar to help the scar retain moisture. Basically, silicone is an extremely powerful moisturizer.

Silicone Sheets, Strips and Pads

According to Wikipedia, silicone gel sheeting has the most widely accepted role in general scar treatment, along with steroid injections. In addition to moisturizing the scar, silicone sheets also provide pressure on the healing area, and this is a combination that’s been shown to be very effective for scar healing. The average treatment time of individual scars is 2-4 months. Popular brands of silicone gel sheets include:

• Cica Care Silicone Gel Sheeting – Cut to fit, lasts up to 28 days, $52.82 5″x6″.
• Dermatix® Silicone Sheets – UK brand, silicone & PTFE, washable/reusable, £13 – £98.
• NewGel+ Silicone Gel Sheeting – Two thicknesses, washable/reusable, $39.95.
• ScarAway Silicone Scar Sheets – 12-week supply, $58.99.
• Syprex Scar Sheets – “Purest, strongest” sheets available. Various sizes & prices.

Silicone Scar Treatment Gels and Creams

• Cicaplast – Water, glycerin, sillicone-based cream, also includes copper, zinc and manganese, plus extract of gotu kola, for enhanced skin healing. While this product is recommended by some plastic surgeons for scar treatment, the manufacturer website doesn’t indicate that Cicaplast is indicated for this use. Approx. $13-$20 for 40ml / 1.33 fl oz.
• Dermatix® Silicone Gel – Popular in the UK. £36 (15 gm) – £108 (60 gm).
• InviCible Advanced Scar Treatment – Silicone-based gel with vitamin C and ProBiosyn-4 (derived from sunflower and safflower oils, aloe and licorice extracts.) $82 – 0.9 fl oz.
• Kelo-cote Advance Formula Scar Gel – Popular brand of 100% silicone gel. $13 6 gm.
• NewGel+E Silicone Gel Ointment – 100% silicone gel. $29 15 gm / 0.5 oz.
• Scarguard – Silicone, cortisone, and vitamin E. $60 1 fl oz.
• SCARprin – 100% silicone blend gel, $49.95 1 fl oz.
• See-No-Scar Solution by Mama Mio – Silicone, vitamin E, sweet almond. $37 30ml/1 fl oz
• SCAREX – Vitamins E and B5 in a silicone blend. $39 15ml.
• SyCream Scar Cream – Contains ceramides in combination with EFAs, linoleic acid and aloe vera. $43.50 17 gm. Cream and sheet packages available for $59-$64.
• TropolActive-S Repairative Scar Cream – Silicone-based cream with proprietary Elastatropin, a genetically engineered form of human tropoelastin. $34.95 2 oz.

Budget Silicone Scar Treatment

Silicone is one of those compounds that has a myriad of uses and can be found in all kinds of products. If you’re looking for a budget alternative to the typically expensive silicone scar creams and gels, options are out there but be sure to examine ingredients carefully. For example silicone grease, which has boating applications, usually contains solvents in addition to silicone. Also, not all silicones are the same. The silicone that’s found in topical scar treatment products is Polydimethylsiloxane, also called Dimethicone, which is sometimes blended with another type of silicone, Cyclomethicone.

Silicone Grease – Most silicone grease products are made from Polydimethylsiloxane. However, some may also contain solvents and/or fused silica. If you can find a 100% silicone grease though, it’s probably Polydimethylsiloxane and it will probably be quite affordable too! $3.95 0.25 oz 100% silicone grease.

Silicone Hair Gels – Cyclomethicone silicone is used in high concentrations in some hair care products. This article suggests looking for hair gloss products as a cheap alternative to silicone scar gels. Given the additional ingredients that you’re likely to find in hair products, be cautious. Look for alcohol-free, pure silicone hair gel, such as Simply Stylin’, available for $10.

Personal Lubricant – Guess what? Silicone sex lube is the cheapest silicone scar treatment gel you can find! Silicone lube is typically made from silicone blends comprised of Dimethicone and Cyclomethicone. Be sure to look for 100% silicone products, such as LifeStyles Luxe, available for just $6.99 3.5 fl oz.

Polyurethane vs. Silicone

Polyurethane Dressings – These have been shown to be as effective as silicone in healing scars, but faster. Results are reportedly evident in as little as 3-4 weeks, with significant improvement expected after 8 weeks of treatment. Others claim that polyurethane is significantly more effective than silicone dressings in reducing the adverse cosmetic effects of mature hypertrophic scars when worn for a period of 8 weeks, especially when used in conjunction with compression. The American Dermatology Association reported the effect of polyurethane dressings to be equivocal in the development of new hypertrophic scars but demonstrated “a significantly more pronounced reduction in severity” of scars, was better tolerated than silicone sheets, and may be especially beneficial in the treatment of mature scars. Sizes and pricing varies.

Skin Lightening

Skin lightening may be an option for those who haven’t had success reducing darker scars. Chemicals are used to reduce the concentration of melanin in the skin. The safety of skin lightening products is debated. The vast majority of them use one of two ingredients. Kojic acid and Hydroquinone, both of which have been linked to tumors in mice and are banned in several European countries. Nevertheless, hydroquinone creams such as Obagi Nu-Derm Clear (4% hydroquinone) are sometimes recommended by plastic surgeons.

Meladerm Pigment Reducing Complex – Meladerm can reduce the appearance of hyperpigmented skin, including areas with old scars. It contains Kojic acid, plus natural ingredients, and small amounts of synthetic preservatives and emulsifiers. (Kojic Acid, Alpha-Arbutin, Niacinamide, Mulberry Extract, Bearberry Extract, Licorice Extract, Tego® Cosmo C250, Gigawhite, Lemon Juice Extract, Emblica Extract). Animal cruelty free and made in the USA. $49.99 1.7 fl oz.

Topical Scar Care Products and Ingredients to Avoid

Lavender Oil: This essential oil has skin rejuvenating and healing properties and reportedly helps with all forms of scarring. However, both lavender and tea tree oils have also been linked to gynecomastia in young boys. It reportedly suppresses male hormones and activates female hormones. This could have unwanted effects for trans men, particularly those who are not on testosterone or who have not had a hysterectomy. Note that both the organic homeopathic Scar Control and the popular Bio-Oil products contains lavender.

ScarFade: This gel is made from silicone diluted with ethylene copolymer and octyl palmitate, an emollient. These fillers do not increase the efficacy of silicone, and you’d be better off choosing a product with a higher concentration of silicone. $25.50 15g / $44.95 30g. www.scarfade.com

Scar Zone: This is marketed as a scar treatment cream with green tea extract, but it’s actually a sunscreen with 4% silicone. While sun protection is important to scar management, it’s unclear what benefit sun screen offers as an ingredient in topical scar treatment creams and gels. $10 1 fl oz. www.scarzone.com/scar-zone.shtml

Verseo Scar Gone: The manufacturer website provides only vague information about this product’s ingredients, noting only vitamin E and mandelic acid. $9.95 15ml / 0.5 fl oz. www.verseo.com/verseo-scar-gone.html

D) Beyond Topical Scar Treatments

Stimulating Collagen Production: The Derma Roller is a device that can be used to improve the appearance of atrophic scars but not hypertrophic and keloid scars. The Derma Roller creates a painless microscopic trauma to the the affected area of skin, promoting collagen growth and reversing the formation of scars. The area may remain be void of hair follicles and sweat glands, but the skin will be thicker, have less pronounced discoloration and improved appearance. £55 each.

Compression Garments to Reduce Scarring: Post-op compression garments can be uncomfortable but there’s a fair body of evidence supporting their use. Compression garments help prevent problematic scars by applying pressure and protecting the tissue from overstretching, widening and thickening. Furthermore, pressure may help break up excessive scar tissue (collagen bundles) and soften the scar. However, treatment is slow: compression garments must be worn almost all day for 6 months or more before significant results can be achieved.

Steroid Injections for Hypertrophic and Keloid Scars: Steroid injections inhibits fibroblast growth, reducing the amount of collagen deposited into the scar, and have thus been a mainstay in therapy for keloids and hypertrophic scars. Potential side effects include hypopigmentation (less than normal pigmentation compared to the surrounding skin), atrophy, and telangiectasias (small dilated blood vessels near the surface of the skin.) Studies have shown that scar recurrence is common but steroid injection is generally considered effective for reduction of hypertrophic and keloid scars.

Laser Scar Removal and Revision: Laser technology offers promising treatment for the cosmetic and functional improvement of scars, including laser assisted scar healing (LASH) and Pulsed Dye Laser. Fractional laser technology delivers rapid, reliable scar revision and removal and is associated with less risk, pain and downtime compared to surgical solutions.

Surgical Treatment of Scars: Most scars won’t require surgery, but for some aggressive hypertrophic and keloid scars surgical excision or cryosurgery are indicated.

E) My Experience With Top Surgery Scar Care

When I had top surgery, I didn’t have the information that I do now about scar treatment and healing. Minimal scarring was important to me, so I got a second opinion when the first surgeon I consulted with recommended double incision as the best surgical choice for me. Despite a higher revision rate, I went with the peri-areolar procedure instead since it offered me less visible scarring. After my incisions healed, I started gently massaging aloe vera gel and cocoa or shea butter on my scars a couple of times daily. This seemed to help considerably with softening the pleated scars around the areola. I wore a compression vest for 6 weeks post-op.

I had a revision surgery 10 months later which included sizing down my areola. I wore a compression vest again, for 4 weeks this time, and my surgeon also suggested taping my incisions to help prevent them from stretching out as I healed. He recommended a wide Elastoplast tape but I developed a painful allergic reaction to the adhesive and we quickly switched me over to paper tape. I still found that my skin was too sensitive to tape regularly though, and I regret this because one of my scars did stretch out and it makes my areola look larger than it is. I continued using aloe vera gel, cocoa or shea butter, as well as castor oil, on my scars after the revision.

I was mostly going on instinct: There’s only a slim amount of medical literature that has demonstrated the effectiveness of aloe vera in relation to scar healing (see: Influence of Aloe vera on collagen characteristics in healing dermal wounds in rats.) Plus, the gel I buy has a small amount of alcohol in it, which could have been counter-productive given the drying effect it has. Also, vitamin E is hotly debated as an effective treatment, and cocoa and shea butters are both rich in vitamin E. Nevertheless, I’ve continued to use these, assuming that any effectiveness is coming from the hydration they offer, plus the massage from their application.

Recommendations (To My Past Self)

If I could go back in time and do it all over again, I would have chosen the same top surgery procedure, and stuck with the (annoying) compression vest, but I would have replaced the aloe vera gel with 100% silicone lube, and the cocoa and shea butters with a custom massage oil containing arnica, rosehip seed oil, seaweed extract and tanamu oil. I would have also been more persistent with the scar taping.

I’d like to further improve the look of my scars and even after a few years I still have some very good options, namely massage and acupuncture. I’m also intrigued by polyurethane’s potential at treating older scars and may look into this further. I would entertain the idea of surgical scar treatment, but only if this second revision was combined with another surgery.

F) 5 Final Tips

1. Don’t over do it post-op, especially if you’re prone to hypertrophic scarring.
2. Follow your surgeon’s recommendations with regards to scar healing. Know that if you choose to work outside those recommendations you could nullify your surgeon’s policies regarding revisions and liability.
3. Delay all post-op treatment until your wounds have completely closed. After that, proceed slowly.
4. Massage scars to break down scar tissue, and keep them “hyper-hydrated.”
5. Keep your scars out of the sun for at least a year post-op.

G) Further Reading

• Clinical Insights – Topical scar modification: Hype or help? [PDF]
  Mary H . McGrath, MD, a board-certified plastic surgeon and an ASAPS member, and David S. Chang, MD.
• Topical treatments for hypertrophic scars. [PDF]
  Zurada JM, Kriegel D, Davis IC (2006). Journal of the American Academy of Dermatology 55 (6): 1024–1031.
• Journal references on the topical treatment of hypertrophic scars

Your Thoughts

Have you tried any of the solutions included in this article, and did you get good results? Or, have you used other scar healing treatments that worked well for you? Please leave your comments below to share your experience with scar healing.

All prices are approximate and in USD unless otherwise noted.

Disclaimer: I am not a medical professional. All of the information contained herein is provided “as is” without warranty of any kind, whether express or implied. See full disclaimer.

DIY or pre-fab? Jock-style leg straps or no straps at all? With a variety of packing harness products on the market, finding the right solution for you can take some trial and error. However, trying out every iteration of packing gear isn’t very practical, or necessary if you have some “base line data” to operate from. And that’s where TransGuys.com can help.

Every day this week, TransGuys.com is publishing a review of a product designed to hold your packer securely in place, so you can confidently move through your day (and night) without having to think about “jock logistics.” Tune in daily for the latest installments in The Great Packing Harness Roundup!

• Monday: The Full Monty
• Tuesday: ASLAN vs. ASLAN: A Packin’ Harness Shootout
• Wednesday: The Tool Belt STP-Friendly Packing Harness
• Thursday: TranZwear Packing Underwear
• Friday: Shock Jock Enhancing Underwear
• The Great Packing Harness Roundup Finale

TransGuys.com is pleased to present The Best of 2010 — Winners in the inaugural TransGuys Community Awards.

The biennial awards honor excellence and achievement by transgender men on the Internet, with the goal of highlighting the important work of these individuals. Please take a few minutes to celebrate the efforts and achievements of this year’s winners:

• Best Blog
• Best YouTube Channel
• Best Resource Website
• Best Action Campaign
• Best Business
• Musician or Music Group of the Year
• Sex Performer of the Year
• The Phoenix Award for Outstanding Achievement

Note: You can scroll through the article using the Previous/Next links near the bottom of each page.

Chest binding is a way for many trans men to curb dysphoria, and is a fairly common step in FTM transition. “Binding” refers to flattening breast tissue to create a male-appearing chest using a variety of materials and methods. While binding with common household items is an inexpensive route, it can also be unsafe. Chest Binding 101 is your guide to how to bind safely, where to get a chest binder, how to choose a binder that best suits you, and how to put on your binder.

How to Chest Bind Safely

The first step in learning how to bind safely is finding about what’s not safe to do. Don’t use Ace bandages or duct tape—they aren’t meant for binding, don’t move with your body, and can cause physical harm. They can seriously restrict breathing, cause fluid build-up in your lungs and other serious injuries, such as broken ribs. There have been numerous cases of trans men who’ve acquired permanent scars and other injuries from using Ace bandages or duct tape to bind. Don’t do it.

Even with the right binder product it’s still possible to bind unsafely. Despite what you may have been told, don’t buy a binder that’s too small for you. Wearing an ill-fitting binder puts you at risk of the same problems as those who bind with Ace bandages or duct tape. Another piece of bad advice floating around out there is to wear tape and/or another binder on top of your binder. This too can cause restricted breathing and physical injury.

Lastly, give your body a break: don’t bind 24/7. In fact, don’t bind for more than 8-12 hours at a time. Suppressing dysphoria can’t come at the expense of your health. Even high quality binders can cause bruising. Use the times that you’re not binding to wash and air dry your binder, which will help make it last longer.

Click here to view the embedded video.

Click here to view the embedded video.

Where to Get a Chest Binder

A proper chest binder should minimize pain, discomfort, sweating, and irritation. There are several places online where you can buy chest binders specifically designed for trans men:

Underworks sells binders originally made for cisgender men with gynecomastia, and subsequently became popular with transgender men for their effectiveness and affordability. Underworks is trans-friendly and have excellent customer service as well. Stick to the binders that have “extreme” in the name or description. A binder without this label may not give you the compression you hoped for unless you have a very small chest already. Prices range from $25-45 USD.

B.Y. Evolution is an online store that’s trans guy owned and operated. They sell Underworks binders that are slightly discounted from what you’ll find on the Underworks site, though there’s less selection.

TuBOQ is also trans guy owned and operated and sells Underworks binders for a slightly lower price. Like B.Y. Evolution, TuBOQ has a smaller selection of binders but they also sell a wide range of other transition related products, giving you the opportunity to save money on shipping costs.

Double T Collection is another trans guy owned and operated company dedicated to the FTM community. Based in Taiwan, they have three binders to choose from priced at $72-84 USD. The Love Boat Shop (see below) also sells Double T binders.

Wow-Wow-Wear is a Blogspot site established in 2009 that sells Esha binders from Taiwan. Esha binders are high quality, durable and easily washable and come in three different styles, with prices in the $32-42 USD range. The Love Boat Shop (see below) also sells Esha binders.

T-Kingdom is also based in Taiwan and sells binders designed for trans men and gender benders. They have a wide variety of styles, including vest binders with Velcro. Prices range from $30-65 USD. Note: T-Kingdom doesn’t accept returns.

Love Boat Shop is another online store based in Taiwan. They feature a large selection of binder styles and colors made by Double T Collection, Esha and Juya, with prices ranging from $21-$100 USD.

Danaë is a trans guy owned and operated company from the Netherlands, offering European guys the chance to save on shipping. Prices range from €30-45, and they allow returns after an email notification and within seven days of your receiving your binder.

Design Veronique has been designing high quality compression garments since 1986 and is the choice of several US-based surgeons. However, higher prices in the $100-180 USD range, and a lack of information about if these products are durable enough for long term use call into question their suitability for daily chest binding.

Nabay is a lesser known company located in Japan. They appear to have a good variety of binder styles to choose from, however all products are currently sold out and they didn’t respond to a request for more information. Prices range from $105-112 USD.

Quick Comparison Chart

Depending on where you live, you might also find chest binders in stock at your favorite local sex positive merchant. Another option, if you know someone who’s skilled with a sewing machine, is to have a custom binder made for you, as YouTube’s sillyyetsuccinct did:

Click here to view the embedded video.

Used Binders

If you can’t afford a binder, don’t despair! Used binders are often passed on by post-op trans men or those whose binders may no longer fit. There are a few programs available that help distribute donated second-hand binders:

• theCircle
• The T-Male Big Brothers Binder Program

You can also try asking around for an inexpensive hand-me-down binder on one of the mailing lists for trans guys or check out LiveJournal’s FTM Garage Sale.

How to Choose a Chest Binder

If you still remember your old bra size, you can find out your binder size by using the Bra to Chest Size Converter Tool. If you don’t know your old bra size, you can measure yourself the old-fashioned way:

1. Take a snug measurement of the fullest part of your chest using a tape measure (best if measured while clothed) and write that number down onto a sheet of paper.
2. Measure underneath your chest where the crease is and write that number down as well.
3. Add those numbers together and divide the sum by 2. This number will differentiate your size not only from brand to brand but from binder to binder as well.

Selecting a binder brand and style can be difficult: there are so many options that it can be overwhelming! Plus, there aren’t very many reviews of binders other than those about Underworks’ and T-Kingdom’s more popular models. After buying your binder, help make the experience easier for guys in the future by contributing your review to one of the review sites listed below.

Essentially, there are two types of binders: short ones and long ones. The short ones end right at your waist. The down side of these is that if you carry some extra weight, short binders tend to roll up and act more like a bra. The long ones can be pulled down past your waist by several inches, however it’s inevitable that it will still roll up. To reduce the chances of this, wear a belt. Choosing between a short and long binder has more to do with your body type, specifically your abdomen, and not your chest size.

Lastly, consider the location of the company you’re buying from. Buying from a company that’s closer to you can save you a significant amount of money on shipping costs.

How to Put On a Chest Binder

It might seem silly, but you’re probably going to need some help figuring out how to put on your new binder, particularly if you purchased one of the longer styles.

1. Put your binder inside out and upside down.
2. Step into your binder and pull the bottom of it up, ideally to your belt line. The binder should still be inside out and upside down.
3. Use the sleeves as handles to pull the top of the binder (the end closer to your feet) up to your shoulders.
4. Put your arms through the sleeve holes and adjust your chest to your needs. You may need to pull the bottom of the binder out from underneath itself if you don’t want it folded under. For others, leaving it folded under may help stop the binder from rolling up.

Don’t be disappointed if you look in the mirror and it looks like you have one big boob in the middle of your chest. You just need to adjust your chest. Reach in from the neck hole and push your chesticles down and out. You’re basically pushing your nipple toward your armpit to achieve the flattest looking chest possible.

FTM Chest Binding Tips

Very important: When binding, you should not by any means feel as though you can’t breathe or like you’re going to pass out from a lack of oxygen.

Binders aren’t the most comfortable things in the world. To make binding more comfortable, and to reduce the possibility of the binder moving around a bit, some guys wear a light shirt underneath.

Depending on the size of your chest, you may need to layer clothing on top of the binder to get optimal chest flattening. You’ll find that some of the shirts in your closet require you to layer more than shirts in your wardrobe.

You can swim in your binder. Just wear a sleeveless or sleeved T-shirt over it. Don’t worry if your binder seems less effective after a swim, this isn’t permanent. Simply wash it and it will go back to normal.

Your chest will look bigger than it really is when you look down at it. Check in the mirror for a more accurate side view.

Not all binders breathe well, and the reality is that you’re probably going to get hot. If you’ve already started testosterone, you’re definitely going to sweat. The build up of sweat can irritate your skin causing rashes and sores. Wearing a thin cotton shirt that breathes well underneath your binder may help prevent this. If you find this uncomfortable, try applying corn starch to your body before putting on your binder to help keep it from holding in moisture. If you’ve already experienced skin irritation of some sort, take care of it the same way you would an open wound. Washing the irritated area with anti-bacterial soap will keep it clean and help it heal faster.

Conclusion

Chest binding, as cumbersome as it may seem, can be very freeing for transgender men. There’s a plethora of quality FTM binding products available for body types of all shapes and sizes. Regardless of what you use for binding, please remember to put your health first. Now that you’re armed with all the information you need to find the right binder for you, go forth and feel more comfortable in your skin!

FTM Chest Binder Reviews

The Trans Consumer: Written and video reviews of any products that are related to transition. The site is mostly full of binder reviews, rated on a scale of 1-5.

Chest Binder Reviews Site: Written reviews of various chest binding products. Binders are rated for effectiveness, comfort, and discreetness.

Binder Reviews’ YouTube Collab Channel: This is a collab channel dedicated to providing reviews of a wide variety of chest binders on different sizes and shapes of people.

More FTM Chest Binding Resources

Hudson’s Guide to FTM Binding: Includes a complete list of other products you can use for chest binding, such as compression garments and sports bras.

FYI Binding Tips: The Butchelor has some useful tips on how to put on a binder, how to keep it from rolling up, and how to wash a binder.

Do you have any tips about binding? Want to share your experience with a particular binder brand or model? Do you know of other binder manufacturers, particularly those outside of Asia and the US? Please leave your comments below.

For many transgender men, being able to stand to pee (STP) is an important rite of passage that can help relieve some of the emotional and physical dysphoria of being trans. Adopting this socialized male behavior can be liberating and make one feel more whole and complete.

Of course it’s certainly acceptable to opt for a stall instead of the urinal, and lots of cis gender men sit to pee, especially at home. However, they have the option of whipping it out at a urinal when the need arises. The simple fact is that not all men’s rooms have a suitable stall. You’ll often find it in a sorry state of disrepair, with the door precariously hanging off a single hinge, or worse, no door at all. This can be extremely distressing for the trans man who doesn’t STP.

Thankfully, there’s a wide range of products that trans men can use to STP. These range from do-it-yourself solutions that cost nothing to more elaborate pack ‘n’ pee prosthetics. This is a fairly individualized art and learning to STP usually requires a little training at home and sometimes trying out several products before you find one that gets the job done.

There are a few downsides to trans male STPing, such as the expense of buying STP devices, jockstraps, sock jocks, suspensories and other harnesses, having to keep your STP device clean and preventing urinary tract infections, and for some, switching to briefs. Also, depending on physiology, skill and focus, STPing can be unhygienic. Don’t believe it? Just ask the Mothers Against Peeing Standing Up whose mandate is to “prevent unnecessary urine stream fragmentation.”

So, why do men STP anyway?

Well, squatting in a urinal would surely get some looks.

There’s a Baptist Pastor who claims that men in the Bible are specifically identified as people “who piss against the wall,” distinguishing them from women. It’s dictated by scripture people: STP is a god-given right!

Even though many cis gender men sit, and the men’s room is not a particularly discriminating venue, there’s a certain segment of society that thinks sitting to pee is effeminate and not what “real men” do. In Standing While You Pee: The Last Bastion of Masculinity? Klaus Schwerma asks,

Is standing-while-peeing an act of masculine identification, a symbolic exercise of power, an exercise of patriarchal power against women, a demonstration of the claims of masculinity and (phallic) male fantasies? Is standing while you pee an expression of masculinity?

Feminists have weighed in on the subject of STP too. Ten years ago, women in Sweden, Germany and Australia pushed to have all urinals removed from public restrooms. This was due in part to concerns about hygiene but “more crucially because a man standing up to urinate is deemed to be triumphing in his masculinity, and by extension, degrading women.” Oy!

Unraveling the ties between STP, masculinity and feminism is outside the scope of this article though, so let’s proceed.

How to STP

Perhaps the first place to start is seeing if you can STP without a device. Nathaniel of transboys.info has preserved a helpful brochure on the subject. Check it out here: How to Pee Standing Up.

Learning to STP with a device takes some practice, and it’s a good idea to master the technique before strutting up to a public urinal. Start by practicing in the shower or while standing in your bathtub. When you’re leak-free and confident, move your training to the toilet. For those who aren’t using an STP packer, think about how you will carry your device, how you will discreetly setup with it, and how you will clean it when you’re done. Be patient. As vlogger and blogger charlesasher explains, learning to STP can be frustrating.

STP Devices

DIY STP Devices

The “Coffee Lid” STP is a free, simple and convenient solution. Simply take a large plastic coffee can lid or equivalent (ie. lids from yogurt, cottage cheese, etc.) and trim the edges off so that you’re left with a flat disk. For smoother edges and more comfort, you can sand the edges with fine grain sandpaper. When you’re ready to use it, roll it into a funnel and simply pee through it. Urine will bead up on the plastic so a vigorous shake will render the disk dry enough to slip it into your back pocket. Free, simple, convenient, though not entirely urinal friendly and perhaps better suited to STPing in a stall.

The Medicine Spoon is a cheap and effective plastic device you can buy at any pharmacy. You’ll find several designs with different sized spoons and tubes and varying plastics, but they all work the same way. You pee into the spoon end. Cut the other end off to provide a hole for the stream. The Medicine Spoon is small enough to fit into your pocket, cheap and is the basis for most STP packer designs, meaning: master the spoon and you’ll master most STP packers.

If you’re good with your hands, consider making your own STP packer. You’ll find complete instructions and helpful tips in the video Make an Ee-zee Pee-zee STP Packer as well as Charles’ Take on STP Devices:

Click here to view the embedded video.

Buy FTM Packers Online

Trans guys on YouTube have posted a ton of videos on DIY STP methods and designs using a variety of materials such as latex tubing, laboratory pipettes, and silicone baking sheets. Watch this Playlist of DIY STP videos for more details.

Also check out these guys’ pages for other DIY STP ideas:

• BMX3r.com: Describes STPs made with medicine spoons, the Uspoon, TravelMate and Whizaway devices.
• FTM.dreamwidth.org: Simple and unique medicine dropper.

Commercially Available STP Devices

The Magic Cone is a disposable, biodegradable, waterproof cardboard cone that’s quite portable. 3 for $3.95 or 9 for $11. Note: You can get lower bulk pricing on the Magic Cone when you buy direct from the manufacturer.

The TravelMate is similar to a medicine spoon. This is a reusable, inexpensive and popular STP device that’s often used to make STP packers. Winner in the 2001 Medical Design Excellence Awards competition. $8.95 each or 3 for $23.00.

The GoGirl is an unfortunately named STP that’s very portable and inexpensive. The soft silicone does call for extra care during use to prevent leakage. $12.95 Want a free one? Read on…

The SNEE-KEE is a reusable and portable plastic STP. Skin tones aren’t available yet. $12.95

There are a number of STP devices that work well and are easy to use but aren’t particularly portable. You can carry them in a knapsack, but not in your drawers. As such, they offer limited value to trans men. They’re included here for completeness, and also to help give you ideas about making your own devices.

• Lady J – $7.99
• Urinelle (disposable) – $8.85
• Whizzy (disposable) – 10 for $10.95
• SheWee – £7.50
• pStyle – $12
• The PEE-ZEE – $12.75
• Sani-Fresh Freshette – $19.99
• The Whiz Easy – $24.95 (Canadian orders, UK orders)
• The Freshette – $34.95

Read a comparison review of the pStyle, Whiz Easy and GoGirl.

STP Packers

The Stand to Pee by Home Grown is a medicine spoon with latex tubing that will fit into your packer. It’s not clear on the website but it appears that the packer is not included. Ships from Australia. $30.

The FTM STUD is another STP packer design that comes in two dick sizes, as well as three varying sizes for the spoon. Unlike other similar STP packers, the FTM STUD’s spoon is coated with a special rubber coating for comfort. The FTM STUD uses latex tubing for a softer appearance to your package. $40 – $45. (Unavailable until July 1, 2010)

The Pissin’ Passin’ Packer by DJ Knows Dick is a popular STP packer that features a medicine spoon, tubing and packer. $50

The Mango Pack and Pee is another popular STP packer with a unique spoon shape, tubing and packer. $69.95 – $74.95 (Unavailable until July 1, 2010.)

Do you STP?
Get the STP T-shirt!

STP Packer Reviews

• Read The Trans Consumer Mango review.
• Watch charlesasher’s video review of the Mango, the Pissin’ Passin’ Packer by DJ Knows Dick and the FTM STUD.

Conclusion

Whether or not one STPs is certainly no measure of the man, but for those who want to, or find themselves in situations where they have little choice, the wide range of STP products available can help solve the logistical problems while also alleviating some of the anxiety that many guys feel around public bathrooms.

We’d love to hear from you if you have suggestions for STP designs or techniques, comments on the devices you’ve tried, and especially if you’re aware of more International options for buying STP devices and STP packers. Please leave us a comment below!

Want a FREE GoGirl? Simply leave a comment below and include “GoDude!” with your comment and you’ll be entered in a draw for a free GoGirl GoDude. Contest details. Contest ended July 22.

Further Reading

• FTM Guide: Men’s Room Etiquette and Safety
• safe2pee: Bathrooms for Everyone
• Trans-Can-Scan: The British Columbia Trans Bathroom Directory
• The Packer Showdown

Unless otherwise noted, all prices are in USD. Convert to your currency with xe.com.

One of the most desired effects of testosterone by transgender men is a deepening of the voice. This change is very helpful for assuming the male gender role. However, there’s an uncertainty to voice changes: testosterone doesn’t always drop the pitch low enough, and the changed voice can be persistently hoarse and weak. This can cause both personal and professional difficulties, but for singers, the “unpredictable and irreversible”¹ nature of testosterone’s effects on the voice is a terrifying prospect. The loss of singing ability is not inevitable for trans men though, and there are strategies for easing the transition of the FTM singing voice.

One of my biggest misgivings about starting on testosterone was my singing voice. Beginning as a teenager, I’d performed professionally as a vocalist and guitarist for more than 10 years. Singing was as fundamental to my identity as gender. Would it have to be sacrificed at the expense of transition?

In Body Alchemy: Transsexual Portraits by Loren Cameron, there’s a portrait of author and educator, Jamison Green. He’s posed with a hand drum, and in the accompanying text he explains that he lost his singing voice once he started hormone therapy.² Here was one of the most visible trans men admitting one of my greatest fears about testosterone! It wasn’t encouraging, so I set out to find some stories that were.

The first sign of hope I found was in Joe Stevens of the queer folk duo, Coyote Grace. Listening to Joe’s smooth, high lonesome vocal on “A Guy Named Joe” was clear indication to me that there could indeed be singing after T.

A Guy Named Joe, Coyote Grace

Click here to view the embedded video.

By the time I found Joshua Klipp in late 2007, his music had already been featured on television and radio across the United States. His song “Little Girl” gained instant notoriety not only due to Joshua’s powerful performance, but also because it marked the first time in music industry history that a song featured a trans man’s pre-T voice alongside his testosterone-changed voice.

L1FE, Joshua Klipp

Click here to view the embedded video.

Scottish folk singer Simon de Voil was the subject of the feature documentary Funny Kinda Guy. The film follows Simon through his early transition as he “irreversibly sacrifices his female singing voice to hormone treatment.”³ Although he couldn’t sing confidently for three years, Simon says that since then his new voice has “really grown into itself.”⁴

Clearly, it’s possible for trans men to continue to sing after starting HRT, whether that’s around a camp fire with friends or on stages around the world. While there’s a serious lack of research in this area, we can look to the science of voice for guidance about how to ease FTM vocal transition.

How Testosterone Affects the Larynx

The larynx, or voice box, is a hormone-dependent organ. In teenage boys, increased testosterone production causes the vocal folds (vocal chords) to thicken, lengthen and mature. The cartilage of the larynx grows, further influencing the tone of voice. It also tilts slightly, resulting in a bump on the throat—the Adam’s Apple. This is a process that happens over time as the teen matures.

Trans men conversely, are often started on the highest recommended dose of testosterone, bringing about changes that would normally occur over several years in a much shorter time. Testosterone therapy makes the vocal folds grow thicker but they are restricted in length by the size of the larynx (which is typically smaller in trans men than in bio-males.) Cartilage growth is said to only happen during puberty⁵, and early cartilage ossification caused by testosterone further limits the growth of the trans male larynx.

In his groundbreaking study however, Alexandros Constansis revealed that his 39-year old larynx had indeed grown wider within the first year of HRT.⁶ Working with a group of FTM singers, Constansis noted that the most common characteristic among study participants was what he called “entrapped vocality.”⁷ The symptoms—persistent hoarseness and the inability to access and control certain areas of vocal range—were attributed to an inadequately enlarged larynx, due to age and the early onset of laryngeal cartilage ossification. (In some people, this ossification actually improves their singing voice, as the “hardened” larynx is better able to support the vocal folds.)

A professional singer himself, Constansis approached his own HRT conservatively, opting for a low starting dose that was gradually increased over a one year period. He reasoned that “abrupt changes are rarely beneficial to the vocal instrument”⁸ and suggested that the vocal difficulties experienced by teenage boys could only be aggravated in trans men due to the quickened hormonal changes.

It took about 3 years for my voice to finally settle where it is now. During those years there were several times when I thought ‘Okay, this is my new voice’, and then it would continue to change in subtle ways. I sang professionally for years pre-T and I still sing professionally now. I don’t have quite the range & sustainability that I once had, but anything I lost, I gained in terms of finally being able to own and identify with my voice now. I have no regrets! — Radford Bishop

Recommendations for Trans Male Singers

Throughout his paper, Constansis advocates that trans male singers who are starting testosterone proceed slowly, beginning with a low dose that’s gradually increased over time. While this is likely to slow virilization, it also produces more gentle changes to the larynx, and may be a more significant factor than age with regards to growth of the laryngeal structure.⁹

In addition to independently pursuing vocal exercises and maintaining good vocal health, trans male singers may also benefit from speech and voice therapy. A Speech-language pathologist (SLP) or vocal coach can develop a custom vocal training program that’s centered around their clients’ goals. They can also identify limitations of the changing voice, helping clients recognize the symptoms of vocal fatigue. While it’s important to continue singing through the first year on T—cracks and all—it’s even more important to avoid doing damage to the developing voice.

For trans men who have already had several years of testosterone therapy, vocal coaching can still be beneficial. Learning proper techniques for breathing, and opening the diaphragm and larynx, can substantially improve singing abilities.

If you choose this route, look for a SLP who has experience working with transgender people. Not only should they possess in-depth knowledge of speech/voice science and speech masculization treatments and therapies, but the ideal SLP also understands transgender basics (terminology, trans sensitive-protocols, etc.)¹⁰

I had been singing all my life, singing is a big part of my family, and songwriting became an integral part of my mental health. When I realized that transition was my path, my voice was the only concern. I set out to find some information about it, and found none. My doctor had nothing conclusive, and most of the transguys I found said that they no longer sang… Not encouraging. But my gut told me that if I could carry a tune before, I could carry one after, and hopefully the tonal quality would be easy on the ears, and I had to move forward. When the voice dropped, the fun began. What I learned is that you just have to keep singing. I had 23 years of muscle memory built up, and that’s a lot for any brain to re-learn. It takes time, but it’s mostly about finding where your new notes are, which can be fun, funny, frustrating, embarrassing – but you only have to do it once, and in the grand scheme of things, it’s a relatively short period of time. Keep singing. If you stop singing, then you won’t sing. Simple as that. The world needs our trans voices, and so do our brothers and sisters, and everyone in between. Sing out! — Joe Stevens

T-Voices

Click here to view the embedded video.

I made a personal decision that I would not let the fear of losing my singing voice obscure my path to transition. Instead, I chose to get excited about how the confidence gained from pursuing my true male identity would positively impact my vocal performance skills. I started with a low dose of testosterone: 50mg every two weeks, increased by 50mg every three months. I knew that testosterone would deepen my range, and I was also prepared for some temporary loss of control. I would need to retrain the muscle memory in my larynx, since shaping the vocal folds and flexing the laryngeal muscles in a familiar way would not necessarily produce the same tone as I was used to. I was advised that practice and patience would help my voice adjust.

Now after 20 months of HRT, the tonal quality of my voice sounds “whiskier” and sometimes I think this has sacrificed clarity but it’s also more rock ‘n’ roll sounding. I didn’t expect the loss of projection that I’ve experienced, but it’s returning with practice. Overall, the most difficult aspect of changing my singing voice has been gaining confidence with it again. It’s a mental adjustment that encompasses more than just my voice—it’s about confidently expressing my new (and not yet fully familiar) identity. All good things in all good time.

Learning to sing again post transition isn’t easy, but it can be done. Strengthen and stretch your vocal cords at a comfortable pace. Most importantly, however, be patient and kind with yourself and your voice.
– Joshua Klipp

Photo credit: Amos Mac, 2009

The “unpredictable and irreversible” effects of testosterone on voice can inject significant doubt into the decision of whether or not to pursue HRT. If testosterone is in your cards, remember that the “no guarantees” clause applies both ways: it’s not inevitable that you will lose your singing voice! Gradual administration of T, speech-language therapy, vocal exercises, maintaining good vocal health, and regular practice will all help ease the transition. And who knows? This woman claims that testosterone is the reason behind her incredible 8-octave range. Maybe you’ll be just as lucky!

More Trans Male Singers

• Geo Wyeth, Jive Grave
• Katastrophe is a San Francisco based rapper and producer.
• Alexander James Adams is an American singer, musician and songwriter in the Celtic and World music genres.
• Michael Woodward sings lead for Too Much Information.
• StormMiguel Florez is a Mexican American singer/songwriter.
• Alex Davis, Los Angeles native singer/songwriter.
• Paige Elliot Phoenix, an Aussie singer who in August 2011 won over the judges on Australia’s X Factor reality show.

Choirs with Trans Men

• Transcendence Gospel Choir of San Francisco was the first trans choir in the world and features trans men.
• One Voice Mixed Chorus used to have a trans choir. Presumably, there are still trans men in the main choir.

Additional Resources

How the Body Works: Speech and Voice – video

Anatomical Tutorial During Trans-Nasal Endoscopy – video

Changing Speech, Shelagh Davies and Joshua Goldberg, Vancouver Trans Health Program, 2006 (420K PDF)

Transgender Speech Feminization/Masculinization: Suggested Guidelines for BC Clinicians, Shelagh Davies and Joshua Goldberg, Vancouver Trans Health Program, 2006 (844K PDF)

Voice And Communication Therapy for the Transgender/transsexual Client: A Comprehensive Clinical Guide, Richard K. Adler, Sandy Hirsh, Michelle Mordaunt, editors, 2006

The Changing Female-To-Male (FTM) Voice, Alexandros N. Constansis, Radical Musicology, Vol. 3, 2008

Voice problems in female-to-male transsexuals, J. Van Borsel, G. De Cuypere, R. Rubens, B. Destaerke, International Journal of Language & Communication Disorders 2000, Vol. 35, No. 3

Effects of Testosterone Replacement on a Male Professional Singer, Austin King, Jon Ashby and Charles Nelson, Journal of Voice – December 2001 (Vol. 15, Issue 4)

How To Protect Your Singing Voice

Speech-Language Pathologists with Transgender Experience

Shelagh Davies – Speech-Language Pathologist, Clinical Associate Professor in the School of Audiology and Speech Sciences, University of British Columbia, Vancouver, BC, Canada.

Sandy Hirsh – Speech-Language Pathologist, co-author and editor of Voice and Communication Therapy for the Transgender/Transsexual Client: A Comprehensive Clinical Guide. Sandy is based in Seattle, WA, USA but provides distance training using Skype video conferencing.

Anita L. Kozan – Dr. Kozan’s doctoral work focused voice care for singers and actors. She is a specialist in the development of the voice for persons who are transgendered, and her chapter on the singing voice in Voice and Communication Therapy for the Transgender/Transsexual Client: A Comprehensive Clinical Guide has been recognized as the first of its kind. Her private practice is in Minneapolis, MN, USA.

Footnotes

1. Medical Therapy and Maintenance for Transgender Men: A Guide for Health Care Providers
   R. Nick Gorton MD, Jamie Buth MD, Dean Spade Esq., p. 59
2. Body Alchemy: Transsexual Portraits, Loren Cameron, p. 38
3. Funny Kinda Guy
4. Simon de Voil
5. Changing Speech, Shelagh Davies and Joshua Goldberg, p.6
6. The Changing Female-To-Male (FTM) Voice, Alexandros N. Constansis, para 17
7. The Changing Female-To-Male (FTM) Voice, Alexandros N. Constansis, para 29
8. The Changing Female-To-Male (FTM) Voice, Alexandros N. Constansis, para 9
9. The Changing Female-To-Male (FTM) Voice, Alexandros N. Constansis, para 29
10. Changing Speech, Shelagh Davies and Joshua Goldberg, p.20

Acknowledgments

Thanks to Radford Bishop, Joe Stevens, Joshua Klipp and Lucas Silveira for contributing to this article. Special personal thanks go out to Joe and Lucas for providing me with very helpful advice and inspiring me to keep singing.

Last updated: September 6, 2011

Dihydrotestosterone (DHT) is a metabolite of testosterone that’s recommended by some SRS surgeons to encourage genital growth in transgender men. DHT can be topically applied in a transdermal cream, but is not to be confused with testosterone cream or testogel/androgel. DHT is at least three times more potent as an androgenic compound and is therefore the preferred choice for FTM genital growth.

DHT plays a vital role in virilization. When a trans man injects testosterone, his body converts some of it into DHT. It influences facial and body hair growth, voice changes, sex drive, and growth of muscle and genital tissue. Unlike other androgens, DHT cannot be converted to estradiol, and it’s not anabolic, so it doesn’t build up in tissues, muscles and bones.

DHT for Dick Growth

For genital growth, a 10% DHT concentration, non-alcoholic cream is desired. A typical dosage is 20 mg administered three times a day, and it dispenses very easily when packaged in syringes (1 line = 1 dose). Simply rub the cream onto the glans, shaft and foreskin; it absorbs quickly. A minimum of three months of use is recommended.

Topical DHT shouldn’t drastically affect blood pressure or testosterone levels, but it’s a good idea to get regular blood work done while you’re using DHT, and to observe your moods and adjust your testosterone dosage as required.

Getting a Prescription for DHT

To get a prescription for DHT, ask your doctor or endocrinologist for “10% Dihydrotestosterone cream.” If they grant your request, take the prescription to a compounding pharmacy. Be sure to specify that the cream should not contain any alcohol.

In North America, DHT has been available to compounding pharmacies through the PCCA. In July 2009, the PCCA announced that they were out of stock and that the manufacturer had ceased production of DHT. This was reportedly the only source of DHT available to Canadian pharmacies. It’s unknown if there are other sources available or not in the United States. It may be difficult to get a prescription for DHT filled in North America at this time.

Buying DHT Online

You can buy a 2.5% DHT gel called Andractim online and without a prescription. However, this product is alcohol based and may cause a temporary burning sensation. It’s also important to note that DHT is a schedule III controlled substance. In North America, it’s illegal to import it. Purchase at your own risk. If you do buy DHT online, check off “female” for gender on the order form, otherwise you’ll be required to purchase a prostate test kit.

Side Effects of DHT

Hair Loss

Despite being responsible for facial and body hair growth, one of the potential side effects of DHT is hair loss. DHT leaves a waxy substance at the root of hair follicles on the scalp that can inhibit hair growth. One possible solution is saw palmetto berry extract tincture, a natural herb that’s been shown to block DHT. The tincture can be mixed with water and topically applied to the scalp to prevent that build up in the hair follicle roots. Dosage is 30-60 drops daily. A one month supply of saw palmetto tincture costs about $25 USD.

Secondary Exposure

Like Androgel, DHT cream presents a risk for transference and requires diligence to prevent accidental secondary exposure to sexual partners, children, and pets. Washing well an hour after application reduces—but does not eliminate—chance of exposure. The only safe form of protection is zero exposure. Since DHT is applied daily, avoiding all direct contact to the genitals throughout the period of usage is recommended.

DHT Research

While there aren’t any clinical studies about DHT use in transgender men, we can look to related studies for some guidance, particularly with regard to safety.

Transdermal dihydrotestosterone therapy and its effects on patients with microphallus.

All patients demonstrated growth of the penis during treatment. The mean increase rate (153%) in the first 4 weeks of treatment was higher than that (118%) of the second 4 weeks… In conclusion, transdermal dihydrotestosterone therapy is an effective and relatively safe modality in the treatment of microphallus.

A Double-Blind, Placebo-Controlled, Randomized Clinical Trial of Transdermal Dihydrotestosterone Gel on Muscular Strength, Mobility, and Quality of Life in Older Men with Partial Androgen Deficiency

We conclude that 3 months treatment with transdermal dihydrotestosterone gel demonstrates expected androgenic effects, short-term safety, and limited improvement in lower limb muscle strength but no change in physical functioning or cognitive function.

Long-term transdermal dihydrotestosterone therapy: effects on pituitary gonadal axis and plasma lipoproteins.

…percutaneous DHT administration is a relatively safe modality of androgen replacement therapy as far as atherogenicity is concerned.

Absorption of dihydrotestosterone (DHT) after its intramuscular administration.

…suitable for long-term substitution therapy.

DHT offers trans men the potential for genital growth that exceeds the promises of testosterone therapy alone. While dedicated research is lacking, related studies and anecdotal accounts suggest that DHT is a safe and promising treatment.

Does pumping work? Yes! There are numerous accounts of trans guys who have increased the size of their penis with a daily regimen of pumping. However, success with pumping depends on a high level of commitment and patience. For best results, pump twice a day, morning and night.

Measure Up

To measure the length of your penis, hold it straight out from your body and measure from base to tip. To measure the girth of your penis, wrap a soft tape measure around it to get a circumference measurement, or wrap a piece of string then measure that length against a ruler.

Cylinder Selection

Select a cylinder twice as long as your flaccid penis, and about 50% more in girth. (Example: If your penis is 1″ long and 1/2″ in diameter, then use a 2″ long, 3/4″ diameter cylinder.)

Warm Up and Get Pumped

Warm up by wrapping your penis in a warm towel for a few minutes. Simultaneously, soak the cylinder in hot water.

Dry everything off, then amply apply lube to your penis, as well as a small amount to the inside of the cylinder.

Position the cylinder to ensure a good fit and seal.

Pump to five pounds. Keep the pump on for as long as it takes for your penis to become fully engorged.

This shouldn’t cause pain or fill the cylinder completely. Check yourself frequently to make sure you’re not blistering or bruising badly (slight bruising is OK.) If you’re experiencing any pain, blistering or significant bruising, disengage the cylinder immediately. These symptoms aren’t the sign of permanent damage but you will need to take a week or so off pumping to heal up.

Advanced Pumping

Once you’re comfortable with basic pumping, you can experiment with increasing the pressure on the pump to achieve more length. Take a cautious approach, always being aware of any pain and bruising.

If you have a second, larger cylinder, you can try the Two Stage Pumping Method: complete the basic pumping technique, then increase the pressure to 15 lbs, disengage the smaller cylinder and attach the larger one.

Where to Buy Pumps

• TransGuys Enhancer Pump Kit
  Excellent 5-star package for just $98 USD. Includes high quality pump with pressure gauge, 3 cylinders, and bonus bullet vibe.
• Find more pumps and cylinders in the TransGuys.com Store.
  
• PumpToys.com Store
  A large selection of seals, tubes, pumps, toys and accessories.
• Boston Pump Works
  Pumps, cylinders and accessories. Order by phone.
• NaughtyThings.com
  Get the pistol-style Magnum Pump for $54.95 USD, recommended by Dr. McGinn.
• Dr. Kaplan Pumps
  Dr Kaplan’s Enhancement Pump is an affordable kit at $69.99 USD. PayPal accepted.
• Vacu-Tech
  Cylinders and pumps. In business for more than 25 years.
• GFH Pump Kit
  Pump with pressure gauge, two cylinders, bonus vibe. $140 CAD.

Videos About FTM Pumping

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