In the expansive journey of gender affirmation, Facial Masculinization Surgery (FMS) offers a profound pathway for transgender men and non-binary individuals to align their external appearance with their authentic selves. While FMS surgically refines facial features to create a more traditionally masculine aesthetic, its optimal outcomes are often achieved through a synergistic partnership with hormone therapy, specifically testosterone. This guide explores the pivotal role of testosterone in preparing for FMS, detailing how Hormone Replacement Therapy (HRT) influences facial characteristics, integrates with surgical planning, and contributes to a cohesive and affirming transition.
Table des matières
Understanding Hormone Therapy in Gender Affirmation
Testosterone therapy is a cornerstone of gender affirmation for many assigned female at birth (AFAB) individuals seeking masculinization. This hormone treatment initiates a series of gradual yet significant changes throughout the body, including those that impact facial features (Tebbens et al., 2019). The goal is to facilitate the development of characteristics socially associated with masculinity, complementing both psychological and physical aspects of transition (GenderGP, 2025).
Over time, HRT with testosterone impacts various aspects of facial appearance. While it doesn’t fundamentally alter bone structure, it profoundly influences soft tissue, skin texture, and fat distribution. The face tends to lose fat in the cheeks and cheekbones, which can highlight underlying angles and reduce the rounded appearance often associated with feminine faces (IM GENDER, 2025). Skin also becomes thicker and, in some cases, oilier (IM GENDER, 2025). These changes, though gradual, contribute to a more robust and angular facial presentation.
Beyond the physical transformations, hormone therapy offers significant psychological benefits. The alignment of one’s physical appearance with their gender identity can substantially reduce gender dysphoria, a form of psychological distress experienced when gender identity does not match assigned sex at birth. This affirmation often leads to improved mental health, enhanced self-confidence, and a greater sense of personal empowerment (Withe, 2023).
The Impact of Testosterone on Facial Features
Testosterone therapy plays a crucial role in shaping key masculine facial features. One of the most noticeable changes is the growth of facial hair, including beards and mustaches, which develops gradually over several years to reach its maximum density (IM GENDER, 2025). This can significantly contribute to a masculine appearance and help to camouflage softer facial contours. Additionally, testosterone stimulates muscle tissue growth, which can lead to a more robust appearance in the jaw and neck areas (IM GENDER, 2025).
The redistribution of facial fat is another significant effect. Testosterone typically causes a decrease in fat in the cheeks and an increase in jaw tissue, contributing to a squarer and more defined jawline (Tebbens et al., 2019; IM GENDER, 2025). While these are not bone-deep, they can create the illusion of a more prominent brow ridge and a more angular facial structure, preparing the face for potential surgical enhancements (Withe, 2023).
The timeline of these hormonal changes is crucial for FMS planning. Facial masculinization effects from testosterone begin to appear within approximately three months and continue to evolve for at least a year, sometimes longer (Tebbens et al., 2019). Most surgeons recommend that patients be on stable testosterone therapy for a minimum of 12 months before undergoing FMS (GenderGP, 2025). Some experts even suggest waiting about two years to fully assess the extent of natural masculinization before considering surgical interventions (IM GENDER, 2025). This allows surgeons to better understand a patient’s natural masculine development and plan complementary surgical enhancements for optimal results (GenderGP, 2025).
Integrating Hormone Therapy with FMS Planning
The successful integration of HRT with FMS planning is paramount for achieving optimal masculinization results. Hormone therapy provides foundational changes, such as skin texture and fat redistribution, that set the stage for surgical modifications. By allowing testosterone to exert its full effect, surgeons can then address the remaining structural differences to create a harmonious and natural masculine appearance (GenderGP, 2025).
During the consultation process, surgeons meticulously assess the effects of testosterone on the patient’s facial features. They considérer existing masculine traits that have developed through HRT and design personalized FMS procedures that enhance these features rather than creating a completely new face (GenderGP, 2025). This holistic approach ensures that the surgical outcomes seamlessly integrate with the patient’s overall masculine presentation. Understanding the characteristics of a male face—such as a wider, more angular jaw, prominent supraorbital ridges, and a straighter nose—is essential for this planning (IM GENDER, 2025; The International Center for Transgender Care, n.d.).
Patients often inquire about the necessity of HRT before FMS. Most surgeons require stable hormone therapy before FMS, as testosterone naturally masculinizes facial features. This allows surgeons to gauge the extent of natural masculinization and plan surgical enhancements that complement these changes, leading to more natural and satisfying results (GenderGP, 2025).
Pre-Surgical Considerations for Patients on HRT
For patients on HRT, several important considerations arise before FMS. The ideal timing for FMS after starting testosterone is generally after a minimum of 12 months of stable therapy (GenderGP, 2025). Some medical perspectives even suggest waiting longer, up to two years, to allow for the full spectrum of hormonal changes to manifest, as the face continues to change for at least a year (Tebbens et al., 2019; IM GENDER, 2025). This waiting period ensures that the chirurgien is working with the most stable and masculinized baseline, which can influence surgical techniques and the predictability of results.
Long-term hormone use shapes the soft tissues and muscle development of the face, providing a foundation that surgeons consider during their planning. While specific surgical techniques are not directly “affected” in a negative sense, the surgeon’s approach will be tailored to refine the features that testosterone has already begun to masculinize. This ensures that the FMS procedures enhance the existing masculine traits rather than creating an entirely new facial structure.
A unified treatment plan requires close collaboration between endocrinologists, who manage hormone therapy, and surgeons. Regular medical monitoring of hormone levels and their effects is essential (GenderGP, 2025). This multidisciplinary approach ensures that the patient’s overall health is optimized for surgery and that both hormonal and surgical goals are aligned, contributing to a comprehensive and successful gender-affirming journey (Withe, 2023).
Expériences réelles et avis d'experts
The journey of individuals combining HRT with FMS often results in profound transformations, leading to a greater sense of authenticity and confidence. The synergistic effects of testosterone-induced masculinization and surgical refinement can create a harmonious facial aesthetic that deeply resonates with their gender identity.
From an expert perspective, surgeons and endocrinologists emphasize the importance of this integrated care. Clinical observations and studies highlight that hormone therapy provides significant changes in soft tissue and fat distribution, which form a crucial foundation. For instance, research indicates that transmen experience a decrease in cheek tissue and an increase in jaw tissue after 12 months of hormone therapy (Tebbens et al., 2019). These changes allow FMS to focus on more structural modifications like jaw augmentation, remodelage du menton, and forehead lengthening to achieve a more angular and defined masculine appearance (The International Center for Transgender Care, n.d.).
Optimizing outcomes through integrated care involves a careful timing of procedures and a thorough understanding of how testosterone has shaped the individual’s face. By waiting for the full effects of HRT to manifest, surgeons can plan with greater precision, ensuring that the FMS complements and enhances the already masculinized features, resulting in more natural and satisfying results (GenderGP, 2025; IM GENDER, 2025).
Challenges and Considerations in Combining HRT and FMS
While the combination of HRT and FMS offers significant benefits, it’s essential to be aware of potential challenges and considerations. FMS, like any surgical procedure, carries general risks such as bleeding, infection, nerve damage, prolonged swelling, and potential asymmetry (Withe, 2023; GenderGP, 2025). While these are not directly tied to testosterone use, overall health and adherence to pre- and post-operative instructions are crucial for minimizing such risks. Surgeons will carefully assess a patient’s medical history, including their HRT regimen, to ensure they are a suitable candidate for surgery (Withe, 2023).
Variations in individual responses to hormone therapy can also impact surgical results. Not every individual will experience the same degree of facial masculinization from testosterone, due to genetic and physiological differences (IM GENDER, 2025). This necessitates a personalized surgical plan that accounts for these unique hormonal effects. For example, while testosterone can promote beard growth, the density and pattern can vary, which surgeons consider when planning hairline masculinization or jawline enhancements (GenderGP, 2025).
Ensuring informed consent and realistic expectations is an ethical imperative. Patients must understand that while FMS can significantly enhance masculine features, the results may not be “perfect” and some post-surgical swelling can obscure final outcomes for several months (The International Center for Transgender Care, n.d.). A comprehensive psychological evaluation often precedes FMS to ensure the individual is emotionally prepared and has a realistic understanding of the irreversible nature of the procedures and their potential outcomes (Withe, 2023; GenderGP, 2025).
Future Directions in Hormone and Surgical Gender Affirmation
The field of gender-affirming care is continuously evolving, with ongoing research aiming to optimize outcomes for individuals undergoing hormone therapy and FMS. Current studies, such as those employing 3D scanning, are providing objective insights into the facial changes induced by hormone treatment (Tebbens et al., 2019). This foundational research paves the way for a deeper understanding of how testosterone influences facial morphology, which can lead to more refined and predictable surgical planning in the future.
While specific innovations in personalized HRT protocols to complement surgical masculinization are not extensively detailed in current public information, the emphasis on a multidisciplinary and individualized approach already highlights this direction. The collaboration between endocrinologists, surgeons, and other healthcare providers is crucial for tailoring treatment plans that account for each patient’s unique physiological responses to hormones and their specific masculinization goals (GenderGP, 2025; IM GENDER, 2025).
Advocating for comprehensive, multidisciplinary care remains a key focus. This approach ensures that individuals receive coordinated support across all aspects of their gender affirmation journey, from hormone management and surgical interventions to psychological support and long-term follow-up (GenderGP, 2025). The goal is to provide a seamless and supportive experience that prioritizes the patient’s well-being and facilitates the most authentic expression of their gender identity.
Conclusion
The integration of hormone therapy with Facial Masculinization Surgery represents a powerful and transformative approach for transgender men and non-binary individuals seeking to align their facial appearance with their gender identity. Testosterone therapy lays a crucial groundwork by initiating significant changes in facial soft tissues, fat distribution, and hair growth, which surgeons then expertly refine through FMS procedures. This coordinated effort leads to a more natural, harmonious, and deeply affirming outcome.
For those embarking on this journey, exploring coordinated HRT and surgical options that align with unique transition goals is paramount. The importance of knowledgeable healthcare providers, including endocrinologists and experienced FMS surgeons, cannot be overstated. By embracing a comprehensive and multidisciplinary approach, individuals can navigate their path with confidence, achieving a masculine facial aesthetic that profoundly enhances their self-esteem and overall quality of life.
Bibliographie
- GenderGP. (2025, 4 août). Chirurgie de masculinisation faciale : votre guide complet sur la masculinisation faciale pour les hommes transgenres. https://www.gendergp.com/facial-masculinisation-surgery-your-complete-guide-to-fms-for-trans-men/
- IM GENDER. (2025, August 25). Facial Masculinization FTM (Female To Male). https://imgender.com/en/facial-masculinization-ftm-female-to-male/
- Tebbens, M., Nota, N. M., Liberton, N. P. T. J., Meijer, B. A., Kreukels, B. P. C., Forouzanfar, T., Verdaasdonk, R. M., & den Heijer, M. (2019). Gender-Affirming Hormone Treatment Induces Féminisation faciale in Transwomen and Masculinization in Transmen: Quantification by 3D Scanning and Patient-Reported Outcome Measures. Journal of Sexual Medicine, 16(5), 746–754. https://pubmed.ncbi.nlm.nih.gov/30926514/
- The International Center for Transgender Care. (n.d.). Chirurgie de masculinisation du visage (FMS). Retrieved October 22, 2025, from https://thetranscenter.com/transmen/facial-masculinization-surgery-fms/
- Withe, M. (2023, October 3). Facial masculinization surgery: What to expect. Medical News Today. https://www.medicalnewstoday.com/articles/facial-masculinization-surgery
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