So. I came out to my dad, who is by the way the most awesome human being on the entire planet. He's hinted that he may be willing to pay for some of my transition costs, including top surgery.

I won't be doing either surgery or T for at least another few months because I have to sort out the situation with my husband. Basically, I think it would be wrong to pressure him into staying with me through transition, but as things stand with him being unemployed he's under de facto economic coercion to stay. So I won't physically transition until I believe he can actually make a free choice (which I expect will be to leave). He's working on going back into the military but that may take some time. So I have some time to make the important decisions. But that also means that if it's important that I be on T for the recommended year before surgery, then every month I wait to get on T pushes the surgery even farther down the road, and I don't like that idea.

Now, I could get the letter of recommendation for surgery pretty much whenever I want - my counselor doesn't do "gatekeeping." Not binding would be a big relief, and having already had surgery would be a big help for me as I transition, and I think there are some big benefits of having major surgeries before I mess with my endocrine system (most specifically that I know my skin in its current condition simply doesn't form serious scars and I understand T causes major skin changes).

But on the other hand, as I understand it there are some major benefits to being on T for some time before surgery as well. In particular I'm told doctors can do a better job of scar placement and have an easier time knowing how much tissue to leave.

So I guess I'm just trying to figure out how important it is to wait.

I had my top surgery about 8 months before beginning T.  I would not have done it any other way.  My chest looks perfect as can be and is developing nicely under the T [just been a year now]

Great question!  I have considered getting top surgery before going on T.  I am so disphoric about my chest.  I just want them gone!!!!  I can also get it done as soon as I want -- since I am large chested I can get it done as a medical necessity.  The doctor said the size of the reduction can be between the two of us and the insurance doesn't need to know.

However, I have too heard that starting T first is recommended.

Assuming that is you in your avatar, you look relatively thin and fit.  I don't think you'll have issues if you get surgery now.

I was a lot chunker when I had top surgery, and even though I'd been on T for 5 months, I wasn't fit at all.  My results look far better now that I've lost weight.

One thing you can do while you decide is work out your upper body and build your pecs. That will help as well.

Another thing, is maybe you should choose a more experienced surgeon who has done pre-T and post-T guys, if you're not.  A surgeon who doesn't do a lot may not anticipate the changes on T.  But I'm not a surgeon.


Jay

I want to do top surgery before T too, but I've also heard it's best to wait.  I'm thin too and I don't see myself building any (substantial) muscle definition on T anyway, so I don't think it would make a difference in that case.  But my therapist told me she would recommend doing it after because it can reduce the amount of tissue there to remove, and since I'm small to begin with, that could mean an easier surgery/less scarring.  It will also depend on which surgeon you want to see, because I think some of them won't or don't like to operate on pre-T guys. 

I did my top surgery pre-T (I went with Brownstein). I went that route because my breasts were unbindably huge, though, and I just did not want to have my T changes while I also had a big rack, ugh. However, for several months prior to surgery I stuck hardcore to a good nutritious diet and working out nearly every day. It's worth your while to use your time that way, it'll aid in your recovery significantly. So don't think about it as wasted time.

Also, some surgeons make you stop taking T for a couple weeks to a month before surgery, something to factor in.

Thanks for the info, all. Yeah, I'm neither slim nor fit (I'm pudgy and sedentary) - I just seem to have a knack for looking a lot fitter in boy-mode than I do with my clothes off. My pecs are nonexistent and I have a hard time motivating myself to work them when I know it just adds bulk to my chest and I can't see any positive results. But I guess it's worth trying.

For me, the loss of mass on T won't make a difference - I have pretty severe ptosis from when my B+ cups swelled up to DD during pregnancy and then deflated again, so even if I lose significant fat/breast tissue mass on T, I'll still have to have the same amount of skin removed because it won't shrink. So the scars will be about the same size regardless, but might heal better with my skin as it is now.

I think I might go for surgery first. I really like the idea.

I'm not sure if i want to pass through T or not... I don't want to have a beard, neither body fur. Also i'm not sure if i want a male voice. I just want to pass through the top surgery, because i really hate to have boobs  >..>
Is the T necessary for a good result with the top surgery? That's my question.
If it's not, then i will try to find a surgeon. If it is, then i will try to find a endo.

Wow, Kyril, I am so happy to see someone started up a thread like this. (Also, it's great your dad is so accepting!) I was wondering the same thing for a long while. I like the idea of getting top surgery first to get rid of the moobage, but that's just my priority.

I was just wondering because I hear that one should start T as soon as they feel ready [to transition] because the earlier the better for the changes. I would just hate to work out again, be on T, and then binding would suck more after the fat redistribution...

Thank you for the additional information, M.Grimm. I pretty much feel the same way.

@Flam: T is not necessary for top surgery. Some of the changes that come along with it would probably help, but... I don't think it's necessary? There are some details about top surgery results by Dr. Brownstein here. Patient 12 started T about one year post-op. Patients 2, 3, 5, and 6 have not started T since the photos were submitted. I guess compare the results and see for yourself.

Flam, you do not need to be on T for a good surgery result. As I mentioned above, I did mine pre-T and I still ended up with a completely masculine chest. I could not be happier with the results. From surgery alone, I went from being read as female 100% of the time by strangers to being read as male roughly 50% of the time; I blame the other 50% on my 'pretty' girlish facial features.

Keep in mind that it's harder for a body on estrogen to build muscles, especially upper body muscles. Also, estrogen pads the body with more fat, which results in a softer look. But if you like that, then there's no reason that you MUST go on T. I would recommend telling your surgeon that you don't plan on HRT, though, it may be something they need to know when doing the reconstruction (I honestly don't know, but it's better to find out, right?).

This guy had top surgery first and he looks like he got pretty good results.