A transgender man is a person who was assigned female at birth but identifies and lives as a man. His internal sense of his own gender does not match the sex recorded on his original birth certificate. Some transgender men also use the terms FTM (female-to-male) or transmasculine, though these labels carry slightly different nuances.
In the United States, roughly 730,500 adults identify as transgender men, making up about a third of the total transgender adult population, according to estimates from the Williams Institute at UCLA.
Gender Identity vs. Sexual Orientation
One of the most common points of confusion is the difference between gender identity and sexual orientation. Gender identity is a person’s internal sense of being male, female, or somewhere along the gender spectrum. Sexual orientation describes who a person is attracted to. These are separate things. A transgender man can be straight (attracted to women), gay (attracted to men), bisexual, asexual, or any other orientation. Being transgender says nothing about who someone is attracted to.
Transmasculine vs. Transgender Man
You may see “transmasculine” and “transgender man” used in similar contexts, but they aren’t interchangeable. Transgender man typically refers to someone who identifies firmly as a man. Transmasculine is a broader umbrella that also includes nonbinary people who lean toward or transition toward a more masculine presentation but don’t necessarily identify as men. All transgender men fall under the transmasculine umbrella, but not everyone who identifies as transmasculine identifies as a man.
Gender Dysphoria
Many transgender men experience gender dysphoria, a persistent feeling of distress caused by the mismatch between their internal sense of gender and their body or the way others perceive them. The clinical criteria require this incongruence to last at least six months and involve features like a strong desire to have physical characteristics associated with one’s identified gender, or a strong desire to be treated as that gender. Not every transgender person pursues a formal diagnosis, but the concept of dysphoria helps explain why transition, whether social, medical, or both, can meaningfully improve quality of life.
Social Transition
Transition looks different for every person. Many transgender men begin with social steps that don’t involve any medical intervention. These can include:
- Name and pronouns: Choosing a new name and asking others to use he/him pronouns.
- Clothing and grooming: Changing wardrobe, hairstyle, or overall presentation.
- Chest binding: Wearing a compression garment to flatten the chest and create a more masculine contour.
- Packing: Using a prosthetic to create a masculine genital contour under clothing.
Some people take all of these steps, some take a few, and some move on to medical options. There is no single “right” way to transition.
Chest Binding Safety
Because binding is so common among transgender men who have not had chest surgery, it is worth understanding how to do it safely. A properly fitted binder, purchased from a company that makes them for this purpose, is the safest option. Stretchy bandages and duct tape are not designed for binding and can restrict breathing, cause fluid buildup in the lungs, or even break ribs.
Key guidelines: wear a binder for no more than 8 to 10 hours at a time, take it off at night, and build in days or partial days without binding each week. People with larger chests should limit sessions to 6 to 8 hours. A binder that is too small does not noticeably improve appearance and puts extra pressure on the back and ribs. When you remove the binder, check for redness, bleeding at the edges, or skin irritation. A thin cotton undershirt underneath can help reduce chafing.
Hormone Therapy
Some transgender men choose testosterone therapy to bring their physical appearance more in line with their gender identity. Testosterone produces a range of changes that happen on a roughly predictable timeline. Shifts in body fat distribution, increased lean muscle mass, and gains in muscle strength typically begin within 12 to 16 weeks and stabilize around 6 to 12 months, though subtle changes can continue over years. Voice deepening, facial hair growth, and changes to skin texture also develop gradually over months to years.
Not every transgender man wants or has access to hormone therapy. Those who do generally work with a healthcare provider to monitor bloodwork and adjust dosing over time.
Surgical Options
Surgery is another component of transition that some transgender men pursue. The most common procedure is top surgery (also called masculinizing chest surgery), which removes breast tissue to create a flat, male-contoured chest. For people with larger chests, a technique called double incision mastectomy is often recommended. Some individuals also opt for pectoral implants to further shape the chest.
Genital surgeries are less common but available. The two primary approaches are metoidioplasty and phalloplasty. Metoidioplasty works with existing tissue that has typically grown from testosterone use, releasing it from the body to increase length. The surgeon can also extend the urethra using a graft, usually taken from the lining of the mouth, so the person can urinate while standing. Phalloplasty constructs a penis using tissue grafted from another part of the body. Additional procedures can include removal of internal reproductive organs or creation of a scrotum with prosthetic testes.
These surgeries vary widely in complexity, recovery time, and number of stages required. Many transgender men choose some surgical steps but not others, and plenty do not pursue surgery at all.