How hard is gender change surgery female to male?

F to M surgery: After starting testosterone, most FTM individuals experience deepening of the voice, increased hair growth, clitoral enlargement. "top" surgery (breast reduction) is the most common surgery done - and results are excellent. Genital surgery is now possible. A penis can be constructed using grafted skin, the labia can house a testicular implant and a pump for the penile implant to enable erections.