Working Out Before Top Surgery: An FTM and Trans Masc Prep Guide
Pre-op training workouts for trans masculine, FTM, trans man, and non-binary individuals.
Whether top surgery is just around the corner or a long-term goal far on the horizon, the training you do beforehand shapes both how your results look and how quickly you recover.
This guide is for trans men, trans masc, and nonbinary folks getting ready for top surgery: what to train, why it matters, and how to prepare your body for the recovery ahead.
The short version: train your whole body, not just your chest. Your upper back, rear delts, rotator cuffs, and core all matter, because they carry you through recovery. If you have six months or more, build general strength and muscle. If you have three months or less, keep training and add dedicated shoulder and pec mobility work. People who train consistently before surgery tend to recover faster and get back to lifting sooner.
I’m a trans personal trainer, and I’ve been through this myself. I remember the excitement, the nerves, the helplessness of just waiting for the surgery date to finally come, worrying about who will take care of you, feeling eager to rip the bandages off to see what your results look like. With so much out of your control, training is one element that you can control.
What should you train before top surgery, and why?
Chest muscles to create more defined contours, which helps your surgeon with more ideal scar placement
Upper and mid back and rear delt muscles to support posture
Rotator cuffs to reduce risk of shoulder injury and improve shoulder mobility
Core to support posture and ease of movement during recovery
Legs to support balance and ease of movement during recovery
In short, top surgery prep is a full-body strength and mobility project, not just a chest workout.
If you have 6 months or more before top surgery
Start working on building muscle and strength throughout the whole body. As we’ve discussed above, top surgery prep is far more than just training the chest. Though I do understand that juicy, pillowy pecs are a crown jewel for most trans folks.
You can learn more in our trans masc guide to building your chest.
A well-rounded program will help you develop strength, muscle mass, as well as improved mobility to help you recover with the best results aesthetically and functionally with lower risk for injuries or pain.
Here’s an example of a beginner A and B workout program, alternated three times a week.
Sample beginner program
| Workout A | Workout B |
|---|---|
| Bench press | Lat pulldown |
| Chest fly | Romanian deadlift |
| Squat | Shoulder press |
| Close grip machine row | Lunge |
| Cable face pull | Rear delt fly |
| Plank variation | Hanging knee or leg raise |
If you have particularly poor posture or shoulder and thoracic spine (upper back/neck) mobility, or you already experience pain in these areas, giving yourself plenty of time to strengthen up the supporting muscle groups will give you the best advantage when recovering from surgery.
You may notice there’s not many fancy mobility drills listed above.
That’s because if you work broadly on your back, shoulders and rear delts long enough in advance, you’ll develop the supporting strength needed to improve posture, mobility, and pain. For many folks with mild posture or mobility limitations, a well-rounded strength program may be all you need.
If after a few weeks, the issues related to posture, mobility or pain still exist, then you may need a more specialized plan from a sports specific physical therapist or personal trainer/coach to address these issues further. And if pain is sharp, getting worse, or comes with numbness or tingling, don’t wait the few weeks – get it looked at by a physical therapist or your doctor.
How long does it take to build muscle before top surgery?
You’ll start feeling stronger within a few weeks of consistent training, with more noticeable muscle growth happening at around 12 weeks. Significant improvements happen around 6-12+ months.
In addition to training consistently at least 3 times a week, it’s important to eat enough protein and overall calories per day to help your body grow and recover.
We’re working on a full guide to nutrition for building muscle and change your physique, and we’ll link it here as soon as it’s live.
If you have 3 months or less before top surgery
Follow the training protocols above and incorporate these following mobility movements.
During warm ups, start incorporating pec stretches and moving your shoulder joint throughout a comfortable, full range of motion.
Doorway pec stretch. Put one arm against a doorframe or the edge of a wall, gently turn your body away until you feel a stretch through your chest and front shoulder.
Wall angels. Keep your back against the wall and slowly move your arms up and down, working through as much range of motion as you can comfortably control. Avoid excessively arching the back and focus on external rotation of the shoulders.
Band shoulder pass through (also known by a terrible name: band shoulder dislocations 🥴). Hold a light resistance band with a wide grip. Keeping the movement slow and controlled, bring the band overhead and behind you as far as your shoulders comfortably allow, then reverse the movement and bring it back to the front. Widen your grip if needed.
Add these to the end of a strength training day:
I’s, Y’s, T’s. Lie face-down on the floor or bend over at least 45° from seated or standing. For each rep, squeeze your shoulder blades together as you lift your straight arms slightly off the ground: straight overhead (I), diagonally overhead (Y), and straight out to your sides (T). Keep your neck relaxed, avoid shrugging the shoulders up toward the ears, and move slowly with bodyweight or very light weights (2-3 lbs).
Optional side lying external rotations. Lie on your side with your top elbow bent to 90°, tucked against your ribs. Keeping your elbow glued to your ribs, bring your hand upward, then slowly lower. Use a very light weight (2-3 lbs).
This set of 5 exercises can be done in this order as a standalone session, outside of a strength training day.
Why the work beforehand is worth it
In my experience working with trans men, trans masc and nonbinary folks through top surgery, the people who have been training consistently for a good while beforehand tend to return to training faster than those who have not. An existing foundation of strength, mobility and stamina makes a real difference to how recovery goes. That is the honest reason to start now, even if your surgery date is still a long way off.
Be patient with the process and trust that the work adds up. Everyone moves at a different pace.
What happens after surgery
Returning to the gym after top surgery has its own timeline, and it is slower than most people expect. We cover it week by week in our guide to working out after top surgery, including the mobility work to start in the first few weeks and how to modify the program above for your first sessions back.
If you would like a training plan built around your surgery date, our team of trans coaches works with trans men, trans masc and nonbinary folks through top surgery prep and recovery. Learn more about our online coaching with our detailed breakdown or book a free consultation through our new client application.