If you’re equipped with a clit and some labia and you’d like a penis (with or without testicles), you’re looking at either a phalloplasty or metoidioplasty. The procedures have different advantages and disadvantages that you’ll want to consider before making a decision.
Phalloplasty involves the construction of a penis from grafted tissue taken from elsewhere on the body like the arm or thigh. The surgeon can create a circumcised or uncircumcised johnson for you, complete with testicles if desired. To construct testicles, the surgeon recycles your labia (and can add implants as well). You’ll retain sensation in your clitoris, and you should be able to have insertive intercourse (some surgeons add a prosthesis that will allow you to get hard. If you want to be able to stand to urinate, it will require an extension of your urethra, which comes with risks including stenosis (becoming fully or partially blocked) or fistula (springing a leak).
This procedure comes with risks. You can experience infection and scarring at the donor site, and the tissue on your penis could develop necrosis (die) even if you’ve cared for it as directed. The ultimate shape and size could be different from expected, and there will be some scarring. If you get an implant, that carries additional risks. Depending on the surgeon and the procedures used, you may need multiple surgeries, and it’s possible you will have to return for revisions to address complications. While this list sounds scary, the standard of care is always improving, surgeons are getting better and better, and these risks are constantly declining—we just want you to make sure you have information to think about while you decide whether you want a phalloplasty. This procedure is also quite expensive, and not always covered by insurance providers.
Metoidioplasty, also known as clitoral release, involves “elevating” your clitoris and may include constructing a new urethra along with it. While your resulting penis can allow you to stand to pee, participate in inserting intercourse, and be highly sensitive, it will also usually be quite small—around two inches or so. Complications can include scarring, infection, loss of sensation or excessive sensation, narrowing of your vaginal opening (which may not be a concern for you, depending on whether you want to be able to have vaginal insertive intercourse), or problems with your constructed urethra similar to those discussed above. As with phalloplasty, your doctor can hook you up with a set of testicles if desired.
This section is part of a larger piece, Trans Summer School: The Wide World of Surgical Transition.
