Don’t Overlook Metoidioplasty.


Metoidioplasty is one of the two of the bottom surgeries available to trans men (phalloplasty being the second).

Favoring a larger penis size, metoidioplasty is quick to be dismissed.

And what a shame! For it is….

Small but mighty. Yes I am using a cliche in this case.

So what’s so mighty about a penis measuring between 1.18” and 3.4”?

Lot’s. Here are the main benefits for your consideration.

Wouldn’t you want a fully sensate penis that can become erect on its own? Preservation of erotic sensitivity is by far the #1 benefit! You’ll be able to get aroused and orgasm.

Whereas obtaining rigidity after phalloplasty remains a real challenge with many complications reported (Hage et al. 1993; Hoebeke et al. 2010; Leriche et al. 20018).

Penetrative sex? It depends, but the answer is definitely not a “no.” Different people have different results. If penetrative sex is absolutely a must, either phalloplasty or a strap on (among other things) is an option.

Forget about penile implants! Especially if you fear complications. Fifty-three patines (41.1%) out of 129 who had phalloplasty needed to undergo either removal or revision of the implant due to infection, erosion, dysfunction, or leakage (Hoebeke et al. 2010). Fears of the implant failing or not functioning properly are going to be worries of the past with metoidioplasty.

Voiding standing up. This is a coveted benefit for many trans guys. Metoidioplasty with urethral lengthening offers this option. The urethra is routed through the neophallus and lengthened using other tissue. Voiding in a standing position was reported in all 82 patients participating in a study after 32 months of follow up (Djordjevic et al. 2009).

Lower complication rates, even with urethroplasty. Out of 38 participants who got metoidioplasty, all 38 reported voiding while standing up. Only two complications were reported, fistulas and one urethral erosion from a testicular implant (Djordjevic et al. 2009).

Say goodbye to large scars and to potential stigma. Common phalloplasty techniques use skin grafts either from the forearm or a thigh. Leading to a recognizable scar tissue for anyone who knows what to look for. For some, not an issue. For others, big deal breaker.

Costs less. $6k - $30k versus $20k - $80k depending on the surgeon, add-ons, etc.,.

Shorter healing time. Think about 2 weeks versus 4-6 weeks depending on the state of your health. Not to mention having to coming back for stage 2 or 3 depending on the procedure.

Curious to see what metoidioplasty look like? Check out the Crane Center for Transgender Surgery. Results vary, so do your homework.

You can have phalloplasty later if you choose! That’s right. Knowing this option is available to you, even with additional costs, is helpful.

About the procedure itself. Metoidioplasty is performed with your existing genital tissue to form a penis. The penis is constructed from the hormonally hypertrophied clitoris due to testosterone. And you’ll have to be on testosterone for at least a year, sometimes two, prior to the procedure.

Doctors perform metoidioplasty differently. An experienced surgeon won’t need additional skin grafts form other parts of the body, in my experience. Grafts from the inside of the vaginal wall and parts of labia should be sufficient for urethral lengthening.

To create a scrotum, the labia major is used. Silicone testicular implants are inserted to form testicles.

For a descriptive outline of the procedure and if you can stomach graphic photos, Dr. Djordjevic is considered one of the best.

Add-ons. Procedure times, costs, recovery, potential complications, all vary depending on the add-ons. What are add-ons? Anything from adding testicles, to urethral lengthening, or even deciding to remove your ovaries while you’re at it, are add-ons. Do your homework!



References & Sources

Djordjevic, M., Bizic, M., Stanojevic, M., Bumbasirevic, V., Koovic, M., Majstorovic, M., Acimovic, S., Pandey, S., Perovic, V. (2009). Urethral Lengthening in Metoidioplasty (Female-to-male Sex Reassignment Surgery) by Combined Buccal Mucosa Graft and Labia Minora Flap. Reconstructive Urology. Volume 74, Issue 2.

Djordjevic, M., Stanojevic, D., Bizic, M., Kojovic V., Majstorovic, M., Vujovic, S., Milosevic, A., Korac, G., Perovic, S. (2009). Metoidioplasty as a singe stage sex reassignment surgery in female transsexuals: Belgrade experience. The Journal of Sexual Medicine. Volume 6(5).

Hage, J., Bouman, F., de Graaf, F., and Bloem, J. (1993). Construction of the Neophallus in Female-to-Male Transsexuals: The Amsterdam Experience. Journal of Urology. Volume 6, 1463-1468.

Hoebeke, P., Decaestecker, K., Beysens, M., Opdenakker, Y., Lumen, N., Monstrey, S. (2010).  Erectile Implant in Female-to-Male Transsexuals: Our Experience in 129 Patients.  European Urology. Volume 57, Issue 2, 334-341.

Leriche, A., Timsit, M., Morel-Jourel, N., Bouillot, A., Dembele, D., and Ruffion, A. (2008). Long-term Outcome of Forearm Free-flap Phalloplasty in the Treatment of Transsexualism. BJU International. Volume 101(10): 1297-1300.