Understanding Metoidioplasty

Metoidioplasty is a type of gender-affirming surgery. It creates a smaller-size penis using a person's existing clitoris. The clitoris has been enlarged from taking testosterone. A scrotum is often created as well.

This surgery may be done for people who are transitioning from female to male (transgender men). Or it may be done for a gender nonbinary person who was assigned female at birth. It is also called a male bottom surgery.

A metoidioplasty creates the outer male genitals. This surgery may be done for transgender men and gender nonbinary people who want their genitals to match their gender identity.

Is metoidioplasty right for you? It's important to know what to expect from this procedure. This surgery:

• Creates a penis from your clitoris. Before the surgery, you are given testosterone treatments to help enlarge your clitoris. During the surgery, the surgeon separates the clitoris. The penis is shaped and lengthened. It is given a head (glans).
• Creates a small penis. With this surgery, you will have a penis that is smaller than a typical nontrans (cisgender) male penis. It is sometimes called a micropenis. It is often about 2 to 3 inches long.
• Allows you to have sexual sensation and some sexual function. After this procedure, you will be able to have erections. And you will be able to feel sexually aroused and orgasm. But the penis may be too small to have penetrative sex.
• Creates a scrotum (scrotoplasty). A scrotum may be created at the same time. This may be done using existing tissue or synthetic materials. Testicular implants can also be placed in the scrotum.
• Can allow you to urinate while standing. Urethral lengthening is often done at the same time. The urethra is the tube that sends urine out of the body. Lengthening surgery creates a new section of urethra. This is connected to your original urethra. And it is extended through the penis.
• Is less complex than phalloplasty. Metoidioplasty is a one-stage procedure. It has a shorter overall recovery time and fewer possible complications than phalloplasty.

It's vital to know what your goals are for male bottom surgery. Talk with your doctor to decide if metoidioplasty is a good choice for you.

Phalloplasty is also a type of male bottom surgery. Like metoidioplasty, phalloplasty creates a penis. But these procedures and their outcomes are different. Your doctor can discuss both choices with you.

You must think about your future fertility choices when planning for any gender-affirming bottom surgery. During a metoidioplasty, you may also have procedures done that will affect your ability to have a biological child. These may include surgery to:

• Remove the vagina (vaginectomy)
• Remove the uterus (hysterectomy)
• Remove the ovaries (oophorectomy)

If you think you may want to have biological children, your surgeon can talk to you about fertility-preserving procedures. These procedures would be done before metoidioplasty. They include:

• Freezing (cryopreservation) of ovarian tissue
• Freezing eggs (oocyte cryopreservation)
• Freezing embryos (embryo cryopreservation)
• Preserving the uterus

Talk with your surgeon about this issue. They can help you find the best choices for you, based on your situation and your future goals.

Before having any type of gender-affirming surgery, you may be advised that it is helpful to see a mental health provider. You may also need to:

• Be age 18 or older
• Have hormone therapy for at least 6 months before surgery

These guidelines are from the World Professional Association for Transgender Health (WPATH) Standards of Care. Most insurance companies require people to meet these standards before starting any treatment.

Talk with your doctor, plastic surgeon, and insurance company to find out what is required in your case.

Choosing how and when to transition is a very personal decision. There are many ways to transition. Surgery is just one choice. Not all trans people want to or are able to have surgery.

Cost can also be a major issue. This surgery is expensive. And it may not be fully covered by your health insurance. Talk with your doctor about your own personal situation and needs.