The Guide To Being Transgender

Types of Bottom Surgery (FtM)

Warning!
This chapter will be graphically descriptive and discuss both "male" and "female" genitalia. If you are uncomfortable with that, please skip this chapter.

I won't be going into super detail, but I will be briefing you on the two main types of bottom surgery for trans men. Some trans men don't want bottom surgery, and that's perfectly okay. This is more so for people who want an informational description of it because they don't quite understand it or are looking into getting it.

First, I'll explain bottom surgery in general.

Bottom surgery is a surgery or, rather, series of surgeries that focus on the primary sex characteristics, or genitalia. For trans men, this is usually to construct aesthetically male genitalia, so that you can pee standing up and gain an erection(in some cases).

The two main types of bottom surgery are metoidioplasty (meta) and phalloplasty (phallo). They are very different procedures and have different effects, so you really have to see which will work best for you.

Meta is less known than phalloplasty. For certain reasons, many men aren't okay with meta, but it's cheaper and typically less risky (though both are still risky no matter what). I'll explain the procedure and then make a list of pros and cons.

So, when you're on testosterone, you experience some clitoral growth. Typically it can reach up to a couple inches. Some people don't have clitoral growth, but most do. Meta uses that growth to form a small penis. When the procedure is formed, the surgeon separates the labia minora from the clitoris. The clitoris is then severed from its suspensory ligament, which holds it up. This causes it to drop to the position of a penis. The urethra is then lengthened so that you will pee out of your penis. Then the penis itself is formed using pieces of the labia minora. The surgeon will wrap the pieces around the clitoris and sew them with stitches.

Let's talk pros and cons.

We'll start with Pros-
• reports of complications are considerably less with meta than they are with phallo.
• the procedure itself is more affordable.
• it does allow the person to pee standing up if a urethral lengthening is chosen.
• sensation is retained and a natural erection is obtainable.
• less than 10% of patients have complications from fistula (or a tear in the urethra).
• most complications that do occur require no medical intervention.
• minimal scarring

And now the Cons-
• the results are not typically aesthetically realistic.
• the size is usually rather small, averaging anywhere from 4-6 centimeters, so 2-3 inches.
• there is a chance that the person won't be able to stand to pee if they are overweight.
• penetration during intercourse is often not an option due to the small size of the constructed phallus.

I have viewed many pictures of meta results, and I personally would not be able to have meta. I can't have a phallus that small. It just won't work for me and it isn't what I want. However, I know plenty of people who do want meta or who have had meta and are happy with it. I'll leave a link to video that explains the two procedures and discusses why the person would prefer meta over phallo.

https://youtu.be/M4OKx1wJur8

Now, let's discuss phalloplasty. In phallo, the enlarged clitoris is used as a basis, but the phallus itself is formed from a graft of skin. This graft can come from your thigh, forearm, or torso under the arm and toward the back. Now, there are different types of phalloplasty depending on where your donor site is. Radial forearm is ideal because it maximizes sensation and creates a more-realistic, proportional phallus. RF also has a lower risk factor. ALT (thigh) tends to create a thicker phallus and cannot be performed on overweight individuals due to the nature of the skin. MLD(back) is a tad controversial because of the neurons in this sight. It tends to lead to less sensation but does have a less noticeable scar.

Pros-
• larger phallus
• penetration during intercourse is not an issue, even if you don't get an erectile device.
• more aesthetically realistic
• easier to aim and pee standing up.
• less issues pertaining to the weight of the patient.
• more research has been done on this (though still not much).

Cons-
• large, noticeable scarring
• less sensation
• more risk and possibility of complications
• longer hospital stay and recovery time
• more expensive

Both procedures have the option of adding testicular implants after a certain time, and scrotoplasty can be performed, as well as vaginectomy or hysterectomy.

If you choose meta and want phallo later down the road, it is still an option. Phallo can be performed after meta has already taken place.

An erectile device can be implanted in the phallus so that you can obtain an erection with phalloplasty. It typically uses one of the testicular implants as a pump for the device, and needs to be changed every six months. Many people opt not to get an erectile device.

Personally, I want phalloplasty. I plan on getting it eventually, once I'm much older and have the money for it. I'm okay with the scar (I would get RF) because I know I can tattoo over the scar once it's healed over. I want as realistic of a penis as I can get, and phallo is my best option for that.

Meta is realistic as well. It's just small, and that works for some people. I hope you come to whatever decision you make and remain happy with it.

I hope that was informative and helpful.