Metoidioplasty or Phalloplasty?

poll-surveyWe surveyed trans men interested in bottom surgery and asked: “If money were no object, would you choose to have a metoidioplasty or a phalloplasty?”

View the survey results »

61 Comments

  • jayke says:

    I would totally have phalloplasty!

  • jamie says:

    phalloplasty

  • alec says:

    phallo

  • DreamDungeon says:

    Definitely metoidioplasty, regardless of the money issue. I want things fully working down there.

  • asg says:

    meto. hands down.

  • Joshua says:

    @DreamDungeon Careful, “fully working” is a relative concept. I don’t think guys who’ve had phalloplasty think of themselves as not having “fully working” genitalia.

  • Darwin says:

    Phalloplasty hands down. Phalloplasty is fully functional, [edited by moderator]

  • FTMTobe says:

    A recent medical technique for phalloplasty is using the extra bone of your leg (fibula) to replace the old technique which leave mark in your forearm. And best thing is it can be cover with sock. It just impress me… for your courage, your plans, your finance management to take up the surgery. I’m having the thinking of “why i am born as a female” since i’m 10, yeah, that’s the time i discover i have feelings on girl rather than boy. I’m planning to do a complete turn before age 30. I wish you all the best with the new experience of your ‘true’ body 🙂

  • Kieron says:

    meta, most definitely

  • adohnes says:

    meto because it will grow bigger n bigger if i get T continuously. i want it fully working :]

  • Joshua says:

    @adohnes FYI, there’s a limit to how much your cock will grow on T, you know this right? Also, please see my previous comment regarding “fully working.” Thanks!

  • Dee says:

    @Joshua I’ve been thinking a lot on possible ways to improve bottom surgery and I was wondering if I could ask you some questions simply because I’m sure your more knowledgeable than me. Now to my understanding in the most common phalloplasty skin is donated from the forearm and twirled into a tube and attached to the pubic area then once its reconnected it remains sensitive (when done correctly) although not erotically sensative, due to nerve hook up and blood vessels reattaching. If anything i say is incorrect please correct me. In a medioplasty I believe one of the things done is it is detached from the pubic bone. I’m a little confused on how that works but I always wonder if combining the two surgery’s is perhaps even possible? I’m wondering if a trans man penis can remain sensative if detached and reattached (as the forearm skin does). I don’t know if you’ve heard of a centrium but its currently done by only one surgeon to my knowledge. Its considered a more “advanced” form of medioplasty where ligaments from the labia are inserted into a trans penis to add girth, then testicle implants are inserted into the “pocket like” labia thats left afterwards. So to recap if you made half of the shaft of the penis from forearm with nerve hook up then connect the transmans penis to the top (giving the correct girth to match the other half through ligament insertion) although appearance may be slightly off, could that leave for a penis that is sensitive enough to reach appropriate sexual functions and reach a more desired length? Does this sound probable or is my understanding of bottom surgery off?

  • Joshua says:

    @Dee: Happy to share what I know!

    There are several different approaches to phalloplasty, forearm phallo is one. Sensation is one of the reasons this procedure is popular, and erotic sensation is definitely possible. Clitoral nerves are connected to the phallus to achieve this. There are different ways of incorporating the clitoris into a phalloplasty, it depends on the surgeon’s method and patient’s needs. It can be buried at the base or left free on the underside for direct stimulation. For more info, check out this phalloplasty website.

    With metoidioplasty, nothing is detached from the pubic bone. For more details about meta, check out “Metoidioplasty: A Variant of Phalloplasty in female transsexuals” a journal article available here.

    Centurion is a variation of meta that can provide more girth. I hesitate to call it more “advanced.” It’s just a different approach. Dr. Raphael in TX, USA performs this. For more about Centurion, see Female-to-Male Urogenital Reconstruction: “The Centurion Procedure” (PDF).

    Scrotoplasty (scrotal implants) can be done with either phallo, meta or centurion.

    If I understand correctly, what you’re describing sounds like it can already be achieved with a phalloplasty where the trans male penis (clit) is buried at the base. Sensation, girth and appearance are achieved.

    Hope this helps!

  • adohnes says:

    im east azn so there will be no big difference (with non-trans male) though i got meto

  • Marc says:

    I must disagree slightly. There is a standard as to how much your penis will grow on testosterone. However I think there are some guys who may grow above and may grow below the standard. But much like a bio male puberty does stop at some point, and what you have is what you will have, I do believe in mechanical devices to gain length however I am a trans guy who knows many people who have grown over that standard, so keep your hopes up but if in your head your thinking porn star big I would just say skies the limit but be realistic with yourself lol. I mean you probably will be no ron jeremy or mandingo lol but it may satisfy your idea of big.

  • Ty says:

    I left BC in 2000. I’m getting ab-flap phallo covered by OHIP in a few months. Meta was never an option in my mind, even before I got approved for funding, I was moving ahead to foot the whole bill for a phallo.

  • Euan says:

    Although I do not want any bottom surgery right now, my decision can change anytime. If I were to do any of these two, I would take the one that would have the least amount of complications in every aspect: aesthetic, medical, psychological, economical and everything else… most importantly, I would do the surgery that will ‘fit’ me the most.

  • Liam Elisabeth Kelly says:

    meto.

  • Declan says:

    If I were to opt for bottom surgery one day, I originally want the meto procedure… [edited by moderator.]

    But lately I’ve found myself leaning more towards the phallo procedure. Sexual sensation, though a concern for me, doesn’t outweigh the general appearance, urination and penetration you can achieve with a bio-equivalent.

    Luckily I feel I have a few years to make my mind up!

  • Adam says:

    Meto. Not that big not testicular implants. Clitoral release, urethral extension.

  • Jonathan says:

    See im sure on this one, cuz i want the actual feeling and sensation of being able to get a natural hard on, but i do want a real size penis so probably meto first, then phallo to finish it off

  • Scott says:

    Such a hard decision. I would still want to learn more and more about both, if possible.

  • Nick says:

    Honestly, I don’t know. There’s days when I think without hesitation I’d do it, there’s other days where I’m thinking ‘does it really matter?’. At the moment? I’m fine as is, as long as people see me as I am, it doesn’t really matter what’s in my pants. That, and I feel like I need to do a hell of a lot more research on both procedures.

  • Benjamin says:

    Am not sure on this either. I’ve tried looking up things on both and if am honest my head’s startin to get a bit frazzled, leaving me slightly confused. What I would like to see is if you guys did an article here on the pros and cons of both phallo and meta, comparing the two. Maybe including accounts from people who have been through them procedures. Also include more links for further reading. Am sure I am not the only person who like to see this and would benefit from such an article.

  • Joshua says:

    @Benjamin I probably won’t write an article comparing different bottom surgery procedures because the pros/cons are relative to what one’s goal is. It’s kind of an apples and oranges thing. FTMGuide has a very good info page on FTM GRS Procedures. The surgery mailing lists are also incredible sources—search the archives and you’ll find lots of info that will help you refine what you’re looking for.

  • Rattus says:

    Ideally, phalloplasty.
    However, I have an intense phobia of surgery. As is my breast removal is the only thing I’m set for without a bit of doubt, mostly because they’re huge and awkward. At least my genitals I can hide sufficiently. =/

  • samuel says:

    meta just dont wana mess to much with what i got and i like being able to get errect naturally if in the future advances got a lot better i may change my mind testicles nah wouldnt matter ither way

  • Ash says:

    Metoidioplasty. IMO, it’s not the size of the shovel, it’s where you dig.

  • sj says:

    My question is that I have heard that there are complications with the urerthral extension and that if often requires follow-up surgeries. I plan on having a scrtoum/metoid/pelvic lift done by Dr. Medalie at the Cleveland Clinic for $8200. Has anyone used him? He did my top surgery and I am so pleased. Thanks guys, sj

  • Jimmy says:

    i myself am transgender, and personally, size and feeling matters to me (i also got aspergers/autism) which i think makes me want to be the exact same as a natural man, cuz when i watch tv and theres a couple in love, or say there s that odd moment and they have sex and i hear them making them noises, it just makes me angry, jealous and irratated(cant spell). so id go for metoidioplasty, but im finding it hard to believe a penis that small could fit in a vagina, exactly what pleasure does metoid bring? and how does it erect? i might find out, if i go for it, (havent had the operation yet) but yeah metoidioplasty. they say feeling beats size.. cant u just get metoid and then have it enlarged? yeah 1 or 2 years after getting metoidioplasty, you then get penis enlargment surgery so u can get size and feeling??? lol

  • Jimmy says:

    another question? say a ftm got phallo? i know he may not feel sensation when he penetrates, but will his partner feel sensation?

  • Joshua says:

    @Jimmy: Yes, (some) guys with meta can penetrate a vagina. The Centurion procedure is similar to metoidioplasty, but adds more girth. There isn’t a “meta enlargement procedure” per se, though one can have a phalloplasty after a meta. Partners of men who are post-phalloplasty absolutely feel sensation from their man’s phallo.

  • Griffin says:

    metoidioplasty

  • Lloyd says:

    I’m really not sure which one I would choose- Meta gives the benefit of getting a natural erection and remaining fully sensate, but phalloplasty gives a larger size and…[edited by moderator] Both allow you to stp, which is good. I don’t know if you can combine the surgeries so you get some of both, but I don’t like the idea of needing to use an implant to get a hard-on. But the meta might be too small for penetrative sex, on the other hand. It’s a tough decision as to which one would be more satisfying for me to have.

  • Brett says:

    For me it will be phallo or nothing at all. If I am going to spend the money on lower surgery, I want something that is similar in size to a bio-man’s penis, and capable of penetrative intercourse. But this will be several years down the road as I have not even had top surgery yet.

  • Zidan says:

    If i did ever get bottome surgery i think i’d go meto first because sensation is important for me. i’d then consider phallo down the line… it’s constantly being updated and improved… [edited by moderator]

  • Fantasyboy says:

    I originally wanted phallo but now I am leaning towards a meta. I am aware that penetration is rare afterwards, but it is not impossible and I wish to take that chance. If meta is not on my side, then I may well desire a phallo at a later date.

  • Fantasyboy says:

    hey guys, I have discovered a new technique but im hoping I can have it done where I am too but if I have to travel for it then I would.
    The Centurion procedure, just a few questions?
    1. What is the largest possible length it can result to (inches wise)
    2. For those who can pee standing up after a centurion and uhreral lengthing etc can they hold the penis with both hands when standing to pee?
    3. Is the resulting penis, well if it is a decent length and can be used in sex will it please both the male and his partner?

    All of these things matter to me im sorry, i guess you could say I am a selfish guy.

  • Fantasyboy says:

    To Brett: you dont need a phallo to be capable of penetrative sex, not all but some guys with a meta or a centurion are capable of it, im not trying to influence you but I just think it would be better to try having sex witha meta or cent first and if u cant then get a phallo but of course if u want a normal size dick then a phallo is best or a prosthetic, probably phallo. Now honestly, size would not bother me as long as I can pee standing up (using both hands) and being able to have pentrative sex its justs so important to me, im sorry.
    lol 🙂

  • Jackson says:

    Meta, as I’m already kind of big down there and I don’t really feel like I need anything else… I don’t really like phalloplasties, although I understand why people want them.

  • Fantasyboy says:

    Good for you Jackson, I hope you will be very happy with what you already have but yh of course the meta is there if you want it, i myself understand why people may wish to choose the phallo, however i am not one of them, and in fact i admit that i am kinda jealous after you saying that your already kinda big down there, i havent started testo yet im still scared ill end up with not just a small(micro penis) but a super micro penis, i hope i will soon be joining the same boat as yourself lol tc(take care)

  • Nick says:

    i’m 17 and i’ve been wanting to be a boy for a long while. I wont lie that im really afraid of how the outcome will be for the meto but i really want it to be reasonable size at least a few inches. its just my preference and i want my partner to enjoy it too. its really a tough matter with me seeing as im bisexual and my partner is a male so im pretty sure we will be active and all so during intercouse i want to be “presentable” but im worried whats the side affects. im not to fond of the Phallo, i dont like the idea of having to implant something to make me have an erection. So can someone tell me please which i should get to have at least 3 inches or more. Meto and i see some things about this centurion procedure now can anyone tell me about this i do have plenty of years ahead of me so maybe im in luck if they advance it possibly i pray.

    Also, if its possible can there be extra skin attached to the meto to increase size it looks like its possible through pictures ive seen just bring the nerves up throught the rest of the skin somehow use some fat tissue to thicken it or somewhat and maybe T will increase the size if thats possible, if that makes any sense.

  • Fantasy says:

    Hey nick, testosterone will enlarge the clit to become a small penis, i cannot guarentee you the size you are after, im in the same boat son, i havent started T yet. I dont have a partner.. i suppose i want mine to be big enough too.. but T usually allows ur penis to grow up to 3 inches 🙂

    metoidoplasty, your penis is held down by ligaments, so during a meta the ligaments are cut and your penis is free and is in a more natural position, but i dont know if it adds length, but once the ligaments are cut off, your penis will look a bit bigger. Centurion does the same job although it adds more girth (width) to your penis, which will make it stronger, i think.

    Im not planning to have any of these surgies, except the utheral lengthning, just in case you dont know yet, even tho testosterone causes a small penis to form, you cannot urinate through it.

    This small penis reacts and acts the same way as a biological penis, the only difference is size and you cant urine through it unless you have the uthera extended. during this procedure, the uthera which is where urine comes from, is lengthed and hooked up with your penis, and you can void standing. But before this can be done, right before it, I read somewhere, that vaginal closing is necessary, i think it reduces infection and complications im not sure, but i am sure it has to be done before lengthening. testicle implants can be made using labia or implanted.

    And depending on how much growth you get from T, you might be able to use your penis to penetrate but very shallowly, both ends i think. Vaginal – very shallow and anal – very shallow. but yh dont worry man, whatever size you do get, should hopefully be enough to use shallowly during intercourse.

    testosterone whichever type you use, i think it depends on your dose amount and genetics as to how big or small your penis will become. Testosterone will only trigger the growth, if you want to help it grow more, you can use creams/gels which is to be rubbed on the penis. I dont think the surgeons do anything to your nerves, they remain intact. And of course, with testosterone, whenever you are sexually aroused that will trigger a natural male erection. Dont worry man, you’ll be okay 🙂

    lol and good luck man, i hope you get the size you want 🙂

  • Joshua says:

    Hey Nick, No one can really tell you which procedure to get. These decisions are highly personal, and tend to shift as one learns more about what’s medically available. Keep reading and researching and you’ll eventually arrive at a choice that’s right for you.

    There’s some experimentation going on with a procedure that Dr. Meltzer calls an “extended meta,” where he uses a Pig-derived reconstructive tissue that adheres to your tissue, adding extra girth. He’s hoping to improve this technique to add more length as well. The Centurion procedure by Dr. Raphael is similar, but uses native tissues to increase girth.

    For reasons of clarity, I should point out that:

    1. Not all surgeons cut ligaments with a metoidioplasty.

    2. A Colpocleisis Vaginectomy is recommended with urethral lengthening to reduce complications, and while most surgeons require it some do not. Some surgeons use vaginal tissues for urethroplasty, so the vaginectomy should not be done prior to urethroplasty (they are commonly done together, in the same surgical event.)

    3. I think I’ve heard of just one guy who had his scrotum enlarged with native fat tissue, versus implants. If you choose not have implants you can still have scrotoplasty done (where tissues are dissected and rotated) but the balls will likely be quite small and perhaps unnoticeable.

    4. To increase size, pumping and DHT cream can work provided you are dedicated and have the genetics and active DHT receptors.

    Hope this helps!

  • Danil says:

    Hello!
    I made metoidioplasty (with scrotoplasty and vaginal removal) this year (in Serbia, dr. Miro Djordjevic). It was a realy good experience, but now I am thinking about next stage – phalloplasty… Because meto solved all my problems, except one – sex with penetration. I am 25 and I don’t want to realize in some years, that I have waste time.

    P.S. Dr.Miro use Musculocutaneous latissimus dorsi for phalloplasty.

  • CC says:

    Another important thing everyone needs to do is also check your doctors qualifications and training. Dr. Tex McFaden, the doctor assisting Dr. Raphael with some surgeries is a Doctor of Osteopathy with a Bachelor in English and a background in body building & nutrition. What qualifies him to do surgery? Here in Australia he wouldn’t be allowed in an operating room unless he was a trained and qualified surgeon.

  • Rob says:

    You know that for a woman to orgasm, it is that same bundle of nerves we’re relying on for sensation after reconstruction, so penetration, despite all the hype, really isn’t the thing, you know? I say go for the most sensation you will be capable of having, and learn how to give a woman a real orgasm. I envy those of you that are capable of paying for the surgery, whichever you choose.

  • Zander says:

    For a fun look at this issue/debate watch Zerk’s puppetshow

    http://www.youtube.com/watch?v=fzjtTqEJrKs (part one)
    http://www.youtube.com/watch?v=Y6Q6H_rx1h0 (part two)

  • Edward Norman says:

    I would definitely want phalloplasty, provided urethral hook-up is part of it. The problem at the moment is that most phalloplasty is fraught with complications and problems if you want the urethral hook-up. I have seen some great results for phalloplasty on a website for an transgender clinic in Philadelphia – BUT – they don’t do the hook-up. I’m sorry, if I pay around $25,000 for a phalloplasty A) I want to end up with a decent looking penis & B) I should be able to pee through it, as well as have sex. Techniques do seem to be advancing quickly so maybe things will get more acceptable to me in a few years.

  • Joshua says:

    @Edward The statement that “most phalloplasty is fraught with complications and problems if you want the urethral hook-up” is overstated. Urethroplasty is complex, but there are plenty of men who have zero complications with their urethra post-op. If you want urethroplasty, the clinic in Philly is not for you, and neither is Dr. McGinn, since neither perform this with their phalloplasties. Have you looked into the Serbian teams doing MLD phalloplasty? Or, the Thai teams?

  • Hannah says:

    My boyfriend is trans, and right now we are looking into different packing methods and bottom surgeries for down the line.

    1.) Whats the chance of tissue death/rejection of the new appendage?
    2.) His pleasure is important too…would he be able to achieve an orgasm with it?
    3.) Have procedures for urethral connection improved?

  • Joshua says:

    @Hannah: It’s hard to be specific since there are numerous phalloplasty techniques. Tissue death (necrosis) sometimes happens, and it’s often connected to smoking. One study I referenced listed this complication rate at around 3-4% (includes full and partial necrosis, with the MLD phalloplasty procedure.)

    Yes, orgasm is retained, though it may be different, depending on the procedures chosen, of course. There are options to connect clitoral nerves to provide erotic sensation through the penis (microsurgical nerve anastomosis.) Some surgeons will only connect one of the nerves, while others will connect both. If this is not pursued, the “little guy” can be left untouched, split and sutured under the base of the penis, or can be buried, which may or may not lessen sensation somewhat—everyone heals differently. Dr. Brassard indicates that in all the years that he’s been doing radial forearm phalloplasty (w/ microsurgical nerve anastomosis) he’s never had one patient lose the ability to orgasm.

    Techniques for urethoplasty are constantly being developed, though it remains a complex part of this surgery. Several factors can influence outcome, such as procedure, tissues used, length of penis, etc. Various studies show various rates of complication for fistulas and strictures.

    In the end, there’s a lot to consider when choosing the type of phalloplasty to be pursued and arriving at a final decision can take years of research, numerous surgeon consults, and personal contemplation.

    If you’re interested in the academic research, check out this growing collection of journal articles about phalloplasty surgery.

  • Milo says:

    So it’s possible to combine meta and phallo? I wanted to know if one could still achieve an orgasm if they got phallo? Is it difficult to get aroused? I’ve been doing some research, but admittedly they’re both still fairly new to me. I just want to be able to penetrate, and get some sensation from it. Size would be nice too. Though, I don’t care about being able to urinate. I mean, if it can happen that would be great, but pleasure and size appeal more to me ultimately. Any information or responses would be great!

  • Meta and phallo can be combined, but if the motivation is erotic sensation you can have nerve hookup done with several types of phalloplasty (where one or two of the clitoral nerves are incorporated into the phallus.) If size is also important to you, then research the various types of phalloplasty as they provide more in this department than metoidioplasty. Hope this helps!

    ps. Check out the comments on this page too. My comment right above yours provides further info related to your questions.

  • top gun says:

    i had phalloplasty 8 years ago and feeling,sensation is so intense. My choices were function and cosmetic.
    lucky to have a large one that works and feels just ..well even more that before. Women have a lot of fun with me and like wise back.
    Best sex ever in all my life since phalloplasty was done.
    Depending where you have it done..not going to lie,a painful and extremely challening ad best to have all supprt you can.
    For me meta never was a option,too small for me and still stared at in gym,scuba diving etc so now fully happy and a hell of alot of pleasure 🙂
    happy days!!

  • top gun says:

    and just to add… i am glad ejaculation is not fully sorted, i do get some occasionally,women I date prefer none of that, they tell me they dont enjoy that bit- so another plus. If it existed I would opt out for that.

  • Sean Elgin Johnson says:

    Hey Top Gun, how many stages of surgery did you have to go through to achieve penetration with phallo? I was thinking of getting meta first and then phallo but if phallo can be done and sensation retained, I am on board with that. I didn’t like the idea of having to wait a year to have something done to be able to get hard. Any clarification on that?

  • Mike says:

    I don’t currently want bottom surgery, as I don’t have the money for it, and still have a lot of questions/concerns regarding the surgery, but I’ve always been leaning more toward phalloplasty. Maybe someday!

  • Lukas says:

    Metoidioplasty.

    Sex can be done in different ways than solely penetrative intercourse.
    Althought it would seem nice to fullfill that natural urge,
    to me sensation is alot more worth it.

    Phallo requires regular surgeries and the erection implant has to be replaces every 7-10 years depending on sexual activity.

    I don’t see me mentally being strong enough to go to alot of pain every 7-10 years AND spend a lot of money for all those years.
    I rather have a one-time surgery. My girlfriend can be pleased in different ways.
    Alot of women don’t even get the MOST enjoyment out of ‘normal’ penetrative sex, but from other methods of pleasing.

  • Ajami says:

    If phalloplasty, whats the average size?

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