METOIDIOPLASTY

Metoidioplasty is a type of gender-affirming bottom surgery that uses hormone-enlarged genital tissue (usually from testosterone therapy) to create a small phallus, also called a neophallus. It can allow for standing urination and preserves erotic sensation. [1] 

This surgery is often chosen by transmasculine and nonbinary individuals who want bottom surgery that aligns with their gender identity but prefer a less invasive procedure than phalloplasty. [2] 

At Align Surgical Associates, we understand that your surgical journey is more than just a procedure, it’s a meaningful step in your transition. Our team provides affirming, respectful, and individualized care at every stage, making sure you feel heard, supported, and empowered.

Editor’s note: In our article, we may use terms that are culturally outdated, as many of our patients still rely on them when searching for information. We want to ensure we remain visible to this audience as well.

Choosing Align Surgical for your gender-affirming care means entrusting your health and identity to a skilled, compassionate team. Hear firsthand from patients who’ve experienced expert care from our renowned doctors.

Metoidioplasty is a gender-affirming surgery that creates a small penis, called a neophallus, using the hormonally enlarged clitoris. This growth typically occurs after using testosterone for at least a year. During surgery, the clitoris is released from the surrounding tissue so it can extend outward and take on a more phallic appearance. [3] 

In many cases, optional procedures can be added to complement metoidioplasty depending on your goals. 

These may include:

1). Urethral lengthening: allows standing urination

2). Scrotoplasty: creates a scrotum from labial tissue

3). Testicular implants: placed inside the newly formed scrotum for a more complete appearance

These options can often be done in the same surgery or in stages, depending on your anatomy and preferences. [4] 

One of the benefits of metoidioplasty is that it preserves natural erectile function and sensation, since the tissue used remains fully connected to existing nerves and blood vessels. Many people find this important for sexual well-being and overall satisfaction after surgery. 

Metoidioplasty offers a safe and effective way for many transmasculine and nonbinary individuals to feel more at home in their bodies, without needing implants or more complex surgeries.

1. Minimally Invasive Compared to Phalloplasty

Metoidioplasty is generally a simpler surgery than phalloplasty because it uses the tissue already present from testosterone growth. This means there’s no need to take tissue from other parts of the body, like the arm or thigh, which makes the surgery less invasive overall. [5] 

2. Retains Tactile and Erotic Sensation

Since the clitoral tissue used in metoidioplasty stays connected to its original nerves and blood supply, most patients keep their ability to feel touch and sexual sensation. This is one of the reasons many people feel satisfied with their results. [6] 

3. Shorter Recovery Time

Recovery from metoidioplasty is usually quicker than phalloplasty. Since there are fewer surgical sites and no need for tissue grafts, many people who undergo metoidioplasty surgery are able to return to regular activities sooner. [4] 

4. No Need for Penile Implants

Unlike phalloplasty, metoidioplasty does not usually require the use of implants to achieve an erection. The neophallus created from clitoral tissue can become erect naturally, thanks to preserved erectile function.

5. A More Natural-Looking Outcome for Some Patients

For many, the results of metoidioplasty feel more natural and align better with their body image and transition goals. The smaller size and natural function are often preferred by those who do not desire a large phallus.

Metoidioplasty can be a great choice for people who want gender-affirming bottom surgery with natural sensation and a less invasive process. Here are some important factors that help determine if this surgery is right for you:

1. Patients on Testosterone Therapy (Typically for 1 Year or More)

To be eligible for metoidioplasty, patients usually need to be on testosterone for at least 12 months. Testosterone causes the clitoris to grow (clitoral hypertrophy), which helps create a more functional and visible neophallus during surgery. [4] 

2. Non-Smokers or Willing to Stop Before Surgery

Smoking can affect healing and increase the risk of complications. If you smoke, you’ll be asked to quit several weeks before and after surgery to help your body heal safely. 

3. In Good Overall Health

Like with any surgery, being in good physical and mental health is important. Your care team may ask for lab tests or a letter from your primary care provider or therapist to make sure your body and mind are ready for the procedure. 

4. Individuals Looking for a Smaller Structure with Preserved Sensation

Metoidioplasty is best for people who want a smaller penis that still allows for sensation and natural erection. If this aligns with your goals and you don’t feel the need for a larger neophallus or implants, this surgery may be a good fit.

There are a few different ways metoidioplasty can be done. The right option depends on your goals, your anatomy, and how much reconstruction you want. At clinics like Align Surgical Associates, your care team will help customize the surgery to fit your needs.

Customizing the Right Approach

Every patient is different, and the type of metoidioplasty you choose will depend on your transition goals, your health, and your preferences. Your surgical team will discuss the pros and cons of each method with you and help create a plan that feels right for your body and identity.

If you’re considering metoidioplasty, knowing what to expect before, during, and after surgery can help you feel more prepared. The team at Align Surgical Associates will guide you through every step of the process with affirming and respectful care.

Recovering after metoidioplasty is an important part of the process, and the timeline can vary depending on your procedure and how your body heals. Here’s what you can expect during your recovery:

1. General Recovery Timeline

After metoidioplasty, you’ll generally need 2 to 6 weeks for your body to heal enough to return to most daily activities. However, full healing, especially if you’ve had more complex procedures like urethral lengthening or scrotoplasty, can take several months.

2. Follow-Up Appointments

You’ll have follow-up appointments with your surgeon to check the healing progress, manage any concerns, and ensure there are no complications. These typically happen at 1-2 weeks, 6 weeks, and 3-6 months post-surgery.

3. Wound Care and Hygiene

Proper wound care is essential to avoid infections. Your surgeon will give you specific instructions on how to care for the surgical site, including keeping the area clean, using prescribed ointments, and avoiding putting pressure on the site. It’s important to keep the area dry and clean to promote healing. [4] 

4. Activity Restrictions

For the first few weeks, you’ll need to avoid strenuous activities, such as lifting, intense exercise, or sexual activity to allow your body time to heal properly. After 6 weeks, most people can resume light activities, but it’s best to avoid any heavy lifting or high-impact sports for a few months

While metoidioplasty is generally a safe and successful procedure, it’s important to understand the potential risks and considerations. Every surgery comes with some risks, but these can be minimized with careful planning and choosing an experienced surgical team.

1. Common Surgical Risks

As with any surgery, there are common risks associated with metoidioplasty. These include infection, scarring, fistulas (abnormal connections between tissues), and strictures (narrowing of the urethra). These complications are relatively rare, but it’s important to follow all aftercare instructions to reduce these risks.

2. Urethral Lengthening Risks (if applicable)

If you opt for urethral lengthening as part of your metoidioplasty, there are additional risks to be aware of, including difficulty with urination, urinary tract infections (UTIs), or urethral strictures. Your surgeon will carefully evaluate whether this procedure is right for you, and closely monitor your healing to prevent these issues. [4]

3. Importance of Choosing an Experienced Surgical Team

The success of your surgery depends on the skill and experience of your surgical team. Choosing a qualified, experienced surgeon with a track record of successful metoidioplasty procedures is one of the most important steps you can take. A skilled team will help minimize risks and provide excellent post-surgical care to support your recovery.

Choosing the right clinic for your metoidioplasty is an important decision that impacts not only the surgery itself but also your overall experience, from consultation to recovery. Here are some reasons why Align Surgical Associates stands out as a top choice for your gender-affirming surgery:

1. Experience of the Surgical Team

Our surgical team is highly experienced in performing metoidioplasty and other gender-affirming surgeries. Our surgeons are specialists who understand the unique needs of transmasculine and nonbinary individuals, ensuring that you receive expert care tailored to your goals.

2. Holistic, Affirming, Safe Care

We provide holistic, affirming, and safe care, meaning we approach each patient with respect and compassion. Our team is trained to provide care that is sensitive to the emotional and psychological experiences of individuals undergoing gender-affirming surgery. We aim to make you feel heard, understood, and supported at every stage.

3. Testimonials or Patient Stories

Our patients’ experiences speak for themselves. We are proud to share patient testimonials and stories about how our team has helped them achieve their goals for gender-affirming surgery. Many of our patients report feeling more confident and empowered after their procedures, and we believe that hearing from others who’ve been through the journey can help you feel more at ease.

4. Aftercare and Long-Term Follow-Up Support

Recovery doesn’t end when you leave the operating room. We offer ongoing aftercare and long-term follow-up support to ensure that your healing process goes smoothly. Our team is available for any questions you may have, and we offer resources such as peer support groups, mental health support, and access to medical care as needed.

At Align Surgical Associates, we prioritize your well-being every step of the way. From experienced surgeons to affirming care and comprehensive aftercare support, we ensure that your metoidioplasty journey is as smooth and empowering as possible.

Get in Touch Today!

Dr. Michael Safir, MD is a board-certified reconstructive urologist in Los Angeles who specializes exclusively in genital gender-affirming surgery. With a subspecialty certification in Female Pelvic Medicine and Reconstructive Surgery (FPM-RS), Dr. Safir is among the few urologists in the world with fellowship training in both male and female genital reconstruction. He completed his undergraduate and medical education through the Honors Program in Medical Education at Northwestern University, followed by a urology residency at the same institution. Dr. Safir completed advanced fellowships in Male Genitourinary Reconstruction at UCSF and Female Reconstructive Urology at UCLA, studying under world-renowned mentors Dr. Jack McAninch and Dr. Shlomo Raz. His leadership roles include serving as Section Chief of Reconstructive Urology at New York Medical College, President of the Los Angeles Urological Society, and Clinical Instructor at both UCLA and UCSF. Certified by the American Board of Urology and a Diplomate in FPM-RS, Dr. Safir is also an active member of the World Professional Association for Transgender Health (WPATH). He is widely recognized for his compassionate, patient-centered approach to procedures such as metoidioplasty, phalloplasty, and scrotoplasty, and is a trusted provider for transgender patients across the country seeking affirming and individualized care