Transgender Metoidioplasty: What You Need to Know

Pros 

• It preserves erotic sensitivity. The sensitivity of the clitoris is present in the newly formed penis.
• The penis formed through metoidioplasty has erectile function.
• When considering metoidioplasty vs. phalloplasty, metoidioplasty is less costly and has a shorter recovery time. A phalloplasty is a more involved procedure, in which a flap of skin is removed from another part of the body and used to extend the urethra and form a more sizable penis. Recovery from a phalloplasty tends to be more extensive.
• Metoidioplasty complications are uncommon.

Cons 

• The penis formed through metoidioplasty is about one to three inches long and may not have enough length for penetration. If that's your goal, a phalloplasty could be a better option. 
• You’ll need to undergo hormone replacement therapy (testosterone treatment) for a year or two prior to surgery, to enlarge the clitoris.
• Recovery can take up to three months.

The average cost of metoidioplasty is $12,000. That doesn’t include:

• Testosterone treatment before surgery
• Additional procedures carried out at the time of surgery, like a hysterectomy or urethral lengthening
• Refinement surgeries, if you’re unhappy with the outcome
• Medications you’ll need after the surgery
• Hospital fees, if you need to stay in the hospital after the procedure

Every clinic is different, so discuss the price with your surgeon during your initial consultation. Some clinics will have a specially trained team member who can detail the costs for you.

Metoidioplasty and testosterone treatments aren’t covered by insurance, but your insurance provider may help with the cost of medications after the surgery.

A metoidioplasty usually takes between 2.5 and 5 hours. Beyond the primary procedure, which reshapes the existing female genital tissue into a penis, there are optional complementary operations, such as hysterectomy (uterus removal) and a vaginectomy (vagina removal); you can discuss these with your surgeon during your initial consultation. 

If you opt for a simple metoidioplasty, with no additional procedures, you’ll be sedated and receive local anesthesia. You won’t remember anything after the surgery, and you’ll feel relaxed, but you won’t be unconscious, as you would be with general anesthesia.

In many cases, patients are required to undergo psychological screening to confirm gender dysphoria prior to surgery. An assessment can help ensure you’re mentally prepared for such an extensive surgery.

The procedure includes some or all of the following steps, depending on your goals.

• Testosterone treatment prior to surgery to enlarge the clitoris, giving surgeons ample tissue to work with. Dr. Praful Ramineni, a plastic surgeon in Washington, D.C., explains in a RealSelf Q&A, “If the clitoris doesn't have sufficient size, then it can't be released and advanced forward, and the aesthetic and functional outcome would be poor.”
• Release of the clitoral tissues
• Rearrangement of the labial tissue to form a new penis
• Rerouting of the urethra so it runs through the penis
• A scrotoplasty, transforming the vulva into a pouch that can house testicular implants

Beyond the type of anesthesia used and the additional procedures you decide on, each surgeon has unique techniques and preferences. You may be able to go home the same day, but you’ll likely stay in the hospital for one to three nights after your surgery. 

If you decide to add urethral lengthening (so you can pee standing up) or choose to have any of your female reproductive organs removed, you’ll need general anesthesia. The risk of complications rises with each additional procedure, and general anesthesia carries its own risks. Other complications of metoidioplasty include infection, wound breakdown, narrowing of the urethra, and urethral fistulas. Be sure to discuss all the risks with your surgeon at your consultation.