Metoidioplasty - Frequently Asked Questions

Will I need surgery referral letters to get Metoidioplasty?
Yes, most Metoidioplasty surgeons and insurance companies follow WPATH guidelines, which require two surgery referral letters. One can be from your primary care provider and the other needs to be from a mental health professional. (Some insurance companies require a total of three letters, one from a PCP and two from a mental health professional.)

How big of a penis can I get with Metoidioplasty?
The average length of a Metoidioplasty phallus is 4.6 cm. Dr. Curtis Crane and the surgeons at Crane Center for Transgender Surgery suggest that 4-6 cm is achievable. If a more adult sized phallus is important to you, consider Phalloplasty instead.

Are there ways to enlarge a Metoidioplasty penis?
DHT cream was used by transgender men for many years to enlarge the neo-phallus before Metoidioplasty, with some success. In recent years however, DHT cream has become unavailable. A surgeon in Iran published a study in 2016 about the successful use of a traction device to lengthen the post-Metoidioplasty phallus. Dr. Toby Meltzer, a Metoidioplasty surgeon based in Scottsdale, Arizona and Portland, Oregon, has long advocated pumping to enlarge the neo-phallus before Metoidioplasty. Pumping is also recommended by some surgeons to prevent traction (loss of length) after Metoidioplasty.

Will I be able to pee while standing after Metoidioplasty?
The ability to pee while standing after Metoidioplasty depends on anatomy and is not always possible. People who are heavier are often not be able to pee standing up after Metoidioplasty.

Will I be capable to sexual penetrate after Metoidioplasty?
Sexual penetration after Metoidioplasty is rarely possible. Some people can find the right position to penetrate but aren't able to thrust or achieve deep penetration. If this is important to you, consider Phalloplasty instead.

Do I need to be on testosterone to have a Metoidioplasty?
Yes, surgeons generally require you to be on testosterone for one to two years prior to having Metoidioplasty, to maximize growth of the neo-phallus before surgery. If you're planning to go off testosterone at some point after surgery, it's important to know that you could lose phallus length, which could prevent standing-to-pee. Intersex patients may not require HRT.

Do I need to have a Hysterectomy before Metoidioplasty?
Only if you're having a Vaginectomy done with Metoidioplasty, then the uterus needs to be removed. (Ovaries do not have to be removed.)

Can I have Urethral Lengthening without having a Vaginectomy?
Most surgeons require a Vaginectomy if Urethroplasty is also being performed because Vaginectomy reduces the risk of fistula. However, there are a handful of surgeons who will do UL without Vaginectomy: Dr. Crane, Dr. Santucci and Dr. Safir. If you'reconsidering this option, it's important to understand the increased risk of complications.

Can I have Testicular Implants put in at the same time as the Metoidioplasty and Scrotoplasty?
Most surgeons prefer to wait until the scrotum has healed before putting in testicular implants. Generally, this takes place 5-6 months after the initial surgery. The exception to this is with the Belgrade Metoidioplasty technique with labial flaps joined at the midline to create the scotum (vs. VY Scrotoplasty). In this case, the testicular implants are put in during the initial surgery.

METOIDIOPLASTY PHOTOS
View photos of Metoidioplasty results from Dr. Safir.

How long do I need to stay near my surgeon after Metoidioplasty?
It's important to stay close to your surgeon during the initial healing period after Metoidioplasty so plan on staying by for four weeks.

What is recovery from Metoidioplasty like?
Recovery can include: moderate to severe pain; a suprapubic catheter for 2-6 weeks if urethral lengthening is performed; no desk work for two weeks and no strenuous activities for four weeks.

How often will I see my surgeon following surgery?
Following discharge from the surgery center, you'll see your surgeon at least once a week for three to four weeks, depending on how you're healing.

What is a fistula?
If you experience urine coming out from somewhere other than the urethra or SP catheter tube, this is a fistula. These often heal on their own but sometimes require surgery. Depending on the nature of the fistula, surgeons will require a period of three to six months between the original Metoidioplasty surgery and a fistula repair surgery to allow tissues to heal and strengthen. Learn more about potential complications from Metoidioplasty here.

What is a Mons Resection?
A Mons Resection or Monsplasty is a procedure that can be helpful for patients with excess skin and a prominent mons (area in front of the pubic bone.) An incision is made across the abdomen and the lower section is lifted to bring the scrotum and phallus out in front of the legs more. Monsplasty can be performed at the same time as insertion of Testicular Implants.

What if I decide after surgery that I need Phalloplasty? Can Phalloplasty be performed on someone who has had a previous Metoidioplasty?
Yes, Phalloplasty can be done for some patients who have had Metoidioplasty in the past. It is dependent on how your original surgery was done and surgeon preference.

Last updated: 01/23/2024