I thought I’d discuss “The Surgery.”
Every time the subject of my being transgender comes up, inevitably there is somebody out there that immediately asks if I have had “The Surgery”. There is this idea that there is one big all-in-one genital surgery for trans folks. I’m not sure where the scare quotes around “The Surgery” come from, but that’s how everyone has asked.
What they really want to know is if you have a penis. I’m pretty sure for transgender women, when they get asked about “The Surgery”, it’s because people want to know if the woman has a penis. There seems to be a huge obsession, culturally, about whether or not transgender people have penises.
This voracious appetite for what we do with our genitals, is one of the reasons I decided to write about my surgery. I’m not going to get into the nitty gritty details here. I have a not so secret Tumblr for that. If you are trans, and want more bottom surgery info, shoot me a line, and I’ll tell you my Tumblr for that.
So in the interest of education, here is how buying a penis works for transgender men.
The first myth we need to dispel is that there isn’t a single surgery for this. There are a smorgasbord of options. Every transgender person picks and chooses what works for them, depending on what works for their anatomy, economic reality, and desires.
When it comes to shopping for a penis, you have two main kinds of penises to choose from.
There is phalloplasty. It’s where they actually build you a penis from scratch, pretty much. You have donor sites for skin, and you can pick your size, have nerve endings moved, and all sorts of things. It’s a bigger surgery, that realistically is multiple surgeries over a period of time. This is the Cadillac of bigger better penises. It’s a lot of work to get their, though.
Then there is metoidioplasty. This is taking your own anatomy, the clitoris that has been enlarged by testosterone, and helping it reach a longer length. At the very minimum, this can be called a basic release, because it’s about disconnecting a ligament and some labia, and letting your little friend gain at most a couple inches in length, if you are genetically able to. This will not create a typical cis gendered penis, but it is a penis with retained sensation. There are cisgendered men with penises this size, so it’s well within the bell curve of normal masculine expression. It’s just small.
I chose the metoidioplasty, because the increased chance to retain sensation, and the less invasive nature of the procedures, and reduced number of surgeries. Guys have great results with either, it’s all about what you want.
With a metoidioplasty, trans men can aways upgrade to a phalloplasty later. We can also decide if we want to keep the vagina, and if we want to lengthen our urethra’s to go through the new metoidioplasty, or not. We can also have testicles. This is a pick and choose situation, where each transgender man will decide what procedures he wants, or not.
For the best results of a metoidioplasty, you might need to have a mons resection if you have body fat. This is basically removing the fat from the mons area under your pubic hair, and then pulling everything upwards to a more masculine sitting position. It’s like a facelift for your penis. I’ve talked to some guys that have not done this, and the metoidioplasty was not very visible at all, and they were unhappy. Insurance does not cover this, because apparently we are half assing this whole trans coverage thing. If I’m buying a new penis, I want it to be visible.
However, we aren’t talking just one procedure for me. I will require a list of optional surgeries rolled into this one procedure:
Hysterectomy – The uterus is voted off the island.
Oophorectomy – The ovaries can go too.
Vaginectomy – Don’t go away mad, just go away.
Mons Resection – This is necessary, if I want there to be any visible change.
Meoidioplasty – The whole point is a penis.
Testicle implants – It would be weird to have a penis without balls, so this is on the plate as well.
One thing I am specifically not getting is urethral lengthening. There is no guarantee with a metoidioplasty that you can stand to pee anyways, and it is much more invasive, and increases my chances for complications and revisions, and seriously increases my healing time. If sitting to pee was good enough for Winston Churchill (according to urban legends), then it’s good enough for me.
So, you can see, there is a lot of options. It’s very mix and match.
There is a huge waitlist for these procedures, only made longer by Trumps inauguration. My top surgeon said she has had a huge flood of patients because of Trump, and the fears of the community about losing access to insurance.
I go to a consult in March, but who knows if I can get into surgery this year, even. I still don’t know if my insurance will be cut for next year. If that happens, my husband and I will be job hunting for sure. I like my job, but if I think we all know most men would choose their penis over their job, and I’m not an exception.
Lastly, I’d like to say this is going to impact my husband quite a bit. Once again, we are focusing all of our finances, vacation time, and efforts on a surgery for my body. He just spent hours organizing airfare, hotels, and car rentals. I feel incredibly happy he’s willing to be 100% supportive, but I wish this was past and done, so we can both just get on with our lives.