Bottom surgeries help bring an individual’s physical features in line with their gender identity. For transmasculine people, options include metoidioplasty, phalloplasty, and scrotoplasty. If you want to pursue surgery, please see our article on Surgery Referral Sessions.
Types of Bottom Surgery
Metoidioplasty
Metoidioplasty releases the clitoris from its surrounding tissue, extending it to resemble a small penis. Metoidioplasty can include urethral lengthening to allow for standing urination, and scrotoplasty to create a scrotum for testicular implants.
A big advantage of metoidioplasty is its potential for preserving the feelings of touch and sexual pleasure, as the neophallus (new penis) is an extension of the natural erectile tissue. The size of the phallus after surgery can vary depending on things like testosterone exposure and natural body differences.
Phalloplasty
Phalloplasty involves constructing a phallus using tissue grafts, usually from the forearm, thigh, or abdomen. Phalloplasty offers the chance for a larger and more traditional looking phallus compared to metoidioplasty. Procedures like urethral lengthening, scrotoplasty, and erectile device placement can be performed at the same time or in later surgeries.
Phalloplasty is well liked for its genital appearance and functional results, but it often requires lengthy recovery periods, and sensation in the area can be changed or diminished.
Scrotoplasty
Scrotoplasty is often done at the same time as metoidioplasty or phalloplasty. A scrotum is created from the labia majora (the larger vulva lips) or skin grafts. The new scrotum can hold testicular implants, giving a more traditional masculine look.
Scrotoplasty can be performed using various techniques, including the creation of a single midline scrotum (one unified sack) or include separate compartments for each testicle.
Scrotoplasty is considered a fair straightforward procedure with low chance of complications.
Hysterectomy
This is the removal of the uterus, and can include the removal of both ovaries and fallopian tubes (Bilateral salpingooopherectomy).
We have a full article exploring hysterectomies here.
Recovery and Aftercare for FTM Bottom Surgery
Immediate Post-Operative Care
Recovery varies significantly between procedures:
Metoidioplasty Recovery:
- Hospital stay: 3-5 days
- Initial healing: 2-4 weeks
- Return to work: 2-6 weeks
- Full recovery: 3-6 months
Phalloplasty Recovery:
- Hospital stay: 7-14 days
- Initial healing: 4-8 weeks
- Return to work: 6-12 weeks
- Full recovery: 12-18 months
Recovery times vary depending on individual health, surgical technique, and adherence to post-op care instructions.
Long-term Recovery Considerations
Wound Care Management
- Daily dressing changes during initial healing phase
- Infection prevention protocols
- Scar management techniques such as massage and silicone sheets
- Regular follow-up appointments with the surgical team
Functional Recovery
- Urination training and techniques (especially after urethral lengthening)
- Development of sexual function and gradual return of sensation
- Management and maintenance of implanted prosthetic devices
Psychological Support
- Post-surgery counselling to helps patients adapt to physical changes and manage expectations.
- Engagement with peer support groups, which many find invaluable for emotional during recovery.
Bottom Surgery Costs in the UK
Bottom surgery costs range between £15,000-£50,000 privately, with procedures averaging $20,000-$35,000 globally. UK costs vary significantly based on:
- Private Surgery Costs
- Metoidioplasty: £12,000-£25,000
- Phalloplasty (single stage): £25,000-£45,000
- Multi-stage phalloplasty: £35,000-£60,000
- Hysterectomy: £8,000-£15,000
- Additional procedures: £3,000-£10,000 each
Many patients consider medical tourism to access surgery abroad. While this can offer cost savings, it is essential to carefully evaluate the availability of aftercare, and the risks of managing complications when far from the surgical clinic or centre.
NHS Funding for FTM Bottom Surgery
The NHS funds for gender-affirming surgery through Gender Identity Clinics (GICs), although waiting times can be substantial.
To qualify for NHS-funded FTM bottom surgery, patients typically must:
- Have a confirmed gender dysphoria diagnosis
- Be aged 18 years or older
- Have lived in their affirmed gender for at least 12 months
- Have undergone hormone therapy for a minimum of 12 months
- Demonstrate psychological stability and readiness
- Have realistic expectations of surgical outcomes
- Complete required psychological assessments
- The NHS Referral Process
- GP referral to Gender Identity Clinic (GIC)
- Initial assessment at GIC (often with a wait time of 2+ years)
- Psychological evaluation and therapy sessions
- Hormone therapy initiation and monitoring
- Consideration of surgical referral after at least 12+ months of hormone therapy
- Pre-operative assessments and final approvals
- Surgery scheduling (which may involve additional waiting time)
The entire NHS process typically takes 4-7 years from initial referral to surgery completion.
Preparing for FTM Bottom Surgery
Physical Preparation
- Health Optimisation
- Maintain a healthy BMI to reduce risks related to anaesthesia and wound healing
- Stop smoking minimum 6 weeks prior to surgery to improve circulation and recovery
- Optimise your nutrition and fitness to support your immune system and healing
- Manage chronic health conditions with your GP/healthcare provider
- Complete required medical clearances including blood tests, imaging and specialist assessments as required
Hormone Considerations Some surgeons require hormone therapy pauses before surgery, whilst others continue treatment throughout. Discuss timing with your surgeon and reach out to us if you require support in making changes to your Transition Pack or prescription referral preferences.
Support System Development
- Arrange caregiving assistance for initial recovery period, considering mobility, wound care and meals
- Plan extended time off work to allow for healing and rest
- Prepare home environment for recovery, with accessible sleeping arrangements, supplies and hygiene essentials
- Build emotional support network of family, friends, or support groups
- Consider therapy or counselling to navigate emotional changes and maintain wellbeing during recovery
Financial Planning
- Verify insurance coverage to understand what is included
- Arrange payment plans with clinics or hospitals, if paying privately
- Account for travel and accommodation costs
- Calculate time off work and plan for unpaid leave if necessary
- Set aside an emergency fund to cover unexpected complications, revisions or extended recovery needs
Risks and Complications of FTM Bottom Surgery
Common Complications
Metoidioplasty Risks:
- Urethral complications, such as strictures or fistulas
- Wound healing issues or infection
- Loss of sensation
- Cosmetic results that may not meet expectations
- Possibility of revision surgery to improve function or appearance
Phalloplasty Risks:
- Flap failure or tissue necrosis
- Urethral complications such as strictures or fistulas
- Infection at both donor and /recipient sites
- Problems related to erectile implant devices
- Multiple revision requirements
Long-term Considerations
- Sensation changes may be permanent and vary between individuals
- Sexual function outcomes varyvaries significantly
- Urination difficulties may persist in some patients
- Prosthetic device maintenance is an ongoing requirement
- Revision surgeries y are commonly needed to optimise function and appearance
Understanding these factors risks helps patients make informed decisions and prepare realistically appropriately for their surgical journey.
Choosing your Surgeon
We have a list of recommended surgeons here.
We always recommend thoroughly researching the best professionals for your surgery. Look up the name of the surgery you are seeking, your region, and the names of surgeons you’ve heard of. Visit their websites and gather as much information as possible. Choosing a surgeon is important, so make sure that when you have a consultation or seek second opinions, you feel completely confident in the surgeon and the services they offer.
If you feel ready, you can book a Surgery Referral session with us to help you with the next steps. You can read more about surgery referral sessions here.