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.
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.