What Is Metoidioplasty
A gender-affirming surgery for trans men and non-binary people assigned female at birth.
Uses an enlarged clitoris (from testosterone therapy) to create a penis-like structure, instead of using tissue grafts from elsewhere.
The result preserves natural sensation and erectile function.
Types of Metoidioplasty
| Type | What's Included | Pros / What It Enables |
|---|---|---|
| Simple Metoidioplasty | Just releasing the enlarged clitoris from surrounding tissue to form a small penis-like organ. | Quicker surgery, fewer complications, preserves sensation & erections. |
| With Urethral Lengthening | Adds extending the urethra (using grafts like inner cheek or vaginal tissue) so you can stand to urinate. | Adds function (standing urination) but more complex. |
| Complete Metoidioplasty | Combines several procedures: clitoral release, urethral lengthening, vaginectomy (closing the vaginal canal), scrotoplasty, and optionally testicular implants. | Most masculinised appearance and function, but also the longest surgery and recovery. |
How It Compares to Phalloplasty
| Aspect | Metoidioplasty | Phalloplasty |
|---|---|---|
| Penis size | Smaller (typically ~3-7 cm, depending on testosterone effects). | Larger, more possibility for penetrative sex. |
| Sensation / erectile function | Usually preserved well. | More complex; depends on technique and grafts used. |
| Surgery time & recovery | Shorter, fewer donor sites, generally quicker recovery. | Longer surgery, more donor-site impacts, more stages often required. |
| Risks / Costs | Lower risk compared to phalloplasty generally; less expensive. | Higher risk of complications; more expensive; more surgical stages. |
Preparing for the Surgery
Hormone therapy: Usually need testosterone for at least ~12 months before surgery. This helps the clitoris enlarge enough for better results.
Medical assessments: Checking overall health, anatomy, doing blood tests, consultations with surgeons.
Lifestyle prep: Quit smoking, optimise weight, stop certain meds, arrange help for after surgery, plan time off.
The Surgical Process
Under general anaesthetic.
Steps depend on type, but usually include:
Freeing/releasing the clitoris from surrounding tissue while preserving nerve and blood supply.
If urethral lengthening is chosen, reconstructing a urethra via graft tissue.
Reshaping surrounding tissues for a male-appearing genital structure. Scrotoplasty and vaginectomy if included.
Duration depends on how much is done:
Simple: ~2-4 hours
With urethral lengthening: ~4-6 hours
Complete: ~6-8 hours
Recovery & Outcomes
After surgery:
Hospital monitoring, pain management.
Catheter(s) for urination if urethral work was done. Wound care.
Healing phases:
First week: rest, limited activity.
Weeks 2-6: remove catheter (~2-3 weeks), gradually increase activity.
Full healing aesthetics can take 3-6 months; final results up to 6-12 months.
What to expect:
Standing urination if urethral lengthening is done.
Erection and/or sexual sensation usually preserved. Some temporary numbness is common during healing.
Size depends on how the body responded to testosterone.
Risks, Costs & Other Considerations
Risks: Urethral problems (narrowing, fistulas), wound healing issues, infection, changes in sensation, possible undesired appearance.
Cost (UK private):
Simple: ~£8,000-£12,000
With urethral lengthening: ~£12,000-£18,000
Complete version: ~£15,000-£25,000
NHS: Funding may be possible but typically involves long waiting times and meeting criteria (diagnosis, assessments, etc.).
Is It Right for You?
You might choose metoidioplasty if you:
Want masculinised genitalia with shorter recovery.
Prioritise preserved feeling, erections, minimal donor‐site surgeries.
Are okay with smaller size and understand the limitations around penetrative sex.
You might instead lean to phalloplasty if you want larger size or more specific aesthetic/functional outcomes that metoidioplasty might not achieve alone.