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Matthew’s Place

So you think you want bottom surgery. Now what?

by Andrew Adams

Image Credit: Vladimir Vladimirov/Getty Images

Hello there everyone! It’s been awhile since I have written for Matthew’s Place, but if you were here between 2018 and 2020, you might remember me. If you are new here, that’s totally okay too! I wanted to reintroduce myself since it’s been so long and because, frankly, I have changed a lot since then.

My name is Andrew, I use he/him pronouns, and I am transgender, queer (bisexual and grey-asexual if you want to get specific), autistic with a side of ADHD, and recently diagnosed Elhers Danlos hypermobily type. I’m a peer mentor and I am going to school to become a therapist, assuming a graduate program accepts me. I like to garden, I love my pet reptiles, and I enjoy Brazilian Jiujitsu, jigsaw puzzles, and video games. If this is your first time hearing from me, it’s nice to meet you! If you have been here before, welcome back!

I wanted to start out my adventures again by creating a series following my journey to get bottom surgery, as when I tried to do research myself, I struggled to find content on exactly how to go about something like this, what the process is like, and most importantly, how recovery is. I could find plenty of short pieces about one or two of those topics, but nothing as comprehensive as I wished I could find for my own benefit. Therefore, I thought it might make a nice blog series.

Bottom surgery is the colloquial name given to dozens of potential procedures involved in changing the genitals of a transgender person from their assigned sex at birth characteristics to the characteristics typically associated with their experienced gender. Every transgender person is different, and surgery, especially bottom surgery, is a complicated and terrifying ordeal, so I want to make sure I am very clear when I say that the desire for bottom surgery is not required to be transgender, and no two bottom surgeries are identical, as each transgender person has different medical needs and desires for their body.

So you think you want bottom surgery. Now what?

The first thing you need to do is decide which procedure you would want. There are two main surgeries available for transgender men who would like the addition of a penis, along with several smaller procedures they can do at the same time to either add or remove features to or from the anatomy. Here is a brief description of some of the procedures available to transgender people who were assigned female at birth (Trigger warning for anatomical terms, also I am not a doctor or expert so I am certain that I do not have the expertise to fully explain all of these, this is just a brief overview so you can start thinking about it):

  • Phalloplasty (phallo)- the creation of a phallus from a donor tissue site, often the forearm, thigh, or I have seen the abdomen used rarely, including connecting the nerves of existing anatomy to the phallus
  • Metoidioplasty (Meta)- The creation of a phallus using the pre-existing phallic tissue (the clitoris), typically much smaller than a phalloplasty penis but does not create the donor site scar that intimidates many people out of phalloplasty.
  • Urethral lengthening — can be done with either phallo or meta, reroutes the urethra through the new phallus, either using tissue from the inside of the cheek (meta) or donor site (phallo)
  • Clitoral release — severing of the tissue holding the clitoris in place, often done during metoidioplasty
  • Glansplasty — creation of a ‘head’ on a phalloplasty phallus
  • Scrotoplasty — creation of a scrotum
  • Testicular implants — adding testicular implants to the previously made scrotum
  • Vaginectomy — removal of the vagina
  • Hysterectomy — typically done before phallo or meta, the removal of the uterus
  • Oophorectomy — removal of the ovaries, sometimes done with hysterectomy
  • Erectile implant — either the insertion of a semi-regid rod or a pump inside of the phalloplasty phallus to assist in sexual function

This list is not exclusive and one can get whichever combination of procedures that they desire, assuming it’s medically possible for them and their medical team.

The first step in the journey to get bottom surgery would be to select which procedures you would like. This means that you need to think about what you want for your body. For me, I desire a phallus capable of both sexual and bathroom use, as close to what a cisgender man would have as possible. This means that I will want phalloplasty, as I do not have enough material there for metoidioplasty to yield the results that I would want. I also want urethral lengthening so that I can use the bathroom while standing, scrotoplasty with testicular implants, most likely glansplasty (although looks are second to function for me), and eventually an erectile implant. I have already had a hysterectomy, but not an oophorectomy, and I do not intend to have an oophorectomy anytime soon as I am unsure if I want to use my eggs for children one day. I will have a vaginectomy though, as I don’t want what is currently there. So overall, I will want phalloplasty with urethral lengthening, scrotoplasty with implants, vaginectomy, and erectile implants.

Now that we know we want phalloplasty, we need to pick a donor site. Since metoidioplasty does not require a donor site, meta patients can skip this step. The most common donor site is the non-dominant forearm, which for me would be my left arm. This donor site has the advantage of being very sensitive to touch while being relatively hairless, which is something that I hope my new organ will also have, and the forearm is rarely too fatty to produce good results, as one can sometimes get with other donor sites (my surgeon referred to this as ‘coke can dick’). I am already a thicker guy, so that rules out my thighs and back as donor sites. While using the arm will require physical therapy for my hand and will leave a big nasty rectangular scar, my arm is the best option. This is called RFF phalloplasty, or Radial Forearm Flap phalloplasty.

The first step is done! Now we know what we want. I feel confident that, while this will be a huge step in my life, I am making the right choice for myself and my body. This isn’t going to be easy, so I am glad to have all of you along for the ride with me. I am hoping to have the surgery itself in May of 2023. Stay tuned for my next post where I talk about picking a surgeon, having a consultation, and more! Thank you all for reading and have a great day!

About the Author

Andrew (he/him) is a transgender student at the University of Central Florida where he is studying psychology in the hopes of becoming a therapist. He is a peer mentor for at risk teenagers at Aspire Health Partners, and he enjoys gardening, taking care of several pet reptiles, playing the piano, and replaying Skyrim on X-Box. While he has focused on his own growth and wellbeing recently, he has previously worked or volunteered with The Trevor Project, Point of Pride, GLSEN, March For Our Lives, and for local political campaigns as an advocate for LGBTQ rights. Specifically, he also is the plaintiff in an ongoing legal battle against his high school who barred him from using the men’s bathroom due to him being transgender, and that legal battle is still ongoing (See Adams v. St John’s County School Board). Additionally, as an Autistic ADHDer with a connective tissue disorder, Andrew is an advocate for both neurodiversity and disability rig

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