Trans Masculine Surgeries Explained

This week on The Slut Show Ellen Moore is joined by Slut Show regular transman and multi talented content creator Deen (he/him). They discuss the various different options for bottom surgery, his top surgery coming up and how he sees the future. This week’s Slutty Science explains - in great detail - what the various surgical procedures include, for which trans (masculine) individuals can opt, illustrating the main differences, their consequences, pros and cons.

This week's Slutty Science builds on the Slutty Science of episode 2, 5 and 6 of season 2, as well as last week's episode.

Last week we took a closer look at testosterone therapy in the transitional process of transmasculine and non-binary individuals. Today we are looking into some of the different kinds of gender affirmative medical procedures available for transmasculine and non-binary people.

Please note: this article contains information about various surgical procedures, which may be triggering for some readers.

Firstly there is the surgical procedure of removing one's boobs. In medical terms this is called a mastectomy, but this is more commonly known as top surgery, created to give a (more) masculine appearance to the chest.               

Then there is transmasculine bottom surgery, aimed to transform the female genitalia and reconstruct them into that of a male. In other words, exchanging your vagina for a dick. There are two different types of bottom surgery: metoidioplasty and phalloplasty. 

When a trans person assigned female at birth begins using testosterone, bottom growth occurs. This refers to the enlargement of the clitoris, as a result of using testosterone.

During a metoidioplasty, the clitoral ligaments - a difficult word for connective tissue - are detached, which allows the clitoris to lengthen and drop into a position similar to that of a cis man’s penis. A plastic surgeon then proceeds to sculpt the head of the clitoris in a way which more closely resembles the head of a cis dick. 

The neo-phallus (aka. dick) created with this method is - on average - anywhere between 5 and 7 centimeters long.

Additionally to this procedure, the labia can be reshaped into a scrotum, either with or without testicular prosthesis. This is called a scrotoplasty.

A metoidioplasty can be done with or without urethral lengthening procedures. Urethral lengthening extends the urethra along the new phallus. This is called urethroplasty and enables transmasculine individuals to urinate from their newly shaped cock, which forms a major reason why people choose to undergo transmasculine gender affirming genital surgery.

However, urethral lengthening increases the risk of surgical complications. These complications can include dribbling or spraying during urination, urinary blockages, a leak or even rupture of the lengthened urethra.

Metoidioplasty is usually considered to be a single-stage surgery. However, some people may require additional surgeries in order to achieve their desired results. Supplementary surgeries can be done to improve either the appearance or function of the neo-phallus.

Perks of metoidioplasty are:

  • Conservation of erotic sensitivity of the clitoris;
  • Lower complication rates, risks and fewer procedures (even with urethroplasty);
  • It doesn't result in large scars;
  • It heals faster;
  • There is no need for a penis prosthesis, as the metoidioplasty dick has a natural erectile function.

The other option transmasculine individuals have is phalloplasty. This is the creation of a dick of a similar volume to that in genetic males.

During phalloplasty tissue, which will be used to construct the penis, is harvested from another part of the body. Usually this is taken from either upper legs or lower arms. It is then shaped to look like a penis. Thereafter, the tissue is transferred to the pelvis where the blood vessels and nerves are attached to recipient vessels in the pelvis. Additionally, patients who choose for a phalloplasty, can - too - choose for a urethroplasty.

Phalloplasty is a more complex surgery in comparison to metoidioplasty, where the latter is a single-stage surgery, phalloplasty is a multi-staged procedure which requires multiple surgeries in order to complete the process. A phalloplasty can result in numerous complications. Most of them are relatively minor and fixable.

Since the more recent development of metoidioplasty, phalloplasty has lost its popularity.

    Perks of phalloplasty are:

    • Patients are more likely to be able to penetrate sexual partners, however erectile rods are needed to achieve an erection;
    • Significantly bigger dick, but less erogenous sensations;
    • A more cis-gender looking dick.

    For transmasculine individuals who initially choose metoidioplasty, it is possible to later undergo a phalloplasty. This is true regardless of whether the person decides to have a urethral lengthening at the time of the procedure. However, the reverse is not true. The procedure for embedding the clitoris in the penis during phalloplasty makes a later metoidioplasty not feasible.

    Concluding this week’s incredibly detailed, complicated, medical and not so Slutty piece of Science: being born as a trans person is complicated enough on its own. The decisions trans folks have to make about their bodies, the way they choose to present themselves and their internal struggle are plenty on their own. So how about we, as a society, make it a little easier on them. Ask your friends what their pronouns are, put them in your Instagram bio - yes, also if you’re a cis person - and educate yourself and those around you about the things unknown to you, so that not all that weight rests upon the shoulders of those obliged to carry so much already.

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    We hope to see you on our socials and for now, Sluts Out!

    Lots of love,

    Ellen Moore.

    ‘The Slut Show With Ellen Moore’: A place to speak openly about shit you and I have to deal with on a daily basis. About feminism, insecurities, feeling like a bomb ass bitch and obviously about loads of sex. Raw, real and uncensored, Ellen Moore brings you your weekly dose of empowerment.



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