# Metoidioplasty Last updated July 30, 2025 > [!important] This report was produced by Gemini Deep Research. It is for educational purposes only and should not be considered medical advice. > [!NOTE] Looking for the complete deep-dive? > This page is a free educational overview. For insurance strategies, WPATH letter templates, and step-by-step surgical preparation, see **[[Becoming Yourself - The Complete Guide to Gender Affirming Surgery|Becoming Yourself]]** — the 1,093-page patient-written guide to gender-affirming surgery. > **[Get the book on Gumroad →](https://borgpup.gumroad.com/l/tyslr)** - [[#Introduction]] - [[#How Metoidioplasty Works]] - [[#Types of Metoidioplasty]] - [[#Simple Metoidioplasty]] - [[#Full Metoidioplasty]] - [[#Ring Metoidioplasty]] - [[#Centurion Metoidioplasty]] - [[#Pre-operative Preparation]] - [[#Medical and Psychological Evaluations]] - [[#Hormone Therapy Requirements]] - [[#Other Preparations]] - [[#The Surgical Procedure]] - [[#Anesthesia and Hospital Stay]] - [[#Post-operative Care and Recovery]] - [[#Immediate Post-operative Care]] - [[#Long-Term Aftercare]] - [[#Recovery Timeline]] - [[#Potential Risks and Complications]] - [[#Sensory Outcomes and Sexual Function]] - [[#Financial Considerations]] - [[#Cost of Metoidioplasty]] - [[#Insurance Coverage]] - [[#Metoidioplasty vs. Phalloplasty]] - [[#Pursuing Phalloplasty After Metoidioplasty]] - [[#Conclusion]] ## Introduction Metoidioplasty (sometimes spelled metaoidioplasty or metaidoioplasty) is a gender-affirming surgical procedure that creates masculine-appearing genitalia for transgender men and transmasculine individuals. Unlike phalloplasty, which constructs a penis from tissue harvested from another body part, metoidioplasty works with the body's existing anatomy — specifically the clitoris, which has typically been enlarged through testosterone therapy. The result is a small but naturally functioning phallus with preserved erogenous sensation and, in most cases, the ability to achieve natural erections without an implant. Metoidioplasty is often chosen by individuals who prioritize preserved sexual sensation, natural erectile function, and a less complex surgical process over penile size. For many transgender men, it provides meaningful gender affirmation while avoiding the extensive scarring, donor site morbidity, and longer recovery associated with phalloplasty. Some individuals view metoidioplasty as their definitive procedure, while others treat it as a first step toward eventual phalloplasty. ## How Metoidioplasty Works Testosterone therapy causes clitoral growth (clitoromegaly), typically increasing the length to approximately 4 to 6 centimeters over time. Metoidioplasty takes advantage of this growth by releasing the clitoris from its surrounding ligaments and skin to maximize the visible length of the new phallus. The procedure essentially "frees" the enlarged clitoris and repositions it to more closely resemble a small penis. The core steps of the procedure include releasing the suspensory ligament that holds the clitoris against the pubic bone, detaching the skin and tissue surrounding the clitoris to increase its visible projection, and reshaping the labia and surrounding tissue to create a more masculine genital appearance. Depending on the individual's goals, additional procedures may be combined with metoidioplasty, including urethral lengthening (to enable standing urination), scrotoplasty (creation of a scrotum using labial tissue, often with testicular implants), vaginectomy (removal of the vaginal canal), and hysterectomy (removal of the uterus, if not previously performed). ## Types of Metoidioplasty Several variations of metoidioplasty exist, each offering different levels of surgical complexity and results. ### Simple Metoidioplasty Simple metoidioplasty involves only the release and repositioning of the testosterone-enlarged clitoris, without urethral lengthening or scrotoplasty. This is the least invasive option with the fewest complications and shortest recovery time. Individuals who choose this approach typically do not prioritize standing urination and may prefer a minimal surgical intervention. ### Full Metoidioplasty Full metoidioplasty includes clitoral release along with urethral lengthening, scrotoplasty (with or without testicular implants), and often vaginectomy. This comprehensive approach aims to create the most complete masculine genital appearance possible through metoidioplasty. Urethral lengthening allows standing urination but carries a higher risk of urethral complications such as fistulas and strictures. ### Ring Metoidioplasty Ring metoidioplasty is a variation that uses a ring-shaped flap of tissue from the labia minora to extend the urethra. This technique may offer certain advantages in urethral construction and can help maximize the length of the neophallus. ### Centurion Metoidioplasty Centurion metoidioplasty is a newer technique designed to maximize the girth and projection of the neophallus. It involves wrapping the round ligaments of the uterus (after hysterectomy) around the shaft of the released clitoris to add bulk. This approach can increase both the length and circumference of the phallus beyond what standard metoidioplasty achieves. ## Pre-operative Preparation ### Medical and Psychological Evaluations As with all gender-affirming surgeries, metoidioplasty requires comprehensive medical and psychological evaluations. Mental health assessments are typically required, and patients are generally expected to meet the standards of care established by the World Professional Association for Transgender Health (WPATH). Surgeons conduct thorough physical evaluations to assess overall health and determine surgical suitability. ### Hormone Therapy Requirements Testosterone therapy is a prerequisite for metoidioplasty, as clitoral growth from testosterone is essential for the procedure to achieve meaningful results. Most surgeons recommend a minimum of one to two years of continuous testosterone therapy before surgery to allow for maximum clitoral growth. A hysterectomy is often required or recommended before metoidioplasty, particularly if vaginectomy will be performed. ### Other Preparations If urethral lengthening is planned, hair removal from the tissue that will be used for urethral construction may be necessary, though the requirements are generally less extensive than for phalloplasty. Smoking cessation is also required, as tobacco use significantly increases the risk of complications. Patients should arrange for post-operative support and time off from work or other responsibilities. ## The Surgical Procedure Metoidioplasty is typically completed in a single surgical stage, though some individuals may require additional procedures. The surgery generally takes 2 to 5 hours depending on which components are included. The core procedure involves releasing the clitoris from its suspensory ligament and surrounding tissue, straightening and repositioning it to maximize projection. If urethral lengthening is performed, tissue from the vaginal wall, labia minora, or buccal mucosa (inner cheek lining) is used to extend the urethra through the neophallus. Scrotoplasty, when included, reshapes the labia majora into a scrotum, which may be filled with testicular implants either at the time of the initial surgery or in a subsequent procedure. ## Anesthesia and Hospital Stay Metoidioplasty is performed under general anesthesia. The hospital stay is typically 1 to 3 days, considerably shorter than the 5-day stay associated with phalloplasty. If urethral lengthening is performed, a catheter will be placed and kept in for approximately 2 to 3 weeks to allow the new urethra to heal. ## Post-operative Care and Recovery ### Immediate Post-operative Care Post-operative care includes meticulous wound management, pain control with prescribed medications, and careful catheter management if urethral lengthening was performed. Patients should limit physical activity and avoid straddling movements or pressure on the surgical area. Swelling and bruising are expected and typically peak within the first week before gradually subsiding. ### Long-Term Aftercare Long-term aftercare includes scar management, pelvic floor exercises, and monitoring for urethral complications if urethral lengthening was performed. Periodic follow-up appointments with the surgical team help ensure proper healing and address any concerns. ### Recovery Timeline The initial recovery period for metoidioplasty is approximately 4 to 6 weeks, with most individuals returning to desk work within 2 to 4 weeks. Full activity, including exercise and sexual activity, is typically permitted after 6 to 8 weeks, though individual recovery varies. Sensation is usually preserved throughout the recovery process, since the procedure works with the body's existing nerve supply rather than requiring nerve reconnection. ## Potential Risks and Complications Metoidioplasty generally carries fewer risks than phalloplasty, but complications can still occur. These may include wound infection, bleeding or hematoma, urethral fistula (an abnormal opening in the urethra, more common when urethral lengthening is performed), urethral stricture (narrowing of the urethra), wound dehiscence (separation), changes in sensation (usually temporary), and dissatisfaction with size or appearance. The complication rate is significantly lower for simple metoidioplasty without urethral lengthening. When urethral lengthening is included, urethral complications such as fistulas and strictures are the most common issues, occurring in an estimated 15-30% of cases depending on the technique used. ## Sensory Outcomes and Sexual Function One of the primary advantages of metoidioplasty is the preservation of erogenous sensation. Because the procedure works with the existing clitoral tissue and its nerve supply, most individuals retain full sensation and orgasmic capacity after surgery. The testosterone-enlarged clitoris has erectile tissue that allows natural erections without requiring a penile implant — a significant distinction from phalloplasty. However, due to the smaller size of the neophallus (typically 4-6 cm), penetrative sexual intercourse is generally not possible through metoidioplasty alone. Some individuals use prosthetic sleeves or other aids if penetrative sex is desired. ## Financial Considerations ### Cost of Metoidioplasty The cost of metoidioplasty in the United States typically ranges from approximately $20,000 to $50,000, depending on the specific procedures included and the surgeon's fees. This is generally less expensive than phalloplasty. Additional costs for hospital fees, anesthesia, and follow-up care may apply. International options, including surgeons in Serbia, Thailand, and other countries, may offer more affordable pricing. ### Insurance Coverage Many insurance companies in the United States now cover metoidioplasty as a medically necessary gender-affirming procedure, subject to eligibility requirements similar to those for phalloplasty. These typically include mental health evaluations, documentation of hormone therapy, and evidence of living in the affirmed gender role. Pre-authorization is generally required. In countries with public healthcare systems, metoidioplasty may be covered but subject to waiting lists. ## Metoidioplasty vs. Phalloplasty Metoidioplasty and phalloplasty are both masculinizing genital surgeries, but they differ significantly in approach, outcomes, and trade-offs. | | | | |---|---|---| |**Feature**|**Metoidioplasty**|**Phalloplasty**| |Neophallus Source|Hormonally enlarged clitoris|Tissue flap from arm, thigh, or back| |Size|Small (4-6 cm)|Average to large, depending on flap choice| |Number of Procedures|Usually 1 stage|Typically 3 or more stages| |Sensation|Often retains full sensation|Variable, can be good with nerve connection| |Natural Erections|Yes, without implant|No — requires penile implant| |Ability for Penetrative Sex|Unlikely|Possible with penile implant| |Typical Scarring|Low-visibility scarring in the genital region|More visible scarring at donor and recipient sites| |Recovery Time|Shorter, initial recovery around 4-6 weeks|Longer, up to a year or more for full functionality| |Donor Site|None|Forearm, thigh, or back| |Cost (US)|$20,000-$50,000|$43,000-$150,000| Individuals choose between these procedures based on their priorities. Those who value preserved sensation, natural erections, minimal scarring, and a simpler recovery often choose metoidioplasty. Those who prioritize a larger phallus and the ability for penetrative intercourse typically choose phalloplasty. ## Pursuing Phalloplasty After Metoidioplasty Some individuals choose metoidioplasty as an initial step and later pursue phalloplasty for additional length and girth. All available phalloplasty techniques are considered feasible for individuals who have previously undergone metoidioplasty, and studies indicate that complication rates for secondary phalloplasty after metoidioplasty are comparable to those of primary phalloplasty procedures. Reasons for pursuing phalloplasty after metoidioplasty include wanting a larger phallus, seeking the ability to have penetrative intercourse, having initially chosen metoidioplasty as a stepping stone, or desiring to urinate while standing (if urethral lengthening was not performed during metoidioplasty). However, medical experts often suggest that if significant length and girth are primary goals from the outset, starting with phalloplasty might be more efficient, potentially resulting in fewer surgeries overall. ## Conclusion Metoidioplasty is a valuable gender-affirming surgical option that offers transgender men and transmasculine individuals a less invasive pathway to genital masculinization. By working with the body's existing testosterone-enlarged tissue, it preserves natural sensation and erectile function while creating a masculine genital appearance. Though it produces a smaller phallus than phalloplasty, many individuals find it to be the right choice for their goals — whether as a definitive procedure or as a first step in their surgical journey. Careful consultation with experienced surgeons, realistic expectations, and thorough preparation are essential for achieving the best outcomes. > [!tip] Related Pages > - [[Top Surgery]] — chest masculinization, feminization, and nonbinary options > - [[Phalloplasty]] — larger phallus construction using tissue flaps from arm, thigh, or back > - [[Orchiectomy]] — removal of the testes > - [[Penectomy]] — full or partial removal of the penis > - [[Vaginoplasty (PIV, PPT, Colo)|Vaginoplasty]] — penile inversion, peritoneal, or colovaginoplasty > - [[Vulvoplasty (Zero Depth)|Vulvoplasty]] — external vulva creation without vaginal canal > - [[Nulloplasty]] — complete genital removal creating a smooth contour > - [[How to Prepare for Gender Affirming Surgery]] — practical pre-op checklist > - [[Bottom Surgery Aftercare Shopping List]] — community-built recovery supplies list > - [[Global Resource Directory]] — providers, funding, and information across 10+ countries - References 1. 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