Start with your priorities#
Neither surgery is the default or the more complete choice. Metoidioplasty and phalloplasty create a phallus in different ways, with different demands on your body and time. The useful question is what you want from your anatomy: size, sensation, erections, standing urination, penetration, scars, or the amount of surgery you can take on. You can care about several of these at once.
Johns Hopkins' metoidioplasty guide describes using testosterone-enlarged genital tissue. Its phalloplasty guide describes building a shaft from tissue transferred from another part of the body. These are starting points for a consultation, not promises about your result.
| Question | Metoidioplasty | Phalloplasty |
|---|---|---|
| What tissue forms the phallus? | Existing erectile genital tissue is released and shaped. | A tissue flap, often from the forearm or thigh, forms the shaft. |
| What about size? | Usually smaller; the amount of growth before surgery matters. | Offers more length and girth options, limited by the donor site and surgical plan. |
| What about erections and sensation? | Existing erectile tissue can become firm without an implant; sensation may be preserved, but changes or loss are possible. | Sensation varies with technique and healing. A later erectile implant may be an option if rigidity for penetration is a goal. |
| What scars and stages should I expect? | No distant flap donor site. Scrotoplasty, implants, or revisions can still mean more than one operation. | A donor site needs its own healing, and reconstruction is often staged. |
| Can I urinate standing? | Urethral lengthening may be offered; the result also depends on anatomy and healing. | Urethral lengthening may be offered; it adds its own risks and follow-up needs. |
The UCSF surgical overview discusses urethral fistulas and strictures, donor-site issues, and how options vary by technique. Ask for your surgeon's results for the specific combination you want rather than a single overall success rate.
Questions worth taking to a consultation#
- Which parts of the plan are essential for my goals, and which are optional: urethral lengthening, scrotoplasty, implants, vaginectomy, hysterectomy, or oophorectomy?
- What sensation, urination, and sexual function are realistic for your technique, and what happens if a stage or implant does not work as hoped?
- Where would scars be, how many operations might be involved, and what support would I need during recovery?
- If I may want the other procedure later, what choices now would preserve or limit that path?
You do not need to rank your body by someone else's idea of a finished transition. Use Procedure Options to widen the menu, then read the metoidioplasty and phalloplasty pages for detail. Bring your priorities, including the ones that feel hard to say aloud, to a surgeon who will answer them directly.
References#
Johns Hopkins Medicine. (2026, April 14). Metoidioplasty for gender affirming care. https://www.hopkinsmedicine.org/health/expert-qa/metoidioplasty-for-gender-affirming-care
Johns Hopkins Medicine. (2025, June 15). Phalloplasty for gender affirmation. https://www.hopkinsmedicine.org/health/expert-qa/phalloplasty-for-gender-affirmation
University of California, San Francisco, Gender Affirming Health Program. (2016, June 17). Phalloplasty and metoidioplasty: Overview and postoperative considerations. https://transcare.ucsf.edu/guidelines/phalloplasty