Skip to content

Transgender metoidioplasty

Metoidioplasty is the creation of a penis with existing genital tissue. It is a type of gender-affirming masculinizing bottom surgery performed primarily on transgender men and nonbinary people to create a neophallus (new penis) from the hormonally enlarged clitoris. The procedure aims to provide male genital appearance and, in many cases, the ability to urinate while standing.

Unlike phalloplasty, which constructs a penis using skin grafts or flaps from other body parts, metoidioplasty utilizes existing genital tissue, resulting in generally shorter recovery times and fewer complications.

History

The origins of metoidioplasty trace back to the mid-20th century, with early techniques developed in the 1970s and 1980s as part of emerging gender-affirming surgical practices. Advances in microsurgery and understanding of genital anatomy improved outcomes significantly. Surgeons such as Harold Gillies, a pioneer in reconstructive surgery, laid the groundwork for modern genital reconstruction, while later refinements in clitoral release techniques established metoidioplasty as a distinct option from phalloplasty by the late 20th century.

Types and techniques

There are several variations of metoidioplasty, differing in complexity and functional goals:

  • Simple metoidioplasty (clitoral release): The clitoris, enlarged through testosterone therapy, is released from surrounding tissues to increase visible length. No urethral lengthening or scrotoplasty is performed.
  • Full metoidioplasty: In addition to clitoral release, the urethra is lengthened using tissue grafts (often from the vagina or labia minora) to allow urination while standing.
  • Ring metoidioplasty: A variation using a ring flap technique to extend the urethra while minimizing donor site morbidity.
  • Centurion procedure: Involves repositioning ligaments around the clitoris to enhance projection and appearance without grafting.

Outcomes

Metoidioplasty typically results in a smaller neophallus, averaging 4–10 cm in length, but preserves erotic sensation due to the use of original clitoral tissue. Some individuals choose to later undergo phalloplasty for increased length, while others prefer metoidioplasty for its natural sensation and fewer surgical stages.

Resources

Oregon Health & Science University (ohsu.edu)

Johns Hopkins Medicine (hopkinsmedicine.org)

University of Michigan Health (med.umich.edu)

Kaiser Permanente (mydoctor.kaiserpermanente.org)

University of Utah Health (healthcare.utah.edu)

Temple University Health System (templehealth.org)

TransHealthCare (transhealthcare.org)

GenderGP (gendergp.com)

Cranects (cranects.com)

UMass Memorial Health (ummhealth.org)

Metoidioplasty.net (metoidioplasty.net)