Transgender men and transmasculine people can get a penis through gender-affirming surgery. There are two main procedures: metoidioplasty, which works with existing anatomy, and phalloplasty, which constructs a full-sized penis using tissue from another part of the body. Both are major surgeries with long recovery periods, and each comes with different tradeoffs in size, sensation, and complication risk.
Metoidioplasty: Working With What Testosterone Builds
Testosterone therapy causes significant growth of the clitoris over time, typically reaching 3 to 5 centimeters. Metoidioplasty takes advantage of that growth. The surgeon releases the clitoris from surrounding tissue, divides the ligament that holds it close to the body, and carefully dissects below the skin while preserving the nerve and blood supply. The result is a small but natural-looking penis with intact erotic sensation and the ability to become erect on its own.
If the person wants to urinate standing up, the surgeon can also lengthen the urethra. This is one of the more complex parts of the procedure. Tissue from the inner labia and the vaginal wall is reshaped and stitched into a tube over a catheter, creating a channel that extends to the tip of the new penis. A graft from the inside of the cheek (buccal mucosa) is sometimes used to bridge gaps in the urethral pathway.
The main limitation of metoidioplasty is size. The resulting penis is typically too small for penetrative sex, though it functions well for urination and has full sensation. The upside is a shorter surgery, fewer complications, and no need for an implant to get erect. For people whose priorities are natural sensation and a simpler recovery, metoidioplasty is often the preferred choice.
Phalloplasty: Building a Full-Sized Penis
Phalloplasty constructs a penis from a large flap of skin and tissue, most commonly taken from the forearm or the outer thigh. Forearm flaps tend to produce thinner, more natural-looking results and have higher rates of sensation, while thigh flaps leave a less visible donor scar and can provide more bulk. Less commonly, surgeons use tissue from the abdomen, back, or lower leg.
The surgery is often performed in multiple stages over the course of a year or more. The first stage builds the shaft and connects blood vessels and nerves at the new site. Later stages may include urethral lengthening, creation of the head (glans), and implantation of an erectile device. Each stage requires its own recovery period.
Tactile sensation returns gradually as nerves grow into the transplanted tissue. About 94% of patients in published studies eventually develop feeling in the new penis, though the timeline varies from several months to over a year. Erotic sensation depends on whether the original nerve supply is connected to the nerve in the flap, and recovery of that deeper sensation takes longer and is less predictable.
Erections After Phalloplasty
A surgically constructed penis cannot become erect on its own, so an implant is needed for penetrative sex. This is typically placed in a later stage of surgery, after the tissue has fully healed and sensation has developed. There are two main types.
Inflatable implants use fluid-filled cylinders inside the shaft, a small reservoir under the abdominal wall, and a pump placed in the scrotum. Squeezing the pump moves fluid into the cylinders to create an erection, and releasing a valve deflates it afterward. This gives the most natural look and feel, cycling between firm and soft. Semi-rigid implants are simpler: a bendable rod that keeps the penis firm at all times. You bend it upward for sex and downward for concealment. Semi-rigid devices have fewer mechanical parts that can fail, but the always-firm state can be less comfortable or harder to conceal.
Penile implants have the highest satisfaction rates of any erectile dysfunction treatment, and most patients and their partners report being happy with the results.
Complication Rates Are High
Phalloplasty is one of the most complex reconstructive surgeries performed anywhere in medicine, and complication rates reflect that. The overall complication rate across published studies is around 76.5%. Most of these are not life-threatening, but they often require additional surgery.
Urinary complications are the most common problem. Nearly half of all phalloplasty patients experience a fistula (an unwanted opening where urine leaks through the skin) or a stricture (a narrowing that makes urination difficult). Depending on the technique used, fistula rates range from 5% to as high as 79%, and stricture rates from 14% to 75%. Between 18% and 56% of patients need revision surgery to fix these issues. These numbers have improved as surgical techniques have evolved, and experienced surgical teams tend to have better outcomes, but urethral complications remain the biggest challenge in the field.
Metoidioplasty has lower complication rates overall, though urethral lengthening (when included) carries similar risks of fistula and stricture on a smaller scale.
What Recovery Looks Like
After phalloplasty, plan on at least five days in the hospital. If your forearm was the donor site, you will not be able to lift more than five pounds with that arm during healing. Walking at least four times a day for ten minutes each time is important for circulation and preventing blood clots. Bending at the waist past 90 degrees is restricted, and you cannot submerge the surgical area in water (no baths, pools, or hot tubs) until your surgeon clears you.
Sexual activity with the new penis is off limits until healing is confirmed, which typically takes several months. If an erectile implant is part of your surgical plan, that is usually a separate procedure performed after the tissue has fully healed, meaning the total process from first surgery to full sexual function can stretch well over a year. Many people describe the process as a marathon rather than a single event.
Eligibility and Getting Started
Under the current international standards of care (WPATH version 8), candidates for genital surgery need a diagnosis of gender incongruence and a mental health assessment confirming that any conditions that could affect surgical outcomes have been evaluated. Most surgeons require at least six months of testosterone therapy before operating, unless hormones are not desired or are medically contraindicated. You also need to demonstrate the capacity to consent to the specific procedure, which means understanding the risks, benefits, and alternatives.
Wait times vary significantly depending on location, insurance, and surgeon availability. In some countries, waits of one to three years for phalloplasty are common due to the small number of surgeons trained in the procedure. Metoidioplasty tends to have shorter wait times. Insurance coverage has expanded in recent years, with many plans in the U.S. now covering gender-affirming genital surgery, though navigating approvals can be a process in itself.