A transgender man’s penis can look quite different depending on which surgical procedure was used to create it. The two main options, metoidioplasty and phalloplasty, produce very different results in terms of size, skin texture, and overall appearance. Both create functional male genitalia, but neither looks identical to a cisgender man’s penis, and the visual differences vary based on surgical technique, healing time, and optional cosmetic refinements.
Metoidioplasty: The Smaller Option
Metoidioplasty works with tissue that’s already there. Testosterone therapy causes the clitoris to grow significantly over time, and this procedure releases and repositions that enlarged tissue to create a small penis. The result looks like male genitalia, with a visible shaft and a natural skin tone that matches the surrounding area, since no skin is transplanted from another part of the body.
The average length after metoidioplasty ranges from about 4.8 to 10.2 centimeters (roughly 2 to 4 inches), with a mean of around 5.6 centimeters. Because the tissue is the body’s own genital tissue, it has natural erogenous sensation and can become erect on its own without any implant. The tradeoff is size. The penis is typically too small for penetrative sex, though it allows standing urination when urethral lengthening is included. Visually, it resembles a smaller or micropenis, and surgeons create a natural-looking angle where the shaft meets the scrotum using rotational skin flaps from the surrounding tissue.
Phalloplasty: The Full-Size Option
Phalloplasty builds a full-sized penis using skin, fat, and tissue harvested from a donor site on the body, most commonly the forearm. This creates a penis with more typical adult length and girth, but the appearance differs from a cisgender penis in several noticeable ways.
Because the shaft is made from forearm skin (or thigh, back, or abdomen skin in other techniques), the color and texture won’t match genital skin. Forearm skin tends to be lighter or differently pigmented than the groin area, and it lacks the visible veins that naturally appear on a cisgender penis. The skin may also have a slightly different texture, since it retains characteristics of wherever it came from. If the donor site had hair follicles, the shaft may grow hair unless the follicles were removed before surgery. The overall shape is cylindrical, and while surgeons sculpt it to look as natural as possible, the surface tends to appear smoother and more uniform than a cisgender penis in its initial state.
How the Glans Is Created
The head of the penis, called the glans, is sculpted through a separate procedure called glansplasty. Surgeons make a curvilinear incision near the tip to create the appearance of a corona, the ridge that separates the head from the shaft. The skin edge is undermined and sutured to the underlying tissue to produce a defined, rounded shape. The result gives the tip of the penis a more recognizable contour, though it typically lacks the exact color contrast and mucosal texture of a natural glans.
Scrotal Construction and Testicular Implants
A scrotum is usually created during or after the main procedure. In metoidioplasty, surgeons rotate and join the labia majora at the midline beneath the penis, forming a pouch. Some patients receive silicone testicular implants, which provide a firm, oval shape that closely mimics the look and feel of testicles. Others opt for augmentation using their own tissue, where subcutaneous fat from the remaining labial skin is used to add bulk. The tissue-only approach produces a softer, less defined shape compared to implants, but avoids the risks associated with foreign materials.
Scarring and Skin Changes Over Time
Scarring is an unavoidable part of any surgical construction, and the appearance of a phalloplasty changes significantly during the first year or more of healing. Skin grafts go through a long maturation process. In the early months, the transplanted skin may look noticeably different in color from surrounding tissue, feel tight, and have an uneven texture. Over six months to a year, the color gradually shifts closer to the body’s natural tone, though it rarely matches perfectly.
Grafted skin permanently differs from natural skin in some ways. It may lack hair follicles and sweat glands, have reduced sensitivity, and remain more vulnerable to injury. The donor site on the forearm or thigh also carries its own scar, which flattens and fades over time but remains visible. Some patients undergo laser treatments on both the donor site and the phallus itself to improve skin texture and thickness.
Medical Tattooing for Realism
One of the most significant cosmetic refinements available is medical tattooing, which can dramatically change the appearance of a phalloplasty. Specialized tattoo artists use pigment blending to match the shaft’s color to the patient’s natural skin tone, creating a smoother transition between the phallus and surrounding groin skin.
Beyond basic color matching, skilled artists can replicate realistic details: veining along the shaft for added texture, freckles and pigmentation variations, and even simulated hair follicles. The glans can be tattooed with a distinct color and shading to mimic the natural appearance of the head, giving it a more lifelike contrast from the shaft. For many patients, medical tattooing represents the final stage of achieving the appearance they want, and the difference between pre-tattoo and post-tattoo results can be striking.
Erectile Devices and Resting Appearance
A phalloplasty penis cannot become erect on its own, since it doesn’t contain the spongy erectile tissue that fills with blood in a cisgender penis. Patients who want erections for penetrative sex can have an inflatable or semi-rigid implant placed inside the shaft in a later surgery.
These devices affect how the penis looks and feels at rest. With an inflatable pump, the penis hangs in a deflated state when not in use, and the material of the implant can be felt through the skin. The appearance differs somewhat from erectile implants placed in cisgender men, because the surrounding tissue structure is different. A semi-rigid rod keeps the shaft in a slightly firm state at all times, which can be positioned downward against the body when not in use. Both options add functionality but also add a subtle difference to how the penis looks in its resting position.
Urethral Complications and Their Visual Impact
The urethra, the tube that allows standing urination, is one of the most complication-prone parts of phalloplasty. Strictures (narrowing) and fistulas (small openings where urine leaks through the skin) are reported at high rates, with strictures occurring in 40 to 80 percent of cases in some studies. These complications can affect the external appearance of the penis if a fistula creates a visible opening along the shaft, or if revision surgeries leave additional scarring. Many patients undergo one or more corrective procedures after their initial surgery, and each revision adds its own healing timeline and potential for scar tissue.
How Results Vary Between Patients
No two surgical results look the same. The final appearance depends on the patient’s skin tone, the donor site used, their body’s healing response, whether they pursue cosmetic tattooing, and how many revision procedures they undergo. A phalloplasty using forearm skin will look different from one using thigh skin, which tends to be thicker and may have more hair. Patients with darker skin tones may see more noticeable contrast between the donor skin and surrounding tissue, making medical tattooing particularly valuable.
Metoidioplasty results vary less dramatically, since the procedure uses existing genital tissue, but the final size depends heavily on how much growth occurred during testosterone therapy before surgery. Some patients start with metoidioplasty and later choose phalloplasty if they want a larger result, and all phalloplasty techniques remain available after a prior metoidioplasty.