Note that in this article biological terms regarding sex organs will be discussed.

Metoidioplasty (also called Meta or Metoidio) is a procedure meant for people who were assigned female at birth, usually trans men. This is one of the two main bottom surgery methods for AFABs.

For reading about the other main method, see Phalloplasty.

Metoidioplasty is a surgery method where a penis is constructed from the existing organ (the clitoris) after it grows as a result of testosterone HRT. The method is suitable for growth of at least 1.5cm.

Most doctors recommend taking hormones for around two years before approaching this surgery, to maximize the final penis size.

Metoidioplasty, and any bottom surgery, can include different stages according to the patient’s wishes.

The results of the surgery look like a micropenis, with the size differing according to the size of the clitoris before surgery.

As part of the surgery, it is possible to remove the uterus, lengthen the urethra to allow for urination while standing, and to create a scrotum, though each of these procedures are not necessary and depend on the patient’s preference.

Surgery Characteristics

Metoidioplasty constructs an organ that spontaneously erects with sexual stimulation. The clitoris, which metoidioplasty is based on, fills with blood naturally and thus can erect. The erection strength varies from person to person.
Sexual sensation remains after surgery, and the risk of partial or full loss of sexual sensation using this method is lower than with the phalloplasty method.
The amount of scarring is also smaller than with phalloplasty.
The penis length after surgery will usually be between 4-10cm, with a thickness of 2-3cm. If the clitoris is small before surgery, it will not necessarily be possible to urinate while standing. However, according to community reports, in most cases it is possible.
Metoidioplasty may be suitable for penetration of a partner, though some in the community claim that the size is not suitable for penetration.
You can do phalloplasty surgery after metoidioplasty.
After the organ is created, there is no ejaculation after an orgasm.

Surgery Stages

Metoidioplasty is usually split into two surgeries. It is not necessary to undergo all procedures, you can choose between them.

The first procedure can include (at the patient’s discretion):

Disconnecting the clitoris from the surrounding tissues to allow for a free range of motion.
Lengthening the urethra to allow for urination while standing.
Removal of the uterus, ovaries and closing the vaginal canal.

The second surgery usually includes:

Scrotoplasty (creation of a scrotum and implantation of silicone testicles).
Corrections if necessary.

Different Metoidioplasty Methods

Simple Meta

The clitoris is disconnected from the surrounding tissues to allow for a full range of motion, without any other surgical procedures. This method does not allow for urination while standing.

Full Meta

Full metoidioplasty includes disconnecting the clitoris from the surrounding tissues, and lengthening the existing urethra using tissue from the inner cheek (tissue that naturally exists in a moist environment) to connect the new urethra to the existing one. This method allows for urination while standing.

Ring Meta

This method is similar to full metoidioplasty, but the urethra is constructed from tissue in the vaginal canal, along with tissue from the outer lips to connect the urethra to the clitoris. This method allows for urination while standing.

Metoidioplasty Centurion

In this method, the bands that hold the outer lips are released and wrapped around the clitoris to give more volume to the organ. As opposed to the other methods, this method does not necessitate the use of tissue from the vaginal canal or inner cheek.

Metoidioplasty Surgery Risks

Along with standard surgery risks, there are potential complications that are unique to metoidioplasty surgery:

Fistula

A fistula is a hole in the urethra, which can cause leaks or urination disorders.

The fistula usually heals on its own, but sometimes surgical intervention is necessary to fix it.

Implant Rejection in Scrotoplasty

A potential complication, where the body rejects the silicone testicular implants. This complication may require additional surgery to fix.

In this case, surgery is necessary to remove the implants, and after 6 months of recovery, it is possible to try to implant again.

Related Procedures Available as Part of Metoidioplasty (Optional)

There is no obligation to undergo all procedures, you can choose whichever you prefer.

Vaginectomy

Removal of all parts of the vagina.

Urethra Lengthening (UL)

Lengthening of the urethra, allowing for urination while standing.

Scrotoplasty and Testicular Implants

There are two main methods for creating a scrotum:

In the common method, VY scrotoplasty¹, a scrotum is created using the vaginal lip skin. Silicon testicles are implanted in the scrotum. The result is one scrotum that bulges from the body.

In the second method, no surgery is done to create a scrotum, and round silicone implants (at a size of choice) are inserted into the outer lips themselves. The procedure itself is simpler, and the result is a scrotum made up of two smaller “bags”, which bulge from the body less.

The silicone implants cannot burst or rip naturally, even if a lot of pressure is applied to them.

Mons Pubis Resection

In this procedure, some of the skin and fat above the sex organ are removed. The remaining skin is stretched upwards to raise the penis. If you chose testicular implants, they will also be raised upwards. This procedure increases penis visibility and access.

Recovery

For each stage of metoidioplasty, the recovery time is usually around 6 weeks. However, the length of recovery can vary from person to person and depends on the specific procedures performed, as well as how successful it was. Recovery time will be estimated individually by the surgeon, at consultation prior to surgery.

During recovery, you are not allowed to lift more than 5 kilograms for one to three months after surgery.

Additionally, most surgeons recommend waiting at least six months between the surgeries for better recovery.

How to Undergo Surgery

The surgery is performed in various countries around the world. For a list of surgeons.

In Israel, you can receive approval for the surgery through the Committee for Gender Reassignment, while the surgery itself is possible abroad (for example in Germany, the USA, or Serbia) with HMO funding. It is important to take into account that not all HMOs work with some countries, so they may not approve surgery in certain countries. If there is a need for a specific country (for example if a specific procedure is performed there and nowhere else), bring the specific recommendation from the Committee for Gender Reassignment so the HMO approves the funding.

As these surgeries are not regularly performed in Israel, the support network in the case of corrections or complications occurring near the surgery is more limited than abroad. This is another reason to undergo surgery abroad with experienced and recommended surgeons.

Occasionally, according to demand and necessity, an expert surgeon used to come to Israel to perform the surgery. Information is available through the Committee for Gender Reassignment in Tel Hashomer.

It is of course possible to undergo surgery with private funding, or with funding from private health insurance if it exists and the surgery is covered by the policy.

The price of metoidioplasty ranges between $2,000-$20,000.

For Further Reading

Wikipedia article about metoidioplasty
The Ministry of Health medical director’s recommendations about bottom surgery abroad

FTM – Bottom Surgery – Metoidioplasty

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