Phalloplasty and metoidioplasty are the two most common gender-affirming penile reconstruction procedures available to transmasculine patients at this point in time. For a phalloplasty procedure, the surgeon utilizes tissue from different areas of the patient’s body such as the forearm, thigh, and abdomen to construct a penis. Metoidioplasty involves releasing the clitoris from the tissues that hold it down and repositioning the genital tissues to create a neophallus, or “new penis.”

Transgender men may choose to undergo gender-affirming surgery (GAS) such as phalloplasty or metoidioplasty for a variety of reasons. Some prioritize the ability to stand while urinating, others would like to be able to have penetrative sex, and still others feel that the appearance of the neophallus is the most important. Currently, no single penile reconstruction procedure is able to accomplish all of these goals, but future advances in surgical techniques may eventually render it possible.

With the goal of better understanding which existing or experimental surgical techniques would be most preferable to gender expansive individuals and transgender men, the authors of a recent Journal of Sexual Medicine study created and disseminated an online survey on the topic to a wide range of potential respondents. A total of 965 qualifying participants completed the survey.

The survey asked respondents to provide an ordinal ranking of interest in five different penile reconstruction techniques, including phalloplasty, metoidioplasty, and three hypothetical/experimental options. (For the purposes of this study, 1 represented the greatest interest, and 5 represented the least amount of interest in a particular surgical technique).

The three experimental or theoretical options described in the survey were penile transplantation, epithesis, and composite tissue engineering (CTE), which was referred to in the survey as “lab-grown penile tissue.” Penile transplantation is an experimental surgery which involves connecting a penis from a human donor to the blood vessels and nerves of the recipient. It has not yet been used for gender-affirming purposes. An epithesis is a currently hypothetical approach that would involve creating a penis from a non-human substance such as silicone and surgically anchoring it to the patient’s pelvic bones. Lastly, CTE would consist of growing human tissue in a lab and then using this tissue to create parts of a neophallus. Like epithesis, CTE is currently a theoretical treatment.

Interestingly, the researchers found associations between the participants’ sexual orientation, gender, and age in relation to their interest in certain surgical interventions. For example, gay participants were not as likely as participants of other sexual orientations to be interested in epithesis. They did, however, show significant interest in phalloplasty. Heterosexual participants were most interested in penile transplantation and phalloplasty, while being the least likely to be interested in metoidioplasty. The respondents who identify as men were more likely than those of other gender identities to be interested in phalloplasty, but older age was associated with a decreased interest in phalloplasty across all participants. No personal characteristics were associated with an increased or decreased likelihood of interest in CTE.

Studies such as this one help researchers to get a better understanding of which existing and potential surgical techniques are of interest to transgender men and gender expansive individuals. They also lend insight into different patients’ goals, values, and priorities for surgery. This is very important information that can help guide conversations between physicians and patients during GAS consultations, inform future research, and support quality gender-affirming care with high satisfaction rates.

Resources:

• Parker, A., Blasdel, G., Kloer, C., Kimberly, L., Shakir, N., Robinson, I., Bluebond-Langner, R., & Zhao, L.C. (2022). Postulating Penis: What Influences the Interest of Transmasculine Patients in Gender Affirming Penile Reconstruction Techniques? The journal of sexual medicine, 19(2), 385-393. DOI: https://doi.org/10.1016/j.jsxm.2021.10.013