TürkçeMetoidioplasty is a surgical procedure preferred by trans men (FTM) during their gender affirmation journey, enabling the creation of an aesthetic and functional neophallus using the body’s own natural tissues. This method aims to preserve natural sensation and nerve structure by maximizing the potential of existing tissues through microsurgical principles. Without requiring distant tissue transfer, this operation transforms the anatomical structure that has gained volume through hormone therapy into a masculine form and is one of the most critical medical steps completing individuals’ bodily integrity. Performed with modern plastic surgery techniques, this process provides physical transformation while permanently increasing the person’s self-confidence and quality of life.
| What Is Metoidioplasty? | Metoidioplasty is a surgical procedure performed within the scope of gender affirmation surgery that aims to release the clitoris enlarged through testosterone therapy and give it a more prominent and functional penile appearance. |
| Primary Purpose | Its purpose is to masculinize the genital appearance, improve urinary function when urethral lengthening is performed, preserve sexual function, and create a genital structure consistent with the person’s gender identity. |
| How Is the Surgery Performed? | The connective tissues pulling the clitoris downward are released. When necessary, the urethra is lengthened, a scrotum is created through scrotoplasty, and testicular implants may be placed at later stages. The surgical technique may vary according to the patient’s anatomy and goals. |
| Urethral Lengthening | It is optional. When performed, the goal may be to enable the person to urinate while standing. However, the risk of urethral complications may also increase. |
| Condition of the Vagina | The vagina may be preserved, or vaginectomy involving closure or removal of the vagina may be performed during the same operation or in a separate session. This decision depends on individual preferences and the surgical plan. |
| Scrotoplasty | A scrotum may be created from the labia majora. Testicular implants may later be placed when considered appropriate. |
| Penis Size | The size of the resulting penis largely depends on the clitoral growth achieved through testosterone therapy and varies from person to person. |
| Sexual Sensation | Since the nerve structure of the clitoris is preserved, touch sensation and erotic sensation are generally maintained. |
| Ability to Achieve Orgasm | The ability to achieve orgasm is preserved in most patients. The surgical technique and individual differences may affect the outcome. |
| Erection | Since the created penis consists of natural erectile tissue, it can become erect spontaneously. An additional erectile implant is generally not required. |
| Ability to Urinate While Standing | This may be possible in individuals whose urethral lengthening is successful. However, it cannot be guaranteed for every patient. |
| Surgery Duration | Although it varies depending on the procedures performed, it generally takes several hours. |
| Anesthesia | It is mostly performed under general anesthesia. |
| Hospital Stay | Depending on the scope of the surgery, hospitalization for several days may be required. |
| Recovery Process | Initial healing takes several weeks, while complete recovery and tissue maturation may take months. |
| Catheter Use | A urinary catheter may be used for a certain period in patients who undergo urethral lengthening. |
| Possible Risks | Bleeding, infection, wound healing problems, hematoma, urethral fistula, urethral stricture, urinary leakage, implant-related complications when implants are placed, aesthetic dissatisfaction, and the need for additional surgery may occur. |
| Urethral Fistula | It is a complication that causes urine to leak through an unintended opening and may require additional surgery. |
| Urethral Stricture | Difficulty urinating may develop as a result of narrowing of the urinary canal and may require treatment. |
| Advantages | Possible advantages include preserving natural sensation and erection, requiring less tissue transfer, providing a shorter surgery duration, and involving a lower surgical burden compared with phalloplasty. |
| Limitations | The limited penis size, the possibility that it may not always be sufficient for penetrative sexual intercourse, and the inability of some patients to urinate while standing are important limitations. |
| Alternative Surgery | Phalloplasty is an alternative genital reconstruction method that aims to create a larger penis. The appropriate method is determined according to the person’s expectations, anatomical structure, and surgical goals. |
| Follow-Up | Regular surgical checkups, wound care, evaluation of urinary function, and long-term follow-up are recommended. |
| Expected Outcome | Following successful metoidioplasty, the aim is for the person to achieve their anatomical, functional, and psychosocial goals. Results may vary according to the technique applied, individual anatomy, and the healing process. |
What Is Metoidioplasty?
A subject frequently discussed in the medical world and among individuals undergoing the affirmation process is what is metoidioplasty? In its simplest and most understandable form, this operation is the process of transforming existing anatomical tissues that have already grown and gained volume under the effects of hormone therapy into an aesthetic and functional structure. It does not require the removal of large pieces of skin or muscle, medically known as flaps, from a distant area of the body such as the arm, leg, or back. For this reason, it is considered a less demanding approach that does not leave large scars on the body.
The main purpose of this procedure is to take the physical transformation already initiated by nature and hormones one step further through delicate surgical interventions. The natural nerve network, vascular structure, and sensation of the organ are completely preserved. A new form is constructed using tissues that appear natural externally, do not cause functional loss of sensation, and belong entirely to the individual’s own body. This strengthens the individual’s connection with their body. Since no external tissue is added, there is no possibility of tissue rejection. In this respect, it is an extremely modern, reliable, and successful method that leaves significantly fewer scars while maximizing the body’s own potential.
Why Is Metoidioplasty Important for Gender Affirmation?
A mismatch between a person’s mental perception of their body and their physical reality can become a serious psychological burden in daily life. Many moments, from getting dressed and showering to being in social environments and intimate relationships, may become challenging because of this incongruence. The answer to why metoidioplasty is important for gender affirmation lies precisely in the bodily freedom it provides to the individual. This surgical intervention is not merely a physical reshaping procedure but also a powerful tool that enables the individual to be relieved of the psychological burden they may have experienced for years.
The new anatomy gained after surgery makes an extraordinary contribution to helping the individual feel complete and whole. Seeing an image in the mirror that matches the correct image in the mind provides invaluable relief. The freedom to urinate while standing and the elimination of anxiety felt in gyms or shared changing rooms are only a few of the greatest daily-life comforts offered by this surgery. The individual stops fighting with their body, makes peace with it, and continues life with much stronger energy.
For Whom Is Metoidioplasty a Suitable Surgical Option?
As with every medical intervention, it should be remembered that this operation may not be a perfect option for every individual. The greatest secret to achieving a successful result is applying the right method to the right patient. So, for whom is metoidioplasty a suitable surgical option? First, the extent to which the bodies of people considering this surgery are anatomically suitable for the procedure is evaluated. Since no tissue transfer is performed, the outcome depends entirely on the quality and size of the person’s existing tissue.
Having realistic expectations is the most fundamental psychological requirement for suitability. If the person does not expect a result as large as that offered by other surgical methods, considers preserving natural sensation their first priority, and wishes to avoid large scars on the body, this method becomes an excellent alternative. The presence of the following factors is extremely important during this decision-making stage:
- Expectations
- Tissue
- Preparation
- Commitment
How Should Hormone Use Be Managed Before Metoidioplasty?
Before moving on to the surgical stage, the body must prepare itself for this major change. The architect of this preparation is externally administered hormones. The question of how hormone use should be managed before metoidioplasty directly affects the success of the operation. When testosterone is administered regularly, it creates a highly significant and direct stimulatory effect on the tissues in the urogenital region. As a result of long-term use of this hormone, the cellular structure in the area expands, blood supply increases, and the tissue gains significant volume.
Reaching sufficient length and thickness for surgical intervention generally takes time. Therefore, it is expected that the person will have undergone an uninterrupted hormone process for at least one or two years before surgery is planned. Growth eventually reaches its peak and enters a plateau phase. This plateau phase is the clearest indication that the body is now ready for surgery. Operations performed too early may not provide the desired aesthetic result because the tissue has not yet reached its full potential.
How Does the Psychological Preparation Process Progress Before Metoidioplasty?
The greater the physical transformation, the stronger the mental preparation must be. The gender affirmation process is a journey in which not only the body but also the mind transforms. When considering how the psychological preparation process progresses before metoidioplasty, the indisputable importance of professional support becomes clear. Being mentally fully prepared for this permanent change makes postoperative adaptation significantly easier.
Sessions conducted with mental health professionals help the person clarify expectations, accept possible risks, and emotionally adapt to the new body. Having strong social support networks and having family members or close friends stand by the individual during this process minimizes stress factors throughout the recovery period. This surgery is not an ending but the beginning of a newly liberated life. Psychological evaluations are indispensable for being mentally prepared for this beginning.
How Is Metoidioplasty Performed?
When we enter the operating room, the heart of the procedure, we encounter a surgical art that requires meticulous, millimeter-level calculations and deep respect for tissue. In answering the basic question of how metoidioplasty is performed, the procedure can be described as the liberation of tissues. In normal anatomy, this enlarged tissue is attached to the pubic bone by several strong ligaments. These ligaments pull the tissue downward and conceal it.
The surgeon’s first task is to release these ligaments with great care. Through this release, the natural downward curvature of the organ is eliminated, and the tissue gains a prominent forward and upward projection. Throughout all these procedures, the blood vessels that keep the organ alive and the delicate nerve networks that provide sensation are carefully preserved. It can be summarized as revealing a concealed structure by freeing it from the obstacles surrounding it. Some concepts forming the fundamental philosophy of the surgery are as follows:
- Precision
- Aesthetics
- Function
- Naturalness
How Is the Urinary Tract Lengthened During Metoidioplasty?
One of the details providing the greatest comfort to individuals in social life is the ability to urinate while standing. For many people, this is one of the most important benefits of the operation. So, how is the urinary tract lengthened during metoidioplasty? In surgical practice, this procedure is a highly delicate reconstruction stage. The existing urinary canal must be extended to the tip of the newly created organ.
For this transfer, other tissues in the region are generally used, such as vaginal mucosa, which is an excellent material for inner lining because of its moist structure, or labia minora tissue with its rich vascular network. Using these tissues, the surgeon constructs a new tube and connects it to the existing urinary tract. It is vitally important for the sutures to be completely sealed and watertight. Beyond aesthetic appearance, this stage may be described as a completely functional engineering achievement.
How Is the Scrotum Created During Metoidioplasty?
To achieve a complete and integrated aesthetic appearance, constructing the organ alone is not sufficient; the surrounding tissues that complement it must also be harmonized. For visual integrity, the question of how the scrotum is created during metoidioplasty frequently arises. At this stage, the flexible and full structure offered by the outer labial tissues is utilized.
The outer labia are joined toward the midline, or center, using special surgical suturing methods. This joining procedure creates the appearance of a natural sac. Initially, only an empty sac is created. The tissues require time to adapt to this new position, stretch, and heal. In a much shorter and simpler second procedure performed months later, medical silicone implants that imitate the natural sensation and weight of testicles are placed inside this sac. In this way, the aesthetic process is completed.
Recovery Process After Metoidioplasty
The completion of surgery means that only half of the process has been completed. The part requiring real effort and patience is the recovery period during which the tissues gradually repair themselves. When examining the recovery process after metoidioplasty from hospital to home, we see that the first few days require a critical hospital stay. During this period, specialist teams continuously monitor the blood supply, color, and general condition of the tissues.
Thin tubes known as drains, used to remove excess fluid that may accumulate in the area, are an inseparable part of this period. Pain is controlled with strong medications, but because remaining continuously in bed may delay recovery, individuals are strongly encouraged to get up early and take short walks. The period at home after hospital discharge should be spent entirely at a slow pace, listening to oneself and allowing the body time. The energy the body expends on healing must be supported. The fundamental building blocks of recovery are:
- Patience
- Rest
- Monitoring
- Time
How Should Nutrition Be Managed During Metoidioplasty Recovery?
The rapid and trouble-free healing of tissues is directly connected to support received from within. Particularly in surgeries involving the pelvic region, the regularity of bowel movements may affect the outcome of the operation. For this reason, how nutrition should be managed during metoidioplasty recovery must be taken very seriously. The body needs high-quality protein to repair cells, while the digestive system requires plenty of fiber to function without obstruction.
One of the greatest dangers is constipation. Any straining or pushing during bowel movements places tremendous pressure on newly placed sutures that have not yet healed. This pressure may cause the sutures to open or lead to internal bleeding. Therefore, the entire dietary pattern should be designed to facilitate digestion. Drinking at least two and a half liters of water per day is the golden rule for preventing sluggish bowel movements. The main foods emphasized in the nutrition plan are:
- Oats
- Apricots
- Vegetables
- Yogurt
What Should People Who Have Undergone Metoidioplasty Pay Attention To?
The first weeks at home are vitally important for preserving the surgical success achieved. Strict rules surround the question of what people who have undergone metoidioplasty should pay attention to after discharge. Due to the anatomical structure of the area, it is highly prone to poor ventilation and moisture accumulation. This moisture creates an ideal environment for infections to develop. Therefore, hygiene after using the toilet should be maintained very carefully by gently rinsing with water and drying with soft touches rather than rubbing.
No clothing that places pressure on the area should be worn. Tight jeans and synthetic underwear should be completely removed from the wardrobe during the recovery period. Movements that stretch the lower part of the body, require the legs to open very widely, involve lifting heavy loads, or require remaining in a squatting position for long periods should be avoided for weeks. Respecting the body means providing it with the space and comfort it needs to repair itself. Items that should be preferred in daily life during this period are:
- Cotton
- Loose
- Breathable
- Soft
How Is Sexual Life Affected After Metoidioplasty?
One of the subjects occupying individuals’ minds most after gender affirmation operations is the future of natural functions and sensation. The continuity of functions determines quality of life just as much as achieving bodily integrity. The clearest answer to the question of how sexual life is affected after metoidioplasty lies in the tissue-preserving nature of this technique. Since skin from another part of the body is not used, the rich nerve network of the existing tissue remains in place.
Temporary numbness or loss of sensation during the first months due to incisions made during surgery is an entirely normal tissue response. However, sensation returns as swelling subsides and the nerve endings gradually regenerate. Since the tissue’s natural erectile capacity is preserved, natural responses continue without requiring an external mechanical pump. The increase in self-confidence experienced by an individual who is more at peace with their body and happy with their reflection in the mirror also has a highly positive and relaxing psychological effect on sexual life.
What Are the Surgical Risks of Metoidioplasty?
No matter how carefully and perfectly it is planned, every surgical intervention has its own nature and possible outcomes. Patients need to be mentally prepared for these possibilities. When examining the surgical risks of metoidioplasty, we see that the most common conditions are generally related to the newly created urinary tract.
Urine may leak from the suture lines of the newly created canal through extremely small pinhole-sized openings. This is called a fistula. These small leaks often close over time through the body’s own healing ability. Another risk is narrowing of the urinary tract due to scar tissue forming internally during healing. This narrowing causes urine to flow with difficulty or in a thin stream and is generally resolved through simple dilation procedures. Small openings in the sutures may sometimes occur in groin areas where tension is high. From a general perspective, conditions closely monitored during recovery include:
- Leakage
- Narrowing
- Opening
- Swelling
Are Metoidioplasty Results Permanent After Complete Healing?
After months of careful care, rest, and great patience, the tissues reach their final form and life returns completely to normal. The final question people generally have is whether metoidioplasty results are permanent after complete healing. Yes, the anatomical changes achieved are permanent for life. As long as hormone therapy is continued, the tissues maintain their structure and form.
As months and years pass, scars fade by blending with the skin tone and become almost indistinguishable. The tissues soften and achieve a much more natural aesthetic appearance. The individual completely integrates with their new body, and their surgical history ceases to be a detail of daily life, becoming an inseparable and peaceful part of normal life.
Frequently Asked Questions
Metoidioplasty is a surgical method performed during the gender affirmation process. It aims to create a more masculine genital appearance and provide certain functional benefits by using the clitoris enlarged through hormone therapy.
Metoidioplasty is an option that may be considered for some trans men undergoing the gender affirmation process. Suitability is determined through an evaluation of health status, expectations, anatomical characteristics, and the specialist team’s assessment.
During surgery, genital tissue enlarged through hormone therapy is released and reshaped. When necessary, urethral lengthening, scrotoplasty, or other complementary surgical procedures may also be performed during the same process.
Metoidioplasty uses existing genital tissue, while phalloplasty involves creating a new penis with tissues taken from other parts of the body. The advantages, limitations, and surgical scope of the two methods are different.
The ability to urinate while standing may be achieved in suitable patients who undergo urethral lengthening. However, results may vary according to the surgical technique, healing process, and individual anatomical characteristics.
One of the important advantages of metoidioplasty is that existing nerve structures can be preserved. Therefore, genital sensitivity and sexual sensation may be preserved or maintained in many patients.
As with every surgical procedure, complications such as infection, bleeding, wound healing problems, urethral stricture, and fistula may occur. Risks may vary according to additional procedures performed and individual factors.
Initial healing generally occurs within several weeks. However, complete tissue healing, reduction of swelling, and evaluation of the final result may take several months. Regular follow-up appointments are important.
Some patients may require aesthetic corrections, urethral revisions, or complementary procedures such as scrotoplasty. These needs may vary according to personal goals and the results of the initial surgery.
Successful metoidioplasty may support a body perception consistent with the person’s gender identity. This may provide positive effects on self-confidence, psychological well-being, and quality of life.
He completed his medical education at Ankara University Faculty of Medicine in 1996 and his specialty training between 1996–2002 at Hacettepe University Faculty of Medicine, Department of Plastic, Reconstructive and Aesthetic Surgery.
Between 2002–2009, he worked at Süleyman Demirel University Faculty of Medicine, Department of Plastic, Reconstructive and Aesthetic Surgery.
Since 2009, he has been working at Hacettepe University Faculty of Medicine, Department of Plastic, Reconstructive and Aesthetic Surgery. He received the title of Associate Professor in 2011. Dr. Nasır became a Professor in 2019 and continues to work as a faculty member in this position.
Between 2006–2008, he conducted studies on composite tissue transplantation at the Cleveland Clinic in Ohio, USA, together with Dr. Siemionow, who performed the first face transplant in the United States and the second in the world.
In 2012, he successfully performed Turkey’s second face transplant, which was the third among full face transplants in the world and the 22nd overall. Simultaneously with this face transplant, the world’s first quadruple limb transplant was carried out at Hacettepe University by a large team under his leadership.
He won second-place awards in the experimental and clinical specialist competitions at the 31st and 32nd National Plastic, Reconstructive and Aesthetic Surgery Congresses. In 2023, he completed his doctorate in Hand Surgery at Hacettepe University Faculty of Medicine.
He is a member of the American Society of Reconstructive Microsurgery, Plastic Surgery Research Council, Turkish Society of Plastic, Reconstructive and Aesthetic Surgery, Reconstructive Microsurgery Association, and Turkish Society for Surgery of the Hand and Upper Extremity.
