Female-to-male (FTM) bottom surgery, often termed as phalloplasty or metoidioplasty, is aimed at constructing male-typical external genitalia. There are several procedures involved, and the best approach for an individual depends on their specific goals, medical considerations, and other factors. Here’s an overview of the FTM bottom surgery process:

  1. Metoidioplasty:
    • This procedure takes advantage of the clitoral growth caused by testosterone hormone therapy.
    • The ligament that holds the clitoris in place is released, allowing it to extend further outwards.
    • The labia majora can be used to create a scrotum, where testicular implants can be placed.
    • The urethra might be lengthened to allow for standing urination, though this can increase the risk of complications.
    • The result is a small phallus, and while it may not be large enough for penetrative intercourse, some individuals prefer this procedure due to its natural appearance and sensation preservation.
  2. Phalloplasty:
    • This is the construction of a phallus (penis) using grafts taken from another part of the body, such as the forearm, thigh, or back.
    • The neophallus is larger and often more visually similar to a cisgender male penis compared to metoidioplasty.
    • Urethral lengthening is often performed to allow urination through the phallus.
    • As with metoidioplasty, the labia majora can be used to form a scrotum, where testicular implants can later be placed.
    • One limitation is that the neophallus typically lacks natural erectile tissue, so an erectile implant is needed for penetrative intercourse. This is usually done in a separate surgery after the phallus has healed.
  3. Scrotoplasty:
    • Regardless of whether one chooses metoidioplasty or phalloplasty, a scrotum can be created from the labia majora.
    • Testicular implants can be inserted to give the scrotum a more typical male appearance and feel.
  4. Urethral Lengthening:
    • A significant challenge of FTM bottom surgery is the extension of the urethra to allow for standing urination.
    • Tissue grafts, often from the mouth or vaginal lining, may be used.
    • This procedure carries risks like urethral strictures or fistulas, which may require further surgeries to correct.
  5. Hysterectomy and Vaginectomy:
    • Hysterectomy is the removal of the uterus and possibly the ovaries.
    • Vaginectomy is the removal or closure of the vaginal canal.
    • These procedures can be done before, during, or after metoidioplasty or phalloplasty.
  6. Implants:
    • After initial surgeries have healed, implants can be placed.
    • Erectile implants allow the neophallus to become erect for intercourse.
    • Testicular implants give the scrotum a fuller appearance.

Recovery time, risks, and outcomes vary based on the specific procedures performed. Many individuals need multiple surgeries to achieve their desired results. It’s crucial to consult with experienced surgeons who specialize in gender-affirming surgeries to understand options, potential outcomes, and risks.