Metoidioplasty in San Francisco

Medically reviewed by Lin-Lin Liu, PA on August 29, 2026.

Simple Metoidioplasty vs Complex Metoidioplasty with Urethral Lengthening, Vaginectomy and Scrotoplasty

In the San Francisco Bay Area, Dr. Zara Ley (she/her/they) is one of the most sought-out board-certified surgeons for metoidioplasty. Gender-affirming metoidioplasty, also known as “meta,” is a bottom surgery procedure for trans men, transmasculine and non-binary patients. Dr. Ley has years of experience providing personalized metoidioplasty surgeries to a diversity of patients, tailoring surgery to their unique gender embodiment goals, anatomy and medical needs. Generally speaking, a meta creates an enlarged appearance of the patient’s natal erectile tissue (i.e. clitoris) by releasing it from its surrounding ligaments.

Metoidioplasty at the Gender Confirmation Center in San Francisco

At the Gender Confirmation Center (GCC), Dr. Ley is the board-certified surgeon who offers metoidioplasty alongside other bottom surgery procedures to our patients. She has been providing bottom surgery for over a decade and has trained several providers in a variety of surgical techniques. Additionally, she is the only trans woman of color in the country that is a board-certified surgeon who offers a full-spectrum of gender care.

Dr. Ley offers surgery out of our San Francisco office. To reduce the barrier to accessing surgery, all of her surgical consultations are free of cost to patients. You can request a consultation to ask Dr. Ley about meta bottom surgery through our website, or by calling our San Francisco office at (415) 780-1515.

What Is Gender-Affirming Metoidioplasty?

Metoidioplasty or meta is a gender affirming bottom surgery procedure. This means that it reconstructs a patient’s genitals to treat their gender dysphoria. In a simple metoidioplasty, Dr. Ley will release a patient’s natal erectile tissue (i.e., clitoris) from its surrounding ligaments, giving it a more forward, visually apparent position on the body. This procedure is ideal for patients that have experienced bottom growth from testosterone hormone therapy.

For a complex meta, Dr. Ley can combine the simple metoidioplasty procedure with the following:

• Primary urethral lengthening (PUL): this involves lengthening the urethra so that it exits near the tip of the penis. This makes it easier for patients to urinate while standing.

• Vaginectomy: this is the surgical removal of the vaginal canal. A vaginectomy is required for patients who wish to undergo a PUL to prevent urinary complications. Please note that patients must undergo a hysterectomy at least 8-12 months prior, to qualify for a vaginectomy.

• Scrotoplasty and testicular implants: this involves the construction of a scrotum using skin grafts from the labia. In a later stage of surgery, patients can have silicone testicular implants inserted into their scrotum if desired.

• Mons resection and panniculectomy: these are body contouring procedures that involve removing fat and skin overhang from the upper groin or mons region. These procedures can help give your metoidioplasty results a more forward and apparent position on the body.

For more information on additional procedures, click here.

Is Metoidioplasty Right for You?

Generally speaking, we encourage patients who are curious about undergoing metoidioplasty to speak with a gender-competent, licensed mental health professional. For some patients, the decision is obvious. For others, it can take years to understand whether you need bottom surgery, or which type of bottom surgery you might need, in order to treat your dysphoria. Beyond a patient’s internal journey of self-exploration, the following are practical considerations that often come into play when deciding to undergo a metoidioplasty:

• BMI limitations: At this time, Dr. Ley is only able to offer simple metoidioplasties to patients with a BMI of 40 or under. A meta with PUL is only available to those who have a BMI or 35 or less. Some patients may elect to first undergo a meta until they lose enough weight to qualify for a phalloplasty.

• Scarring and number of surgeries: Generally speaking, metoidioplasty takes less surgeries and leaves less scarring compared to phalloplasty procedures. This means recovery is often less intensive, the complication risk is lower, and that patients can achieve their final results in less surgeries.

• Penis size and penetrative sex capability: The size of your meta results will depend on how much bottom growth you have experienced taking testosterone. That said, generally, patients’ results are about the size of a thumb. This can make it difficult to have penetrative sex with your natal genital tissue, whereas a phalloplasty result will be larger and better suited for penetration.

• Erogenous sensation: Since a meta does not rewire clitoral nerves through innervation surgery––like some phalloplasty surgeries do––patients can expect to experience the same level of sensitivity after surgery.

For more on the comparison between metoidioplasty and phalloplasty, click here.

Metoidioplasty Cost and Insurance in California

Under California law, all private and public insurance providers are legally obligated to cover some gender-affirming medical care for qualified patients. Still, we highly encourage patients with insurance to review their provider’s clinical guidelines for transgender surgery. This will help you understand which exact requirements you will need to meet, such as providing a support letter from a licensed mental health provider.

Costs for metoidioplasty in San Francisco vary. This is because each surgical plan is customized to an individual’s gender embodiment goals, medical history and anatomical limitations. Generally speaking, without insurance coverage, patients may be charged $23,000-24,500, in addition to hospital, anesthesia, and other fees. For more information on bottom surgery costs, click here.

What to Expect: From Consultation to Recovery in San Francisco

At the GCC, every patient journey begins with requesting a free surgical consultation. Once you meet with Dr. Ley, you two will agree upon a unique, surgical plan for you. From there, you will be given a quote for surgery and a date. You can request a follow-up consultation with Dr. Ley if you have additional questions. In the meantime, our team will help you through the insurance approval process or with any other questions you might have.

If you will be traveling into the San Francisco Bay Area for surgery, you can consult this free resource guide. It contains tips for reducing travel and accommodation costs, as well as trusted patient care resources for trans and non-binary folks.

For a simple meta, you will most likely be discharged from the hospital the day of your operation. If you get a meta with PUL you can expect to stay in the hospital for two nights and use a catheter to urinate for 2-3 weeks. Your care team will give you your recovery instructions before surgery. Once you go home, you can always get in touch with your care team through our secure patient messaging platform, Klara, if you have questions or concerns. For more information on healing from meta, click here.

Frequently Asked Questions

Who performs metoidioplasty in San Francisco?

Dr. Zara Ley is one of the most sought out surgeons in the San Francisco Bay Area for metoidioplasty. She has provided meta alongside other bottom surgery procedures for over a decade, in Arizona and now in California. She offers free consultations in San Francisco for patients interested in undergoing bottom surgery.

Does insurance cover metoidioplasty in California?

Yes, most insurance plans in California cover metoidioplasty as a medically necessary, gender affirming surgery for eligible patients. Most plans require that patients be at least 18 years-old, have undergone at least 12 continuous months of testosterone hormone therapy, and present a gender dysphoria diagnosis to qualify for coverage. Consult your provider’s transgender benefits for specific requirements.

How much does metoidioplasty cost?

Without insurance coverage, metoidioplasty in San Francisco often costs $23,000-24,500, excluding facility, hospital and anesthesia fees. Having your metoidioplasty combined with other surgeries, such as a vaginectomy or mons resection, can increase these costs.

What is the difference between metoidioplasty and phalloplasty?

Phalloplasty is generally a more invasive and difficult surgery to recover from as it tends to involve more stages of surgery, and more aggressive grafting from other parts of the body to create a penis. A metoidioplasty uses only the natal genital tissue to reposition and reconstruct the genitals. Metoidioplasty results are generally smaller (about the size of the thumb) of phalloplasty results.

Do you work with patients who travel to San Francisco for surgery?

Yes, the GCC has years of experience working with patients from all over the US and even internationally. Once out-of-town patients leave San Francisco after surgery, we can work with your local care providers to ensure that you continue to receive the care you need.