Vaginal and/or vulva preservation: Several patients request that the vaginal canal and/or parts of the vulva be kept in-tact with the creation of a penis. Vaginal preservations are only possible when the original urethra is kept intact; this means a patient could only urinate while sitting down or with the use of an assistive device, as opposed to being able to pee out of the tip of their penis. Likewise, the clitoris/natal penis and labia can be kept intact so long as the patient does not wish to have a urethral lengthening..  Urethral lengthening: If a patient wishes to get a urethral lengthening to pee out of the tip of …

The RFF phalloplasty takes a large skin graft from the sensitive forearm region to construct a phallus. The ALT phalloplasty takes a large skin graft from the sensitive outer thigh region to construct a phallus. Nerve innervation microsurgery allows the patient to experience erogenous sensation in their penis by hooking up one of the clitoral nerves to the sensory nerve of the forearm or thigh. A very noticeable scar is left on the forearm or outer thigh from the skin graft. 2-4 weeks after the flap is taken from the forearm, Dr. Ley will cover the donor site with a split or full-thickness skin graft from the thigh. The illustrations …

Groin flap phalloplasty uses groin tissue to create the new penis. Using groin tissue allows the scars from this surgery to be more easily concealed, and allows a penis of adequate length and girth for most patients.  The groin flap does not have erogenous sensation; most patients experience normal levels of tactile sensation in their new penis. If a patient wishes to urinate standing up, our surgeon can perform a urethral lengthening using a forearm or hip skin flap. An advantage of a radial forearm flap is that nerve innervation microsurgery can be performed. This allows for the possibility of erogenous sensation to be felt in the new penis, as …

Insurance coverage for MTF transition procedures such as HRT and gender-affirming surgeries will depend highly on your individual insurance plan. Many insurance plans now cover gender-affirming care, but vary in requirements and necessary documentation. At GCC, our insurance advocacy team has a 90% success rate for securing coverage for interested patients. For more information refer to our insurance coverage page.

Given that an orchiectomy or removal of the testicles is a sterilization procedure, it will irreversibly prevent having children. However, the long-term, permanent effects of HRT on fertility are less certain. Many people assigned male at birth seek out fertility preservation, often through sperm banking or cryopreservation. For more information on transfeminine fertility, you can check out this resource.

Many patients ask this question due to worries around post-transition regret. This is very rare and according to the World Professional Association of Transgender Health (WPATH) Standards of Care 8 (SOC 9), regret rates of gender-affirming care are as small as 1%. Destransition is similarly uncommon. Those who detransition do so for complex and individual reasons and should be met with empathy; most often, these have to do with weak support networks and few financial resources to pursue transition safely. Ultimately, it is normal to feel nervous about making a large change in your life. It is important to remember that for many transitioning brings measurable benefits to quality of …

The length of your timeline may vary on a number of factors, from goals, to safety and your ability to access legal and medical changes if you choose to make those a part of your journey. Some people may not be in a safe environment to transition or gain access to resources. Forms of transition can vary in time as well. For example, depending on the state you live in, changing the gender marker on your license may take less time than the physical changes one experiences from HRT. To get a sense of what to prioritize, you may want to ask yourself what changes would help relieve the most …

Choosing to transition is a deeply personal choice. Some find it helpful to ask whether you feel that you currently embody and live as the gender identity you wish to live as. In answering that question, it is important to consider how much daily, persistent discomfort you experience by not embodying your gender. Many people who detransition do so not out of regret, but rather because they lack the social and economic support to do so safely and/or securely.  Reasons for transitioning can include many things, from experiences of dysphoria to longing for a certain gender presentation. While for many, transitioning is an avenue to realizing their gender identity, you …

Patients must adhere to a strict no smoking and no nicotine consumption for 3 weeks before and after surgery to reduce nipple graft reduction, anesthesia interference and delayed wound healing. While nicotine is the major culprit, smoking marijuana can interfere with healing and anesthetic. We suggest that patients switch to edibles or CBD and communicate openly with their surgeon to minimize risk. We also advise patients to not drink alcohol one week before and after surgery, and to never drink while taking prescription pain medication.

At GCC, we use the labia minora tissue to create the phallus in metoidioplasty and phalloplasty. As a result, it is not possible to retain the vaginal opening. There are procedures that do not use the labia minora to create a phallus and preserve the vaginal opening, though these are not performed at GCC.