• linkedin
  • Increase Font
  • Sharebar

    Management of the patient requesting transgender surgery

    Urologist’s role may include orchiectomy, treatment of voiding dysfunction


    Urologic concerns of transgender men (FtM)

    Transgender men (FtM) on masculinizing hormones will experience facial and body hair growth, scalp hair loss, increased muscle mass, body fat redistribution, amenorrhea, clitoral enlargement (figure 2), vaginal atrophy, and voice deepening.

    Also see: Slow breathing technique helps reduce hot flashes

    FtM patients may undergo genital reconstructive procedures including metoidioplasty or phalloplasty (utilizing pedicled or free vascularized flap), vaginectomy, urethroplasty, scrotoplasty, penile prosthesis placement, and/or testicular implant placement, with oophorectomy and hysterectomy (figures 3 and 4).

    Metoidioplasty involves construction of a microphallus from release of the suspensory ligaments of the clitoris, which requires hormonally induced clitoromegaly. Patients may choose to undergo urethral lengthening as well if they desire the ability to stand while voiding.

    There is no phalloplasty technique considered to be the standard for penile reconstruction, and the choice of technique is dependent on the patient’s needs and requests, with each approach having benefits and drawbacks. Radial forearm free flap involves use of a free vascularized forearm flap, with a urethral tube made from cutaneous skin with an outer phallus tube. Other reconstructive options include anterolateral thigh flap, fibula, latissimus dorsi, and suprapubic flaps.

    Erogenous sensation may be achieved via anastomosis of the dominant sensory nerve from the flap to the clitoral nerve, or transposition of the clitoris to the superficial aspect of the base of the phallus. Patients may also undergo scrotoplasty, immediate or delayed glans sculpturing, urethroplasty, and later placement of a penile prosthesis and/or testicular prosthesis.

    The complication rates for FtM genital reconstruction are high, with immediate risks of partial phallus loss due to flap failure, wound breakdown, neo-urethral fistula and stricture, and donor site morbidity. Changes in urinary habits, including a post-void dribble, are common. Due to the surgical risks, many patients will choose not to undergo surgical reconstruction beyond hysterectomy and salpingo-oophorectomy.


    Urologists in the United States may see a greater number of transgender or gender-variant patients in their practices due to changing legislation, insurance coverage, and greater social acceptance of transgender individuals. While gender-confirming surgeries should only be attempted by experienced reconstructive surgeons, patients may seek care from general urologists for orchiectomy and management of voiding dysfunction or other concerns that may be complicated by prior reconstructions.

    More from Urology Times:

    Meta-analysis links LUTS to heart disease in men

    LUTS’ burden may extend to cardiac events

    Urology work force faces gender pay gap, shortage

    Subscribe to Urology Times to get monthly news from the leading news source for urologists.


    You must be signed in to leave a comment. Registering is fast and free!

    All comments must follow the ModernMedicine Network community rules and terms of use, and will be moderated. ModernMedicine reserves the right to use the comments we receive, in whole or in part,in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

    • No comments available