Ive recently been referred for lower surgery (phalloplasty) and have obviously done my research (years worth!).
For me, the pros far outweigh the cons.
Ill start with the cons for phallo:
-The scarring. (Ive seen different places used as the donor site; forearm, abdomen, hip, thigh, and ofcourse the MLD flap on your side).
-The risk of complications, as others have already mentioned, it is much greater than with meta. The risk for complication is increased when you have the urethral hookup (so you can stand to pee), and especially when you have the vaginectomy.
-The chance of having an insensate penis, though there are guys out there Ive spoken to who have sensation including erotic sensation.
-The actual surgery. Many surgeons do the phallo in stages, so you have to consider the time off work etc, and at different intervals.
-The aesthetic appearance may not be what you hope. (But again, surgeons seem to be improving on this).
-The available options for erectile devices. You can either have the pump up rod, though this device doesnt last a lifetime. Or you can have the malleable rod, which is semi erect permanently which could make you feel very self conscious! Also, there is the chance over time, of protrusion through the skin.
-A full sized penis. No more packing, or self consciousness. This procedure gives you something meta cant.
-You can stand to pee.
-Balls to complete the picture.
-No more "wrong part" (or front hole as people may say), some people may choose to not have this dealt with, I personally do not understand at all why anyone would want to keep this. But I wont go into those opinions.
-Many surgeons do perform nerve hookups, including to the "little guy" you already have, to allow for erotic sensation, so there are cases of guys being able to cum from sex or just plain wanking!
-You can have penetrative sex.
Cons for Metoidioplasty:
-Risk of complication, thought this goes for any surgery, and it is much less with this, than it is for phallo.
-It will be no bigger than 3inches really. Some guys get this surgery then opt for phallo at a later date.
-Too small for penetrative sex.
-Have to accept the small size, no noticeable bulge. Just something to think of if you want this.
-Sensation will be amazing.
-No visible scars.
-A much smaller risk of complication.
-Is performed in one stage and healing time is much quicker.
-You can pee to stand if you get the urethraplasty.
I personally have always wanted the phallo, though I am adamant that I do not want the forearm phalloplasty. Though this seems to give the best results sensation wise, I can live with that aslong as I avoid that particular scarring.
Also, I am not sure I will opt for any erectile device put in. Im leaning more toward no. Simply because once I have the surgery, I want everything to be done. I want to live my life without being reminded, and I dont want to have to come back years later to get stuff down there sorted or replaced.
I have seen that you can buy external devices out there somewhere, that you just slip on when you need and take off after. Seems simpler.
I dont like the idea of an internal erectile device malfunctioning, or beginning to protrude. Id rather just have my penis and no foreign object inside that could be a risk. (Although Im aware that to have balls, Id need implants. Even though it may sound contradictory, Ill have the balls, but not the erectile device :p)
Loss of sensation doesnt bother me, standing to pee is whats high on my list of priorities.
The London team I think do do great jobs for the phalloplasty, and to me, itll all be worth it to have a good sized penis there, that I can pee through and feel comfortable with. To have the wrong parts sorted and never have to deal with what feels so wrong ever again
Right, I know Ive rambled on, but yeah, thats my bit said!