Choosing which procedure is right for you

[FTMax]

I originally wanted to get full meta with the works, but started worrying that I wouldn't be happy with my size. I then started looking into phallo and getting more comfortable with the idea of a much more involved set of surgical procedures. But I've had some additional growth recently that I'm pleased with. So now I'm a little torn and I'm really looking for other people's stories.

I'm hoping to have both of my referral letters in hand by the end of December, and my hysto scheduled for January or February. I'd like to spend my recovery time scheduling consults, but I can't do that until I know what I want. My feeling is that starting with meta might be the best option for me. If I'm satisfied with the results, great. If not, I can always get phallo after the fact. I'm still in my 20s, so time and recovery capabilities are not an issue.

After deciding that you wanted bottom surgery, what led you to choose meta over phallo, or vice versa? Is there anyone here who had a meta initially and then later had phallo that would be open to sharing their experience?

[Bimmer Guy]

Hi, FTMax,

I see no one else is posting.  So even though I don't know that I will be very helpful, maybe I can get the ball rolling on this thread for you.

For me, it was an easy decision.  I always knew that if I transitioned and got bottom surgery, that I would get the metoidioplasty. 

Reasons for this:

1) I would like to use only genital tissue to change my genitals.  There is something about using another part of my body to create a penis that just doesn't sit well for some reason.  The idea of it just makes me feel uncomfortable.  It doesn't sit well in my gut.
2) I think having a 5-6 inch shaft in my pants all of the time would be inconvenient on many levels, for many reasons
3) I would only want the RFF and I don't like the scar.  More importantly, I am concerned that I would never get back to baseline of arm use (functionality yes, return to baseline function I worry about).
4) The surgeries are hard on the body, in general
5) Healing time and potential need for more than one-two surgeries
6) I don't like the erectile options that are available at this moment in time.

Of the above list, I would say that number 1 and number 6 are the biggest reasons.  Number one is what has kept me from considering it as a real option and number 6 is what confirms why I shouldn't.  Number two is important to me, as well.

The only thing that really bothers me about it is not being able to penetrate my partner.  Or rather, not being able to penetrate my partner easily and "powerfully".  I met a guy a couple of weeks ago who got meta over 15 years ago.  He said to me to not listen to others saying that you can't penetrate your partner (vaginally).  He said that with pumping and getting into the right position, you certainly can.  I asked him the length of his phallus and he showed me like 1.5 inches.  He says he has no problem bringing his heterosexual wife to orgasm.  He says she has never orgasmed with a cis male, but does with him.  We need to remember that the G spot is only 1-2 inches into the vaginal canal.  Missionary position isn't the only option for sexual intercourse.  I physically am able to move around and get into different positions.  I recently found a link that is 20 positions for small penises.

As you probably remember, I am older than you.  I am 45 years old.  However, I am confident in saying that I still would choose the meta if I were your age.  In fact, I might more readily choose the meta since I would know that I would still have the option later to get the phallo. 

Moreover, it is logical to think (well, really we KNOW, don't we?), that the surgeries will only get better.  The erectile devices will definitely get better.  There is one right now that is being made specifically for use in phalloplasty for trans men.  I don't remember if it is already in use in other countries, but it is not FDA approved yet, so it is not used here. I personally don't want the pump because it has to be replaced within 3-5 years (this is what I heard last), and the semi rigid never really lies flat.  Too, I think I would struggle with an "erectile" device because it is a man made item in my genitals.  That feel uncomfortable to me.  For me, it would make me feel like my penis is "less real".  I certainly know that cis men get pumps, I am just saying this is how it would feel for me and my body.

In sum, if I were you, I would go for the meta.  ESPECIALLY if your insurance if paying for it.  It is not like you need to worry that 5-10 years from now if you decide to go with phallo that there is less of a chance that insurance companies will have stop paying for it.  I doubt the AMA is going to decide it is indeed a mental illness that can be fixed with medication or something.

I guess I had a hell of a lot more to say than I thought!     I hope this was helpful.

[mm]

Pre bottom surgery here, looking and reading about what is available when I have the money on a few years.  There are so many decision with all that is available now.  I am interested in everyone comments and experiences.  Hopefully there will be some more comments in this thread.

[FTMax]

That was so helpful man. Thank you for all of that. A lot of the things you discussed have been in my head this entire time, and I think I've downplayed them to myself (esp. regarding permanent size, ability to penetrate). At the end of the day, I want to be able to pee standing up and I want to pass in a locker room setting. Everything else is secondary for me, and everything of importance is easily accomplished with meta (perhaps even better than phallo for both of those things).

Are you having yours with Crane or Chen?

I'd still love to hear other people's experiences!

[Bimmer Guy]

That was so helpful man. Thank you for all of that. A lot of the things you discussed have been in my head this entire time, and I think I've downplayed them to myself (esp. regarding permanent size, ability to penetrate). At the end of the day, I want to be able to pee standing up and I want to pass in a locker room setting. Everything else is secondary for me, and everything of importance is easily accomplished with meta (perhaps even better than phallo for both of those things).

Are you having yours with Crane or Chen?

I'd still love to hear other people's experiences!

Crane.  I would never consider Chen since he is so new.  I'd wait another year for Crane.  But, that is just me.  I actually met Chen when I did my consult with Crane back in June of this year.  He hadn't started his training yet.  Very nice guy.

To me, creating a meta is an art.  You have little tissue and have to create the best looking phallus (length and width) with what you have.  Crane evidently does 5 different types of meta, dependent upon what he has to work with.  I can't imagine there are 5 distinct "types" (especially when he doesn't do the centurion), so I am not sure what that means, exactly.  But to me, it means he is skilled at taking what is in front of him and customizing that person's meta.  He doesn't have a Step 1, 2, 3, done approach.  It may be Step 2 before Step 1 or half of Step 2 with a twist on Step 3, if that is what would give the best result.  He looks at it and then decides.  To me this means Crane has the ability to maximize the possibilities for greatest length and width than a surgeon who takes the same approach with everyone.  And that is the name of the game with meta, right?  Getting it as long and thick as possible?

Anyway, back to Crane vs. Chen.  Lets say, for example, I am an odd duck and there is an extra piece of skin hanging around.  If it could be used for something, there is a better chance he could figure it out instead of Chen.  He can figure it out because 50 metas ago he saw that same piece of skin on somebody else and it worked when he attached to spot B.  He made a fatter phallus with it.  I am just playing around, but you probably get what I am saying.

It is just a learning curve.  Nothing negative around Chen.  Now, when it comes to phallo, I might be comfortable enough to go with Chen.  That is a different bird, so I don't want to talk about that here.

FTMax, you asked me a question in PM I am going to answer here.  The reason why I chose Crane out of all the GRS surgeons is training and dedication to his craft.

He created his own Fellowship in transgender surgery.  Like I said, he trained in Thailand, Serbia, and (somewhere else I can't remember).  He spent a year doing this.  He didn't study under one guy.  He decided to study under three different teams.

Another thing about Crane is that he is the only transgender surgeon who is both a reconstructive plastic surgeon AND a reconstructive urologist.  Remember part of what we are getting done in our surgeries?  Urethral lengthening.  A lot of reconstructive urocologic surgery is on male newborns whose urethra is not in the right place.  They are on the underside of the phallus (I forget what it is called).  Guess who has else has a small phallus guys?  That would be us.

As an aside, Chen had the same reconstructive urology fellowship as Crane.  So, that means Chen is also the only other GRS surgeon who is also a reconstructive urologist.  He spent many years doing specifically urologic surgery.  This would carry an even bigger weight with me if I was getting phallo with urethral lengthening.  I would want the best uro guys to lengthen my urethra that far.

I also love the look of Crane's scrotum on his metas.  He also focuses on moving the scrotum to the anterior position so that it does not hang between the legs like you see with some other surgeons.  Of course, the most important thing about Crane's scrotum is that it is a fused scrotum, not two separate sacks like most GRS surgeons.  Check out his pictures on his site.

I know that there are other good surgeons out there.  Flying from one coast to the other isn't cheap.  Staying in San Fran isn't cheap.  The frustration with my surgery getting canceled in Austin after I had my flight and housing reserved wasn't pretty.  I lost my $185 service fee from AirBnb.  I don't know if I am going to get the money back for my Austin flight.  There has been a hell of a lot of stress around getting this thing scheduled.  I wish his office was more organized.  When I signed up in Austin they didn't even know who was going to do my hysto because they didn't have anyone hired yet.  In fact, they still hadn't contracted with a surgeon for this when my surgery canceled.  This hasn't been an easy process and I am not even sure how much my insurance is going to cover.

But, yes, I am going with Crane.  Just like I didn't want anyone else but Garramone for my top surgery, I only am interested in Crane doing my bottom surgery.  I am willing push through the crap to make it work.

[mm]

Bimmer Guy, I liked your extended comments on why you are going to Dr Crane and I agree with all of them.  He does have by far the most experience with doing the meta procedure which is as you pointed out is very important for this type of procedure where we are all slightly different on what we have to work with when he starts out.  I too think his scrotum's results are the best I have ever seen by far, properly placed and fused to look just like a normal cis scrotum.  His going to Austin was great, but didn't workout and unfortunately many made plan as if it was a done done.

[Bimmer Guy]

Bimmer Guy, I liked your extended comments on why you are going to Dr Crane and I agree with all of them.  He does have by far the most experience with doing the meta procedure which is as you pointed out is very important for this type of procedure where we are all slightly different on what we have to work with when he starts out.  I too think his scrotum's results are the best I have ever seen by far, properly placed and fused to look just like a normal cis scrotum.  His going to Austin was great, but didn't workout and unfortunately many made plan as if it was a done done.

Thanks for your thoughts, mm.

As a comment, there are actually a number of surgeons who have logged a lot more metas than Crane.  Really he is rather new to this, only being in practice a few years.

However, I appreciate his extended training (and subsequently high level skill set/not having a "cookie cutter" meta approach), and also the improvements he has brought to scrotoplasty surgery.  I think we will see more surgeons making fused scrotums.  I can't remember who else does one.  But, I think at least one guy has started to do them.  Schechter maybe?  I thought I saw that on his site once, but can't find it. 

[Daft]

I'm scheduled for metoidioplasty with Dr. Meltzer in Scottsdale, Arizona, May 24th of this year.
Full with testicular implants, v-ectomy, urethral lengthening. I had my hysto completed earlier last year.

I bounced back and forth determining what surgery I wanted. A huge issue for me was size, even though I'm not overly concerned; I kept telling myself that if meta resulted in bigger, "average" sized results, I would be set on it 100% and wouldn't even think twice about having phallo. It took me a long time to sort out my concerns about size and if I cared enough to go through with phalloplasty. I've come to a weird conclusion, rather intuitive, I feel like had I been born with the right genitals, they would have been on the smaller side. And my sexual concerns aren't very linked to size. Just as long as I have the right set, I will be happy.

There was also a part of me who was concerned that over time, my thoughts about it would evolve and I didn't know if in the future, I would want phallo. I consulted with Dr. Meltzer, and he said that if I ever decide to pursue phalloplasty, the meta provides a great base, so he is going to purposely set up things to be functional in the pursuit of future surgery if I decide. He was really thorough about it, which I'm glad.

To me, the biggest thing was testicular implants, and I'm really impressed with both Meltzer's and Crane's work (I was thinking of meta first with Meltzer, then balls with Crane, but I don't want to take too much time out and travel around for surgeries). To me, they are more important than the meta itself, but everyone's priorities are different.

A dealbreaker to me was the arm scar from phallo, too. I am stealth in daily life, and while the scar can be explained for, I wouldn't want to deal with extensive care for another scar area, seeing as my top surgery scars have been slow healers so far. And the scars from meta are very minimal, plus nobody will be seeing them other than myself, a partner, doctor, etc.

Keep in mind I am 19, one of Meltzer's youngest patients. My opinion can change drastically, but I've thought about this extensively. In the case that I desire phallo later on in adult life, at least the setup will work out fine for it, so I've planned my surgery "preemptively".

[blink]

Way off topic but Daft, dude. Great avatar. Punchy was my favorite.

Haven't gotten lower surgery yet.
I tended from the beginning towards metoidioplasty. All other pros and cons aside, if I got meta and that wasn't enough for me I could - hypothetically, barring obvious cost issues - get phalloplasty down the road. Don't think it works the other way around. So I've argued to myself that would be the smart route. If you noticed the past tense despite still being pre-op, you know where this is going. I'm not as settled on metoidioplasty as I wanted to be.

I am good at lying to myself about my own wants and needs. This is a huge problem in deciding on surgery. It's too easy to tell myself I don't "need" something. That's the biggest thing I'm struggling with, aside from trying to find a way to finance this process. Desperation factors in, too. It's tempting to think something more affordable and less far-off would be enough.

I've been trying hard recently to be more honest with myself. If I don't look out for my best interests, no one will, and in the long term I'm not doing myself favors with the sour grapes routine. That works great for talking myself out of junk food, but it's a stupid approach to long term life goals.

I've caught myself too many times comparing surgeon prices for meta and thinking, "But for $__,____ more I could get phalloplasty." If I heard someone else say that, I'd say he needs to think real carefully about whether metoidioplasty is really what he wants.
There's been too many moments where I was intensely, painfully sure what I need is phalloplasty - followed by despair at how unattainable it seems.

I'm settled on some things. For me a vaginectomy is necessary, along with a fused scrotum (things being split down there is a big cause of dysphoria for me), and testicular implants. If I were up to my eyeballs in cash there's a good chance I'd go to Dr. Crane for a meta, to see if it'd be enough for me. His meta results look real good.  But somehow I have an increasingly distinct sense of what should be there, of what's missing, and although it's not unusually well-endowed, a meta isn't it. Multiple surgeries involving my urinary tract also does not fill me with joy or confidence, no matter how much money I hypothetically had. And the reality is, I don't have much. If what I really need is phallo, I need to save all my money for that, not plop down a huge sum for meta that could've gone towards phallo.

I have concerns aside from financial ones. I prefer sleeping on my stomach and wonder if that's compatible with phalloplasty.
It sounds odd, but I definitely want urethral extension even though I'd rather sit to urinate (have concerns about fully emptying bladder) - I wonder if this is compatible with phallo or if it somehow creates problems with sitting to urinate. And at the risk of being graphic (and showing exactly how little interest in dating I have, that my concern is with masturbation rather than sex) I wonder how masturbation would work with phallo but without an erectile device.
I don't know where or who to ask about this stuff. I don't really want to ask another man for details on how he masturbates, much less hear the answer, but at the same time it's a factor in whether it's the right surgery for me.

[Sir Real]

I'm late to the party but wanted to share my thoughts as well. I had been going back and forth between meta and phallo recently. I originally was set on meta, then got disappointed with how little I grew on T. I got some gains in the first 2-3 weeks, and then that was it, even after a significant dose increase. (started at maybe 1", now 1.25" fwiw) I haven't been sure whether or not that's "enough" for meta to clear the fly. But going to see if DHT is at all possible, and going to start pumping. So, we'll see. Anyways, one reason I'm more than likely going for meta at this point is because medicine is advancing in some very interesting ways. I believe that one scientist is ready to start doing human trials for "lab-grown" penises. If by the time I'm ready to get bottom surgery, it's advanced far enough, who knows, maybe I'll have a chance to get in on the action. But if it takes way more time than that, I would think meta is a better choice for a baseline than phallo. Even if it's possible to cut off and start over (sorry for the imagery), I'd feel pretty sad about that, personally. Mostly because of the grafting that is required. Not the end of the world and anyways I'm sure it wouldn't bother some people much. Just my take on it.

The other thing is changing my mindset. There are men who have micropenises. Maybe I'm just one of them. And there's no shame in that. I was just one of the many men who was born with smaller-than-average goods. That's all.

One idea that I like is that it'd really be all genital tissue there. Basically what Blimmer Guy said in his first point.

Anyone give me crap for my size? Depending on the situation, I might say, "What, too small for you? I'm flattered, I didn't know you were interested."  Or perhaps, "Yeah, all the size went to my brain instead. Looks like you weren't as lucky." 

Anyways, jokes aside, my point is maybe having a small dick isn't the most ideal of situations, but hey, maybe it won't be so bad, either. And maybe there's hope for advances in the future. That's how I see it for my own personal self, anyways.

[mm]

 Asa Spades, I want most I think to be able to pee standing through a fly. From what I read you need 3 inches after meta which is above average for what I read.  There are some real nice looking phallo and have erection device too so may consider that when the time comes.

[Arch]

Having spent my entire adult life with well-endowed (and very well-endowed) men, I've become so sensitive to size that I don't see how I would be happy with meta.

In addition, my downstairs growth is not at all impressive, so I don't have very much to work with. An acquaintance told me that to masturbate, he grasps his part between thumb and forefinger and pumps up and down, much as a cis man might do with his whole hand. I don't have enough growth for that. I jack off pretty much the same as I did before T.

On the other hand, there's something to be said for having the original erectile tissue down there instead of transplanted material from an arm or leg. But if it's so small in the first place...I keep coming back to phallo. I need a penis of typical size that I can use to pee standing up--a penis that will pass muster in the men's room. I don't expect to be in a relationship again, but if I do, I'll feel more inadequate with meta than with phallo.

I don't plan to have any kind of erectile device, as I am not happy with the options. But since my constructed phallus won't naturally shrink on its own, I'll be packing something pretty large and ungainly in my pants. I really don't want that, but I can't see any alternative.

[WorkingOnThomas]

Standard practice here is everyone getting bottom surgery starts with a meta, then they use that as the base for the phallo if that is what is wanted. For now, I'm happy stopping with the meta, depending on how much growth I get once I start T. I've been thinking it over a lot and I just don't feel comfortable with the idea of a penile implant. Nor have I been thrilled with pics of the phallos that I've seen. If the surgery improves, perhaps I'll change my mind. I have more time to think about it in any case, since it's two years away.