Inclusive Care for Gender Affirmation Surgery

Gender affirmation surgery refers to a group of surgical procedures that help align a person’s physical anatomy with their gender identity. It is a medically recognised, regulated and evidence-based part of gender-affirming care for transgender and gender diverse individuals.

The goal of this surgery is to reduce gender incongruence, improve mental health, and enhance quality of life.

Common gender-affirming surgeries for transmasculine individuals include:

Gender-affirming surgery is for:

Not everyone who identifies as trans or gender diverse will choose surgery, and that’s valid. But for many, surgery can be life-changing, offering improved self-esteem, intimacy, and social comfort.

At my clinic, I offer gender-affirming genital surgery – including phalloplasty, penile implants, and urethral reconstruction – with an affirming, respectful, and highly specialised approach. We provide clear guidance, coordinated care, and long-term support throughout your surgical journey.

Preserving or restoring sensation is a critical goal in procedures such as penile reconstruction, penile implant surgery, and gender-affirming phalloplasty.

Sensation plays a key role in sexual function, body confidence, and overall quality of life.

The approach depends on the type of surgery and the patient’s baseline anatomy.
In penile implant surgery, sensation is typically preserved because the procedure does not interfere with the skin or nerves responsible for tactile and erotic sensation. Most men retain normal sensitivity after healing and report satisfaction with their sensory experience.

In phalloplasty or complex penile reconstruction, restoring sensation involves:

Nerve regeneration is gradual and varies between individuals. Protective sensation may return within 12-24 months, while erogenous sensation, if achieved, can take longer. Not all patients regain full sensation, but many report meaningful improvements over time.

Additional strategies to support sensory outcomes include:

At my clinic, I use microsurgical techniques and work closely with each patient to maximise both functional and sensory outcomes – whether performing penile implant surgery, revision procedures, or genital reconstruction.

In penile reconstruction – whether for trauma, congenital conditions, cancer, or gender-affirming surgery – the goal is to restore or preserve three key functions: sensation, urination, and sexual function. Each is addressed carefully during surgical planning and reconstruction.

Sensation: Where possible, nerve-sparing techniques are used to preserve natural sensitivity. In gender-affirming surgery or total penile reconstruction, nerve coaptation is performed – connecting donor tissue nerves to recipient sensory nerves (such as the ilioinguinal or dorsal clitoral or penile nerves). This allows sensation (touch, pressure, temperature) to return over time. Some individuals also regain erogenous sensation, though this varies.

Urinary function: For patients who require urethral reconstruction, a new urinary channel (neourethra) is created to allow standing urination. This involves staged procedures to connect the native urethra with the reconstructed phallus. Special care is taken to minimise risks of fistula (leak) or stricture (narrowing). Postoperative catheterisation and follow-up imaging are part of the recovery process to ensure proper healing and flow.

Sexual function: Sexual function is restored in two main ways:

At my clinic, I take a comprehensive approach to each patient’s goals, with detailed surgical planning, evidence-based techniques, and multidisciplinary support to restore form, function, and comfort.

In many cases, yes. It depends on the type of procedure you undergo. Follow-up surgeries or staged procedures may be part of the overall treatment plan, especially in complex surgery like penile reconstruction and gender-affirming surgery.

Common reasons for further procedures include:

Staged surgeries:

Refinements or adjustments:

Managing complications (if they occur):

Routine follow-up:

At my clinic, every surgical plan includes a clear roadmap for postoperative care, future planning, and long-term outcomes. Patients are supported not just during surgery, but throughout recovery and beyond.

The length of hospital stay, and recovery time depend on the type of procedure – whether it’s a penile implant, penile reconstruction, or gender-affirming surgery – and your individual health.

For penile implant surgery:

For penile and scrotal surgery):

For phalloplasty (gender-affirming or cismen):

Every patient receives a tailored recovery plan, including:

At my clinic, we provide close aftercare to ensure healing is safe, smooth, and aligned with your personal requirements – both surgical or non-surgical.

Penile reconstruction, whether for medical, functional, or gender-affirming reasons, aims to restore or improve multiple aspects of health: physical function, aesthetic appearance, and psychological wellbeing. Outcomes are highly individual, but many patients report significant improvements across all areas.

Functional outcomes:

• Restoration of urination (e.g. standing voiding via a reconstructed urethra, if included in the procedure)
• Ability to engage in sexual activity, particularly when combined with penile prosthesis implantation
• Relief from discomfort, deformity, or functional impairment caused by previous trauma, disease, or scarring

Aesthetic outcomes:

• A phallus or reconstructed penis that reflects your identity and personal goals
• Natural shape, symmetry, and appearance (depending on donor site and technique)
• Improvement in abnormal scarring or wound healing following previous surgery

Psychological outcomes:

• Improved confidence and body image
• Reduction in gender dysphoria (in gender-affirming cases)
• Stronger sense of self, intimacy, and quality of life
• Greater comfort in relationships, public spaces, and everyday routines

At my clinic, we focus not only on technical success, but also on how the results align with your expectations. This includes pre-operative counselling, realistic planning, and ongoing support throughout recovery.

While no surgery is without risks or limitations, many patients experience life-changing outcomes – both physically and emotionally – when treated by an experienced and specialist-led team.

Before undergoing penile reconstruction, penile implant surgery, or any form of gender-affirming genital surgery, a detailed preoperative assessment is essential to ensure safety, suitability, and optimal outcomes. You must also have been comprehensively assessed and cleared by qualified gender clinicians to proceed.

At my clinic, the following steps are typically included:

1. Medical history and physical examination

• We review your general health, medications, previous surgeries, and any existing conditions
• A physical exam helps assess anatomy, tissue quality, and any scarring or complications from previous procedures. Your height, weight and body mass index (BMI) will be checked in addition to suitability for penile reconstruction
• If you are a smoker, you need to have stopped for 6 months before phalloplasty. You may vape up to 1 month before phalloplasty.

2. Blood and urine tests

• Routine blood work to check organ function, clotting, and infection risk
• Urine tests to screen for urinary tract infections or abnormalities

3. Hormonal evaluation (if applicable)

• For gender-affirming surgery or hormonal issues, we review your endocrine profile and current hormone therapy
• Additional tests may be recommended for testosterone, LH, FSH, or prolactin

4. Imaging (if required)

• Ultrasound or MRI may be used for evaluating your previous surgical sites, vascular (blood vessel) supply, or current anatomy
• Urethral imaging is sometimes necessary before and after urethral reconstruction

5. Specialist referrals

• Depending on your medical history, referrals may be made to anaesthetics, cardiology, endocrinology, or psychology for surgical clearance

6. Informed consent and counselling

• We’ll discuss the procedure in detail, including risks, benefits, expected outcomes, and the recovery process
• Psychological support and fertility counselling may be included, particularly in gender-affirming or fertility-related surgeries

7. Lifestyle and medication guidance

• You may be advised to stop smoking, pause certain medications (e.g. blood thinners), and optimise health before surgery
• Preoperative instructions will be given for fasting, hygiene, and logistics (e.g. arranging transport or postoperative care)

Every surgical journey starts with a personalised assessment plan, ensuring you’re physically, psychologically and emotionally prepared. Our goal is to deliver safe, affirming, and evidence-based care every step of the way.

Knowing when you’re ready for gender affirmation surgery is a deeply personal decision – one that involves physical, emotional, and social considerations. There is no single “right” moment, but there are important signs and steps that can help guide you.

You may be ready when:

• You have a consistent and well-established gender identity, and surgery aligns with your goals for gender expression and bodily autonomy
• You’ve had discussions with two gender-affirming healthcare providers or therapists who supports your readiness
• You understand the benefits, risks, and limitations of the procedure and have realistic expectations
• You feel emotionally and mentally prepared for the changes and recovery process with support available for your recovery
• You’ve had time to explore non-surgical options (e.g. hormone therapy, social transition) and still feel surgery is right for you
• You are medically fit for surgery, or have taken steps to stabilise any health conditions

International guidelines (such as WPATH) typically recommend:

• Two referrals or support letters from a qualified gender care clinician
• Evidence of gender dysphoria or persistent discomfort with sex characteristics
• Capacity to provide informed consent
• Ongoing hormone therapy >1 or 2 years (for genital surgery), unless contraindicated
• At least 12 months of living in your affirmed gender role, though this may vary depending on individual pathways

At my clinic, we take a respectful, person-centred approach. We offer comprehensive consultations, coordinated care with mental health and hormone specialists, and support at every stage, from decision-making through to postoperative recovery.

If you’re considering surgery and unsure about timing, a consultation is a good place to start.

Eligibility for phalloplasty or metoidioplasty – two types of gender-affirming genital surgery for transmasculine and gender diverse individuals – depends on your personal goals, anatomy, health status, and readiness for surgery.

Both procedures aim to affirm gender identity and restore function, but each has different requirements and outcomes.

General eligibility criteria include:

• A well-established gender identity that aligns with masculinising surgery goals
• Two formal referral letters or support from a qualified gender health professional (per WPATH guidelines)
• Informed consent and a clear understanding of the risks, stages, and outcomes of surgery
• Typically, at least 12 months of hormone therapy (testosterone), unless medically contraindicated
• Good overall physical and mental health, including stable chronic conditions and no active infections
• Non-smoking status (or willingness to stop), especially important for phalloplasty due to flap healing risks

Phalloplasty is typically recommended for:

• Those who desire a larger phallus, standing urination, and/or the possibility of sexual intercourse
• Patients willing to undergo multi-stage surgical procedures
• Individuals with sufficient and appropriate donor tissue (e.g. forearm or thigh)

Metoidioplasty is typically recommended for:

• Individuals seeking a less invasive option
• Those with significant clitoral growth from testosterone therapy and slim build
• Patients not seeking penile implants or penetrative sexual function (although this is sometimes possible after metoidioplasty)

At my clinic, I offer detailed surgical consultations, including anatomical assessment, donor site evaluation, and collaborative care planning. We’ll explore whether you’re a good candidate and which procedure best aligns with your body, identity, and goals.

Phalloplasty and metoidioplasty are two types of gender-affirming surgeries designed to create a neophallus, but they differ significantly in technique, appearance, recovery, and functional outcomes.

Phalloplasty involves constructing a neophallus using tissue from a donor site – most commonly the forearm (RFFF) or thigh (ALT). It is a multi-stage surgery that can include urethral lengthening, glansplasty (glans sculpting), scrotoplasty, and later, penile implant placement for rigidity.

Key features:

• Creates a full-sized phallus
• Allows for standing urination with urethral lengthening
• Penile implants can provide penetrative sexual function
• Requires a donor site, which leaves a scar and requires healing
• Typically involves more surgical stages and a longer recovery

Phalloplasty is often chosen by those who want greater length, girth, and the option for future penile prosthesis.

Metoidioplasty uses the enlarged clitoris (typically developed through long-term testosterone therapy) to form a small phallus. Urethral lengthening and scrotoplasty can also be included, depending on the patient’s goals.

Key features:

• Shorter, less invasive surgery
• Retains natural erotic sensation
• No donor site (extensive scarring) required
• May allow for standing urination (if urethral lengthening is performed)
• Does not typically allow for penetrative sex due to limited size
• Shorter recovery time compared to phalloplasty

At my clinic, we offer comprehensive consultations to help you decide which approach best suits your goals, anatomy, and lifestyle. Both procedures are valid and affirming options, the choice depends entirely on what feels right for you.

Yes, with the appropriate surgical technique, many patients are able to urinate while standing after gender-affirming genital surgery or penile reconstruction. However, this depends on whether urethral lengthening is included as part of the procedure.

In phalloplasty:

A neourethra is created by connecting your existing urethra to a newly constructed channel that runs through the phallus. This allows standing urination through the tip of the neophallus.

• Urethral lengthening is typically performed in stages to reduce the risk of complications
• Postoperative care includes catheterisation, imaging to assess flow, and monitoring for issues such as fistulas (leaks) or strictures (narrowing)

In metoidioplasty:

Standing urination is possible if urethral lengthening is performed. This is often achievable due to the clitoral length gained through testosterone therapy, but not all patients choose this step. We will often have to harvest buccal mucosa (mouth lining) to augment the reconstruction.

• The choice depends on individual anatomy, lifestyle goals, and willingness to accept additional surgical complexity

In reconstructive surgery (e.g. for trauma, cancer, or Peyronie’s disease):

If the urethra is affected, urethroplasty may be required to restore normal or functional urination – including standing, if appropriate.

At my clinic, we carefully assess your anatomy and goals to determine whether standing urination is achievable and safe in your case. We offer a staged approach to try minimise complications, with close follow-up to support healing and function.

Like any major surgery, gender affirmation procedures – including phalloplasty, metoidioplasty, urethral reconstruction, and scrotoplasty – carry risks. While many patients experience excellent outcomes, it’s important to understand the potential complications are not uncommon, so you can make informed decisions and plan for recovery.

Common surgical risks:

• Bleeding or haematoma
• Infection at the surgical or donor site
• Delayed wound healing or tissue breakdown
• Scarring or tightness at the incision or flap edges

Procedure-specific complications:

• Urethral fistula (a leak from the neourethra)
• Urethral stricture (narrowing of the urinary channel), which may require revision surgery
• Loss of sensation or delayed return of nerve function in the phallus
• Donor site complications, including poor healing, sensitivity, or aesthetic concerns
• Implant-related complications (if a penile prosthesis is added later), such as infection, erosion, or mechanical failure

Psychological and functional considerations:

• Adjustment to physical changes, especially in the early months
• Body image concerns, which may improve over time or with revision procedures
• Sexual function challenges, depending on the individual’s anatomy, goals, and healing
• Emotional or psychological stress during recovery, which is why ongoing support is encouraged

At my clinic, we follow a staged, evidence-based approach designed to reduce complications and support long-term outcomes. We also provide comprehensive aftercare, work closely with specialist teams, and ensure every patient has access to clear information and support before, during, and after surgery.

The cost of gender-affirming or reconstructive genital surgery can vary significantly depending on the type of procedure, number of surgical stages, required hospital stay, and post-operative care.

Private care costs typically cover:

• Pre-operative consultations and assessments
• Anaesthesia and operating theatre fees
• Surgeon and surgical team fees
• Hospital admission and post-operative care
• Follow-up imaging and further unplanned surgery, if required
• Any planned revision or secondary procedures (where applicable)

A detailed quotation is always provided after your consultation, tailored to your specific treatment plan.

NHS or public funding (UK):

Gender-affirming surgery is covered by the NHS through referral pathways within a Gender Identity Clinic (GIC) via the Gender Dysphoria National Referral Support Services (GDNRSS). However, waiting times can be lengthy and it is only available to those who qualify for NHS care. Please ask if you would like me to refer you for further treatment under the NHS at any time.

Other procedures – such as surgery for Peyronie’s disease, penile cancer, or buried penis correction – are also eligible for NHS treatment, depending on clinical need and referral status.

Private insurance:

• Coverage varies greatly depending on your provider and policy
• Most UK insurance plans do not routinely cover gender-affirming genital surgery
• Some may partially cover medically necessary urological procedures (e.g. penile implant for erectile dysfunction)

We work with you to ensure transparent, itemised costing and coordinate with your insurer when applicable. International patients are also welcome and provided with clear pricing and logistical support.

At my clinic, we offer multiple phalloplasty techniques tailored to each patient’s anatomy, goals, and medical profile. The two most performed approaches are:

1. Radial Forearm Free Flap (RFFF) Phalloplasty

This is one of the most widely used and reliable techniques worldwide.

• Tissue is taken from the forearm, including skin, blood vessels, and nerves
• Offers excellent tactile and sensory nerve connections, making it ideal for restoring sensation
• Provides a natural shape, with the option of urethral lengthening and glansplasty
• Suitable for patients seeking penile prosthesis implantation in the future
• Leaves a visible forearm scar, which can be covered with a skin graft or tattooed over

2. Anterolateral Thigh (ALT) Flap Phalloplasty

A good option for patients wanting to avoid visible arm scarring.

• Tissue is harvested from the thigh, which can offer a more concealed donor site
• Can be performed as a pedicled or free flap, depending on vascular anatomy
• May be bulkier, so additional contouring may be needed
• Sensory outcomes can vary and may be slightly less consistent than with RFFF

Additional options (in select cases):

• Abdominal flap or other customised donor sites, based on medical need or prior surgeries
• Staged urethral reconstruction, glans shaping, vaginectomy, scrotoplasty, and eventual penile implant and testicular placement can be integrated into your surgical plan

Each technique is discussed in detail during your consultation, considering your body type, lifestyle, scarring preference, and long-term goals.

At my clinic, I prioritise precise attention to microsurgical and reconstructive techniques to ensure the best possible functional and aesthetic outcomes – including sensation, standing urination, and penetrative capability where desired.

Gender affirmation surgery encompasses a range of procedures designed to align a person’s physical characteristics with their gender identity. For transmasculine and gender diverse individuals, several surgical options are available depending on individual goals, anatomy, and health.

At my clinic, I focus on genital and reconstructive procedures as part of a comprehensive, evidence-based approach.

Common surgical procedures for transmasculine patients include:

Phalloplasty

• Construction of a phallus or penis using tissue from a donor site (e.g. forearm or thigh)
• Can include urethral lengthening for standing urination
• Often staged with later addition of a penile prosthesis for sexual function and penetrative intercourse

Metoidioplasty

• Creation of a small phallus using an enlarged clitoris (developed through testosterone therapy)
• May include urethral lengthening and scrotoplasty
• Less invasive, retains natural sensation, but does not typically allow penetration

Scrotoplasty

• Creation of a scrotum using labial tissue
• Option to insert testicular implants for realistic appearance and weight

Urethral reconstruction

• Extends the urethra to the tip of the neophallus for standing urination
• Often performed in stages to reduce risk of fistula or stricture

Penile prosthesis implantation

• Malleable (semi-rigid) or inflatable device placed in the neophallus to allow penetrative sex or intercourse
• Typically performed after full healing from phalloplasty

Glansplasty

• Shaping of the glans (head) of the neophallus for a natural appearance

Revision or enhancement procedures

• Cosmetic or functional refinements based on patient goals or healing outcomes
• May include contouring, scar revision, or implant adjustments

Each procedure is highly individual and may be performed in stages. Surgical planning always includes discussion of risks, benefits, timelines, and realistic outcomes – including sensation, sexual function, and urinary goals.