What is metoidioplasty?

Permanent surgical lengthening and straightening of the clitoris.

It's also known as Meto, Metoidioplasty, Meta, or Clitoral release.

What does metoidioplasty do?

• Lower body

  Lengthens and straightens clitoris, lets you stand to urinate

Who can have metoidioplasty?

• You must have had 12 continuous months living as your gender identity

• You must have had 12 continuous months of HRT, unless you’re unable to

• You must have capacity to consent for this treatment

• If you have significant medical conditions, these need to be “reasonably well-controlled”

• Under 18s cannot have this but can be referred at 17

• You typically need a BMI of less than 30

How long does metoidioplasty last?

The effects are permanent and cannot be reversed. Metoidioplasty in the UK is performed in at least two operations which take place several months apart. The number of operations and time between them will depend on whether the ability to stand to urinate or testicular implants are required.

What should I be aware of?

Why might I want metoidioplasty?

The main effect of a metoidioplasty is to enlarge the apparent size of the clitoris. In a metoidioplasty, the clitoris is detached from the labia and the ligaments which hold the clitoris are cut. This “releases” the clitoris, adding 2-4cm in length and allows the clitoris to point upwards 2, p.296.

If you wish to be able to urinate from the end of the clitoris, urethroplasty (construction of an extension of the urethra) can also be performed along with metoidioplasty. This is an optional procedure - you may not have this procedure and continue urinating from your existing urethral opening if you want, though this would require continuing to sit to urinate or using a stand to pee device. Avoiding a urethroplasty reduces the risk of complications 3, p.30.

If you also wish to have a scrotum, you can optionally also have testicular implants added as part of a scrotoplasty that takes place at the same time as a metoidioplasty 2, p.297.

Why might I not want metoidioplasty?

If the size is important to you, you might wish to avoid metoidioplasty and instead have phalloplasty, surgery to create a penis. Phalloplasty usually creates an average sized penis, compared to the much smaller (5-7cm length) results of metoidioplasty. However, as metoidioplasty uses only clitoral tissue, it will usually provide an organ with good erogenous sensation which can become erect without the use of prostheses. Metoidioplasty also often requires less surgeries, less time in hospital, and less scarring.

How do I get metoidioplasty?

Metoidioplasty first requires taking testosterone which causes hypertrophy (enlargement) of the clitoris. Once this has occurred (usually after 1-2 years into taking testosterone), metoidioplasty can be carried out 1, p.732.

In order to be accepted for a metoidioplasty, you will normally need to meet the following conditions:

• persistent and well-documented gender dysphoria
• capacity to make fully informed decisions and to consent to treatment
• if significant medical or mental health concerns are present, they must be reasonably well controlled
• two medical opinions, usually at least one from a gender clinic, that surgery is appropriate
• 12 months’ continuous endocrine treatment as appropriate to the patient’s goals (unless the patient has medical contraindications or is otherwise unable to take hormones)
• at least 12 months’ living continuously in a gender role that is congruent with the gender identity 3.

NGICNS maintains a list of NHS surgery providers providing various gender-related surgeries. At the moment, all of these surgeons are based in England, so you will have to travel if you live in another part of the UK. If you have decided to pay for your own surgery, rather than using NHS funding, there are additional options available to you. For more information about these private surgery options read our private surgery page.

Sometimes a metoidioplasty will be carried out during the same surgery as salpingo-oophorectomy, vaginectomy, or hysterectomy. This can provide useful tissue for performing the urethroplasty.

For some people, metoidioplasty can provide a significant improvement in mental health. There is overall agreement in medical studies that after gender confirming medical interventions, rates of psychiatric disorders and psychiatric symptoms reduce considerably 4, p.181. However, as with other major life changes, you may find that counselling before and after surgery may be helpful.

Where can I learn more?

You can read more about metoidioplasty in this booklet from the NHS Gender Dysphoria National Referral Support Service.

You can find information and regular updates about waiting times for phalloplasty and metoidioplasty in the UK on the TransActual website.

There is some detailed information about phalloplasty and metoidioplasty on the St. Peter’s Andrology Centre website. Please note that St Peter’s are no longer offering gender surgeries, so some information on this site may be out of date.

How do I get ready for surgery?

Doing some preparation in advance can help make sure everything goes smoothly during your hospital stay and recovery. To help you avoid forgetting to do or buy something we have created a Getting ready for gender surgeries page.

Where can I ask questions about surgery?

When you and your clinical team agree that you are ready for surgery on the NHS, the NHS Gender Dysphoria National Referral Support Services (GDNRSS) will process your referral to your chosen surgical provider. They have a Single Point of Access support line that you can call for information about your referral, the status of your chosen provider and practical information such as travel and parking, who can accompany you, what to take with you and where to report when you get there.

You can also book a virtual consultation with one of the GDNRSS Clinical Nurse Advisors who can provide information on:

• Surgical techniques used by various providers and surgeon teams
• Typical recovery times following surgery
• Potential post-surgical complications
• Surgical eligibility criteria, where providers have these in place
• Waiting times for surgical providers
• Supporting patients to change provider

You can contact the service by calling 01522 85 77 99 or by email. The service is open Monday to Friday from 9am until 5pm. You can find out more about the service in this booklet.

How much will it cost?

If you have a formal diagnosis, the NHS will usually provide funding for metoidioplasty or phalloplasty.

The NHS will normally fund hair removal from the donor skin sites for urethroplasty, either by laser hair reduction or electrolysis.

If you're receiving certain benefits, or are on a low income, you may be able to get help with the cost of travel for NHS treatment. Further information about help with travel costs can be found:

• on the NHS website
• on the Welsh Government website
• on the NHS Scotland website
• on the Northern Ireland government website

If not funded by the NHS, the cost of a metoidioplasty performed in the UK is approximately £35,000 (last updated July 2020). The only clinic currently performing metoidioplasty in the UK is New Victoria Hospital.

References

1. 1.
   Frey, Jordan D, Poudrier, Grace, Chiodo, Michael V and Hazen, Alexes (2017) “An Update on Genital Reconstruction Options for the Female-to-Male Transgender Patient: A Review of the Literature.” Plastic and Reconstructive Surgery, 139(3), pp. 728–737. Link
2. 2.
   Christopher, Nim, Ralph, David and Garaffa, Giulio (2017) “Genital Reconstructive Surgery for Transgender Men,” in Bouman, W. P. and Arcelus, J. (eds.), The Transgender Handbook: A Guide for Transgender People, Their Families and Professionals, Nova Science Publishers Inc, pp. 277–300. Link
3. 3.
   Royal College of Psychiatrists (2013) “Good practice guidelines for the assessment and treatment of adults with gender dysphoria.” Link
4. 4.
   Arcelus, Jon and De Cuypere, Griet (2017) “Mental Health Problems in the Transgender Population: What Is The Evidence?,” in Bouman, W. P. and Arcelus, J. (eds.), The Transgender Handbook: A Guide for Transgender People, Their Families and Professionals, Nova Science Publishers Inc, pp. 173–188. Link

Acknowledgements

This page is illustrated using a photograph by Павел Сорокин available at Pexels.

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