What effects does it have?
- Lower body
Longer straighter clitoris and ability to stand to urinate
What is it?
Permanent surgical lengthening and straightening of the clitoris.
It's also known as Meto, Metoidioplasty, Meta, or Clitoral release.
How long does it 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.
Metoidioplasty is a complex surgical procedure with significant risks that you must understand before it is carried out. Complications are common in this operation, particularly problems with urinating which may require surgical correction, including urethral strictures and fistulas (urethra closing up so you cannot urinate) 1.
An alternative to metoidioplasty is 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.
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.
At this point, urethroplasty (construction of an extension of the urethra) is often performed to allow urinating from the end of the clitoris. 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.
In combination with metoidioplasty, you can optionally also have testicular implants added 2.
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.
Sometimes the operation 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. However, as with other major life changes, you may find that counselling before and after surgery may be helpful.
You can find more information about phalloplasty and metoidioplasty on the St. Peter’s Andrology Centre website.
Cost and funding
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.
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.
- 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.
- 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.
- 3 Royal College of Psychiatrists (2013) “Good practice guidelines for the assessment and treatment of adults with gender dysphoria.” [online] Available from: https://www.rcpsych.ac.uk/docs/default-source/improving-care/better-mh-policy/college-reports/college-report-cr181.pdf
- 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.
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Page last updated: September 2017