LGBTQ+ & Gender Care Services

Phalloplasty

A phalloplasty is a multi-stage procedure that may include a range of techniques, including the creation of a phallus (penis), lengthening of the urethra so you are able to urinate standing up, creating the tip (glans) of the phallus, creation of the scrotum, and placing erectile and testicular implants.

The three phalloplasty techniques offered are:

Radial Artery Phalloplasty (forearm tissue)
Abdominal Phalloplasty (lower abdomen tissue)
ALT (thigh tissue)

Your surgeon will discuss and advise which technique is the best for you

Qualifications

At least 18 years of age.
On hormone therapy for a minimum of 12 months (unless clinically contraindicated, supported by a letter of explanation from medical provider).
Control of all co-morbid concerns (high blood pressure, diabetes, anxiety, etc.).
2 separate letters of recommendation from qualified professionals licensed in mental health (this includes psychiatrists, psychologists, therapists) specifying what procedure you’re being referred for (“top” or “bottom” surgery or “both”). Cannot be written by your primary care doctor or endocrinologist unless they are also licensed mental health professionals.

Inpatient Process

Days 1–2

You will have patient-controlled anesthesia (PCA), or a “pain button,” to safely deliver relief when you need it.
After your first 24 hours, you will be eased into an anti-nausea diet.
You’ll be given sequential compression devices (SCDs) on your legs to help prevent blood clots. A daily aspirin will also help prevent clots.

Days 2–3

You’ll stay in a special hospital unit where you’ll be checked on every 1–2 hours.
A Doppler machine will be at your bedside. It’s attached to a probe around the blood vessels that supply blood and oxygen to your penis. This helps ensure that if there’s a problem with your phalloplasty graft, we can catch it early and act quickly.
The surgery and nursing team will check your phallus’ color, capillary refill, temperature and Doppler signal.

Days 3–5

If your recovery permits, at this point you’ll be transferred to a less acute surgical unit, where you’ll be able to get more rest.
You will go home with the vac dressing. This will be removed by your surgeon in clinic 10–14 days after surgery; do not attempt to change or remove this dressing at home.

Days 5–7

Your wounds will be dressed with Xeroform gauze, Kerlix gauze and your splint.
Your groin and scrotum drains will be removed.
The Doppler wire will be cut.
You will be given supportive underwear. You can bring your own, but it must be approved by your surgeon in advance.
You’ll be allowed to walk with assistance. PT may be involved in your care to help with this transition.

Urinating with a Catheter

You will have a bladder catheter after surgery that will be removed before discharge.
There will also be a red catheter in your penis, which will hold your urethra in an open position. Your surgical team will remove this catheter before you leave the hospital.

Drain Care

Your scrotal drain will usually be removed before you leave the hospital.
The Penrose drain will usually be removed from your groin while you’re in the hospital. IV catheters will be removed before you go home.

Recovery

This procedure requires multiple surgeries and can be a lengthy process– from months to years, depending on personal progress. It’s important to consider this and plan appropriately.
You’ll be admitted to the hospital for 5–7 days, and you will be discharged with all the supplies you need for self-care (bandages, wound care supplies, etc). and a phone number to call in case of urgencies outside office hours.
Plan for weekly postoperative appointments until your surgeon plans otherwise, depending on your progress.
Plan to meet with a physical therapist after your forearm grafting to work on your wrist and arm function.
Remain in the care of your primary care provider and your mental health providers during the perioperative process. Email the office (LGBT@UHhospitals.org) with regular status updates and questions.

Support Services

Affirming cosmetic therapy providers for hair removal
Licensed mental health service that’s specialized for LGBTQ+ individuals
Physical therapy providers intimately familiar with the needs specific to affirming reconstructive surgery
Perioperative volunteers who offer emotional support and can answer questions

Important: You are responsible to notify our office immediately of any interruption or changes in your insurance coverage.

Next Steps

1

Call Central Scheduling at 216-844-5661 to schedule a surgical consultation with Shubham Gupta, MD

2

Start permanent hair removal (contact our office for recommendations or referrals). Notify office via telephone 216-286-5428 or email LGBT@UHhospitals.org when hair removal is approximately 50% completed (to plan surgery date)

3

Ask mental health providers to send referral letters to office at fax number 216-201-4034 or email ChrisTina.Reed@UHhospitals.org

4

Discuss a care plan with your support person(s)

5

Notify our office if you would like to have FMLA forms completed (if you qualify) to cover your time off work, and ask your HR representative to send your forms to office at fax number 216-201-4034

6

Notify your primary care provider when you have received a surgery date

7

Remain in contact with office (LGBT@UHhospitals.org) with updates and questions throughout the perioperative process