Essential Guide to FTM Phalloplasty: Types, Costs, Preparation, and Recovery

FTM phalloplasty is a gender-affirming surgery that gives transgender men a functional, natural-looking penis. It’s a big decision, but with modern techniques, over 97% of patients remain happy with the look and size of their neophallus.

Wondering about sensation, healing, or how to choose the best option? Backed by Bookimed’s research, this article breaks it all down, from surgical methods to recovery and long-term outcomes.

Table of Contents

1. What to Expect from FTM Phalloplasty Results?
2. Types of Phalloplasty: Choosing the Right Method
3. Phalloplasty Costs & Insurance Coverage
4. Surgical Requirements & Preparation
5. Phalloplasty Surgery Steps
6. Recovery Timeline & Post-Op Care
7. Potential Risks & Complications
8. FAQ
9. Key Takeaways

What to Expect from FTM Phalloplasty Results?

Phalloplasty, also known as female-to-male bottom surgery, creates a functional penis using a skin flap from another part of the body—most commonly the forearm, thigh, or back. Modern surgical techniques ensure that patients achieve a natural-looking penis with sensation, the ability to urinate while standing, and the option for penetrative sex with a penile prosthesis.

1️⃣ Appearance: How natural will it look?

• The penis typically measures 5–6 inches (12–15 cm), but size depends on the donor site.
• The neophallus may have a different skin texture or color, but medical tattooing or revision surgery can improve appearance.
• 97.4% of patients who undergo FTM phalloplasty report being satisfied with their penis size and overall appearance.

2️⃣ Sensation: Will I be able to feel touch?

• 93.9% of patients regain tactile sensation in their penis over time.
• Nerve regeneration varies—some feel touch as early as after a few months, while others take over a year.
• Protective sensation (detecting pain, temperature, and pressure) usually returns first, followed by more refined sensation.
• Many report erotic sensation, with 88.5%–100% able to achieve orgasm.

3️⃣ Urination: Can I pee standing up?

• 92.2% of patients successfully urinate while standing after urethral lengthening.

4️⃣ Sexual Function: Can I have penetrative sex?

• The neophallus is naturally flaccid unless the patient chooses to have an erectile implant. With an implant, patients can have penetrative sexual intercourse.

5️⃣ Scarring: What about the donor site?

• The forearm method (RFFF) leaves the most visible scarring, but medical tattooing and skin grafts can help.
• Thigh and back donor sites have less noticeable scars, often hidden under clothing.
• With proper care, scars fade over time and can be treated with laser therapy or silicone sheets.

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Types of Phalloplasty: Choosing the Right Method

Phalloplasty uses a skin flap from another part of the body to create male genitalia. Here are the main options:

• Radial forearm free flap (RFFF) – the most common method, using skin, nerves, and blood vessels from the forearm. It offers the best sensation but leaves a visible scar from the wrist to the mid-forearm.
• Anterolateral thigh phalloplasty (ALT) – uses tissue from the thigh, leaving less visible scarring but providing less sensation than RFFF.
• Musculocutaneous latissimus dorsi flap (MLD) – uses skin and muscle from the back. The scar is closed in a straight line and can be hidden under clothing. This method causes less sensation than RFFF, but the donor site doesn’t require a skin graft.

Phalloplasty Costs & Insurance Coverage

Phalloplasty costs vary significantly across the world. 

➤ In the USA, the procedure ranges from $43,000 to $75,000, but it can reach $150,000. Plus, patients have to factor in additional hospital fees, anesthesia, and medications.

➤ In contrast, countries like Thailand, Turkey, and Mexico offer all-inclusive packages at a more affordable price. Thai phalloplasty surgeons perform the procedure for $12,000 – $22,000, making it up to 85% cheaper than in the US.

You can compare approximate costs for phalloplasty across different countries in the table below:

Country	Average cost (USD)
USA	$43,000–$75,000 (up to $150,000)
UK	$50,000–$88,000
Australia	$31,000–$50,000
New Zealand	$101,000–$123,000
Thailand	$12,000–$22,000
Turkey	$10,000–$15,000
Mexico	$32,000–$40,000

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Insurance & public healthcare coverage

➤ 95% of US insurance companies cover phalloplasty, but patients must meet strict requirements, such as mental health assessments, HRT, evidence of living in the desired gender, and pre-authorization. Coverage often excludes hospital stays, anesthesia, and post-op care.

➤ In the UK, Australia, and New Zealand, public healthcare may subsidize costs, but wait times span 5 to 30 years.

Surgical Requirements & Preparation

Phalloplasty is a complex surgery, and proper preparation is crucial for the best results.

1️⃣ Medical requirements

✔️ Mental health clearance. Two letters from licensed mental health providers confirming the patient is prepared for bottom surgery.

✔️ Hormone therapy. Most clinics require 12 months of testosterone therapy.

✔️ BMI & overall health. Many phalloplasty surgeons require a BMI under 30–32 to reduce complications. Conditions like diabetes should be under control.

✔️ Medical tests. Blood work, tissue and blood flow assessments, and gynecological exams.

2️⃣ Hair removal for the donor site

✦ For urethral lengthening, electrolysis or laser hair removal is required on the donor skin to prevent hair growth inside the urethra.

✦ Hair removal should start 6–12 months before surgery for best results.

3️⃣ Lifestyle adjustments before surgery

🚭 Quit smoking. Smoking reduces blood flow, increasing the risk of necrosis (tissue death). Most surgeons require quitting at least 6 weeks before surgery.
💊 Adjust medications. Some blood thinners and supplements must be stopped to lower the bleeding risk.
🥦 Improve nutrition & hydration. A healthy diet aids wound healing and recovery.

Phalloplasty Surgery Steps

Surgeons can perform phalloplasty in multiple stages over 12–18 months or, in some cases, as a single-stage surgery. Patients stay in a hospital for at least 7 days so that doctors can monitor the blood supply to their neophallus.

The procedure involves the following steps:

1️⃣ Penis construction

• Donor tissue is shaped into a penis and attached to the groin.
• Blood vessels and nerves are connected to establish circulation and sensation.
• The donor site is closed, often requiring a skin graft.

2️⃣ Urethral lengthening & refinements

• The urethra is extended for standing urination.
• Scrotoplasty (scrotum creation), glansplasty (penile head shaping), and vaginectomy (removing the vagina) may also be performed.

3️⃣ Penile implant

• A penile implant is inserted, allowing for erections and penetrative sex.
• Testicular implants are placed in the scrotum for a natural look and feel.

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Recovery Timeline & Post-Op Care

Full healing and function can take 1 year or longer, especially if the procedure is done in multiple stages. Here’s what to expect:

🗓️ Weeks 1–6: Initial recovery

• Hospital stay (6–7 days). Swelling, bruising, and pain peak during this time.
• Urinary catheter (2–6 weeks). A catheter prevents strain on the healing urethra. Bladder spasms may occur, but they can be managed with medication.
• Limited movement. No lifting over 10 lbs, no stretching, and minimal walking to avoid excessive bruising or bleeding.
• Diet. A low-sodium, nutrient-rich diet helps reduce swelling and speeds up healing.

🗓️ Weeks 6–12: Mid-term recovery

• Catheter removal. Urologists perform a urethrogram (X-ray with dye) to ensure the urethra is functioning before catheter removal.
• Physical activity. Light movement is encouraged, but jogging and gym workouts should still be avoided.
• Scarring & skin graft healing. The donor site heals significantly, but redness and tightness may persist for several months.
• Returning to work. Most patients resume work or school after 2–3 months, though physically demanding jobs may require 3–4 months off.

🗓️ Months 3–6: Functional improvements

• Urination. If urethral lengthening was performed, standing urination may still feel unfamiliar but improves over time.
• Sexual activity. Patients with urethral lengthening should avoid manual or oral stimulation for at least 3 months to prevent infection.
• Physical activity. Exercise can be reintroduced slowly under medical guidance.

🗓️ Months 6–12+: Advanced healing

• Nerve regeneration. Sensation slowly returns—protective feeling (temperature, pressure) comes first, with erotic sensation taking longer.
• Implants & refinements. If done in multiple stages, penile and testicular implants are placed around this time.
• Sexual function. Before attempting penetrative intercourse, patients should get their surgeon’s approval and may need to use a pump or silicone erectile sleeve for adjustments.
• Full functionality. Achieving a fully functional penis—including urination, sensation, and erections—can take a year or longer.

Potential Risks & Complications

Like any complex surgery, FTM phalloplasty comes with potential risks. However, most complications are manageable with proper medical care and an experienced surgical team. 

Potential complications include:

• Infection. Like any surgery, there is a risk of infection at the incision sites or within the urinary tract, but antibiotics help prevent this.
• Scarring & donor site healing. The forearm, thigh, or back will have visible scars that fade over time; silicone dressings and scar treatments can improve appearance.
• Partial tissue loss. Possible if the blood supply to the phallus is compromised. Early monitoring helps catch issues quickly.

If bottom surgery involves urethral lengthening, some urethral complications are possible:

• Urethral strictures (narrowing). Can make urination difficult and may require a minor corrective procedure.
• Fistulas. A small opening may form between the urethra and surrounding tissue, which can be repaired with additional surgery.
• Dribbling or spraying during urination. It can take time to adjust to the new urethra, and minor leaks are common in the early months.

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FAQ

How long does phalloplasty take?

The surgery itself lasts 8–12 hours. However, if you choose to have phalloplasty as a multi-stage procedure, the full process can take 12–18 months. Some surgeons offer one-stage phalloplasty, completing most steps in a single surgery.

How big will my penis be after phalloplasty?

Penis size depends on the donor site, body type, and patient preferences. Typically, the length is 5–6 inches (12–15 cm). Patients with thinner donor tissue (e.g., lean forearm skin) may have a slimmer penis, while those with more fatty tissue (e.g., thigh or back flaps) may have more girth.

What happens if I don’t get urethral lengthening?

If you choose not to undergo urethral lengthening, you will continue to urinate from your original urethra, which remains in place between the scrotum and anus. However, you won’t be able to pee standing up.

Will my penis grow hair after phalloplasty?

Before surgery, your surgeon will identify areas that need permanent hair removal to prevent future growth on the penis. This is especially important for those undergoing urethral lengthening, as hair inside the urethra can cause infections and blockages.

Do I need other procedures before phalloplasty?

A hysterectomy and oophorectomy (removal of the uterus and ovaries) are typically required. A vaginectomy (removal of the vagina) is optional and can be done alongside phalloplasty or in a separate stage.

Are there alternatives to phalloplasty?

Yes, metoidioplasty is the most common alternative. This procedure enhances the growth of the clitoris to create a small penis. Unlike phalloplasty, it does not require a skin graft and has a shorter recovery time. 

Key Takeaways

👉 Phalloplasty uses a skin flap from the forearm, thigh, or back to construct a penis. It allows for standing urination and penetrative sex (with an implant).

👉 97.4% of patients are satisfied with their penis size and appearance.

👉 In the US, phalloplasty can cost about $43,000–$75,000 but often reaches up to $150,000. Thailand and Turkey present options that are up to 85% cheaper ($10,000–$22,000).

👉 Phalloplasty can be done in one operation or multiple stages over 12–18 months. Most patients need at least two surgeries, including a final stage for penile implants.

👉 Hospital stay lasts 5–7 days. Most return to work after 2–3 months, but achieving full functionality can take over a year.

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