Under 5% of transgender men have had surgery to build a phallus – about 3% by phalloplasty and 2% by metoidioplasty. A larger share, roughly one in five, say they want it in the future.
Female-to-male (FTM) bottom surgery reshapes the genitals to match a trans man’s identity. It is the least common step in a sex reassignment surgery pathway, and one of the most considered. That gap usually comes down to cost, eligibility rules, and the choice between two very different operations.
You will learn how the two operations differ, who performs them, and what they cost. You will also see the eligibility rules, how to prepare, and what recovery looks like.
Key Takeaways
- Cost: $4,000–$8,500 in Turkey and $7,000–$12,000 in Thailand at Bookimed partner clinics, against a $15,000–$30,000 baseline in the United States.
- Procedures: metoidioplasty keeps natural erectile sensation in a smaller phallus; phalloplasty builds a larger one and adds an implant for rigidity.
- Eligibility: six continuous months of hormone therapy before genital surgery, plus one assessment letter.
Table of Contents
- What is Female-to-Male (FTM) Bottom Surgery?
- FTM Bottom Surgery Types
- Best FTM Bottom Surgeons
- How Much is Female-to-Male Bottom Surgery?
- How to Prepare for Female-to-Male Bottom Surgery?
- FTM Bottom Surgery Recovery
- Female-to-Male Bottom Surgery Results
- The bottom line
- Frequently Asked Questions
What is Female-to-Male (FTM) Bottom Surgery?
Female-to-male (FTM) bottom surgery, also known as transmasculine surgery, changes the genitals from female to male. This type of sex reassignment surgery is a pivotal part of the physical transition. It is separate from top surgery, which reshapes the chest. The goal is a body that matches identity, better mental health, and less gender dysphoria.
The term "female-to-male bottom surgery" covers a range of surgical options, which may involve:
- removal of the vagina, uterus, and ovaries;
- construction of a penis.
What does FTM bottom surgery look like?
The result varies with the chosen procedures, the patient’s body, and the surgical technique.
- Phalloplasty: a phallus that looks and feels closer to a cisgender male penis. Size and shape depend on the graft site and personal preference.
- Metoidioplasty: a smaller, naturally sensitive phallus that keeps its original nerve connections.
- Scrotoplasty: a scrotum similar to that of cisgender males, often enhanced with testicular implants.
Where does the tissue for phalloplasty come from?
A phalloplasty builds the phallus from a skin flap taken elsewhere on the body, and the donor site shapes both sensation and scarring.
- Radial forearm flap: the strongest erotic sensation, because the nerves connect well, but it leaves a visible scar on the forearm.
- Anterolateral thigh flap: the scar is on the thigh where clothing hides it, and the result has more girth, though the thicker tissue may need a later slimming step.
- Latissimus dorsi flap: uses back tissue and avoids skin grafts, with less sensation as the trade-off.
Expert Insight
"Scarring is a common concern after female-to-male surgery. Fortunately, scars tend to heal well and can be hidden in pubic hair or become barely noticeable over time.
For phalloplasty, the scar’s location depends on where the graft comes from. A groin flap phalloplasty has the most easily concealable scars. Forearm or thigh phalloplasty leaves a visible scar on the inner forearm or outer thigh. Patients can cover it with clothing or have it repigmented by a medical tattoo artist after healing. Many choose metoidioplasty because the scars are much less visible." – Dr. Pichet Rodchareon, Board-Certified Plastic Surgeon, FTM Bottom Surgeon.
12.08.2026
Let’s take a closer look at these and other FTM bottom surgery options below.
FTM Bottom Surgery Types
Transgender men have several types of FTM bottom surgery to consider during transition:
- Hysterectomy – removal of the uterus. It suits patients who are uncomfortable having a uterus, or when hormone therapy does not stop menstruation.
- Oophorectomy – removal of the ovaries. An option for those who want to end menstruation and reduce female reproductive organs.
- Vaginectomy – removal of the vagina and closure of the vaginal opening. A surgeon often does it alongside penis creation.
- Metoidioplasty – a single-stage procedure that turns the clitoris into a penis. Testosterone enlarges the clitoris beforehand.
- Phalloplasty – a multi-stage reconstruction that builds a penis from skin grafted from other body areas.
- Scrotoplasty – builds a scrotum from the labia majora and adds silicone testicular implants. It can accompany either metoidioplasty or phalloplasty.
Metoidioplasty vs Phalloplasty Surgery
Metoidioplasty and phalloplasty are the two main ways to build a neopenis. Both offer strong pathways to masculinity, but they differ in method and in what they give the patient.
What happens during metoidioplasty?
Metoidioplasty follows a set sequence, and the last two steps are optional.
- Hormonal therapy. The process begins with at least a year of testosterone to enlarge the clitoris.
- Clitoral release. The surgeon cuts the ligaments around the enlarged clitoris, freeing it from the pubic bone.
- Creation of a neopenis. The released clitoris becomes a penile shaft of 4–6 centimeters. It can become erect naturally, without an implant.
- Urethral lengthening (optional). The urethra is extended with tissue from the cheek, labia minora, or vagina, so the patient can urinate standing.
- Scrotum formation (optional). A scrotum can be built from the labia majora, completing the male genital appearance.
Metoidioplasty is a single-stage procedure that takes 2–5 hours to complete.
What are the benefits of metoidioplasty?
Patients usually choose metoidioplasty for sensation, recovery time, and cost.
- keeps the erotic sensitivity of the clitoris in the new phallus;
- lower complication rates and fewer follow-up procedures;
- minimal noticeable scarring;
- usually costs about half as much as phalloplasty;
- a shorter healing time than phalloplasty;
- natural erectile function, with no penile prosthesis needed.
What happens during FTM phalloplasty?
Phalloplasty follows a longer sequence, spread over more than one operation.
- Skin grafting. The surgeon selects a donor site for the graft, commonly the arm, thigh, back, or abdomen.
- Neopenis construction. The grafted skin is shaped and attached to form a penis, often noticeably larger than with metoidioplasty.
- Urethral lengthening. As in metoidioplasty, the urethra is lengthened for standing urination, using grafts from the mouth or other body parts.
- Scrotoplasty (optional). The surgeon uses labia majora tissue and silicone testicular implants to build a scrotum.
- Erectile implant (optional). A phalloplasty phallus cannot become erect on its own. After recovery, an implant can be placed to allow erections.
Unlike metoidioplasty, phalloplasty is staged. The operations take about 5–8 hours and are spread over months to reach the final result.
What are the benefits of FTM phalloplasty?
Phalloplasty appeals to patients who want size and penetrative function.
- allows penetrative sex with the help of an erectile device;
- a noticeably larger phallus of 12–15 cm, though erogenous sensation may be reduced;
- a more natural-looking result for some preferences.
Can the neophallus get an erection?
A phalloplasty phallus has no erectile tissue of its own, so it cannot get hard unaided. Rigidity for penetration comes from an erectile implant fitted later – a semi-rigid rod or an inflatable device. A metoidioplasty phallus keeps its own erectile tissue and can become erect naturally. A semi-rigid prosthesis, such as the ZSI 100D4, can add extra stiffness if a patient wants it.
Each procedure has its place: metoidioplasty appeals for its sensation and lighter recovery, while phalloplasty stands out for size and penetrative function.
Best FTM Bottom Surgeons
The surgeon you choose shapes the outcome of FTM bottom surgery. Two transmasculine surgeons at Bookimed partner clinics in Bangkok show the credentials worth looking for:
Bangkok, Thailand
Dr. Saran Wannachamras heads the Sex Change Department at Wansiri Hospital. He trained under Dr. Preecha Tiewtranon – Thailand’s first sex reassignment surgeon – and completed further training in the USA and Japan. He is a member of:
- International College of Surgeons;
- Oriental Society of Aesthetic Plastic Surgery (OSAPS).
Dr. Sukit Warathamrong
Bangkok, Thailand
Dr. Sukit Warathamrong is a board-certified plastic surgeon in aesthetic and reconstructive surgery. He is a member of:
- Association of Plastic & Reconstructive Surgery of Thailand;
- International Society of Aesthetic Plastic Surgery (ISAPS).
How Much is Female-to-Male Bottom Surgery?
Female-to-male bottom surgery runs about $4,000–$8,500 in Turkey and $7,000–$12,000 in Thailand. The United States baseline is $15,000–$30,000. The final figure depends on which procedures you combine, the surgeon, and the clinic.
Procedure | United States (baseline) | ||
|---|---|---|---|
FTM bottom surgery | $4,000–$8,500 | $7,000–$12,000 | $15,000–$30,000 |
Metoidioplasty | $6,000–$9,000 | $7,000–$11,000 | $18,000–$34,000 |
Phalloplasty | $15,000–$25,000 | $18,000–$32,000 | $80,000–$160,000 |
Hysterectomy | $4,800–$7,500 | $3,100–$6,900 | $30,000–$55,000 |
Clinic price data across these four procedures puts Turkey and Thailand roughly 50%–90% below the US baseline. The widest gaps are on phalloplasty and hysterectomy.
A package that combines metoidioplasty or phalloplasty with a hysterectomy or vaginectomy costs less than booking each step separately. Removing the uterus and ovaries in one session also costs less than two operations. Oophorectomy and vaginectomy rarely carry a standalone price, because surgeons perform them in the same session as the genital surgery. On its own, ovary removal runs about $9,400–$14,700 in Turkey. The FTM surgery cost guide covers the other steps of a female-to-male transition.
How to Prepare for Female-to-Male Bottom Surgery?
Preparation runs on two clocks. The paperwork – lab tests, an assessment letter, informed consent – takes weeks, while hormone therapy and hair removal at the donor site take months and set the earliest possible surgery date.
Expert Insight
"The WPATH Standards of Care set a floor of 6 continuous months of hormone therapy before genital surgery. For metoidioplasty, many surgeons prefer longer, because testosterone keeps enlarging the clitoris through the first one to two years and gives more tissue to work with.
Patients often worry about starting testosterone – side effects, long-term health, and fertility. These concerns are understandable and manageable. Side effects like mood swings or acne are usually minor and settle with regular check-ups. Long-term risks stay low with proper supervision, and if fertility matters to you, options like egg freezing are worth exploring." – Dr. Pichet Rodchareon, Board-Certified Plastic Surgeon, FTM Bottom Surgeon.
12.08.2026
Surgery requirements
- Lab testing and medical evaluation to catch any health issues to manage before gender-affirming surgery.
- At least 6 continuous months of hormone therapy before genital surgery.
- One assessment letter from a qualified health professional, down from the two letters asked for previously.
- Informed consent confirming you understand the risks, expected outcomes, and social and legal implications.
- Stopping smoking to lower the risk of complications.
The WPATH model and the informed consent model are the two main ways to assess suitability for gender-affirming surgery. Programs increasingly use the informed consent model, which emphasizes patient autonomy. The letters of recommendation from mental health professionals in the WPATH model still shape most programs.
Individual clinics and countries can set stricter rules. Thailand’s gender-recognition law, for example, calls for two psychiatric evaluations, at least one from a local clinician. If your documents are not in the required language, Bookimed can translate them for you.
Surgery preparations
- Consultation. Choose a board-certified surgeon experienced in gender-affirming surgery and discuss the procedure, expectations, and aftercare.
- Hair removal. Laser hair removal or electrolysis prepares the donor or surgical site for some procedures. It can take 9–12 months and should finish 6–8 weeks before surgery.
- Medication and hormone management. Review all medications with your surgeon and pause hormone therapy about 2 weeks before surgery.
FTM Bottom Surgery Recovery
Recovery time follows the size of the operation. Metoidioplasty is single-stage and heals in weeks. Phalloplasty is staged over months, and the implant step comes only once the phallus has healed and regained sensation.
How long does it take to recover from FTM bottom surgery?
Recovery depends on the procedure, individual health, and technique. Metoidioplasty tends to heal faster because it is less invasive. Phalloplasty is a bigger anatomical change, staged over several operations, with a longer recovery.
Hospital stay:
- Metoidioplasty. Usually about 3 days.
- Phalloplasty. More complex, often 5 to 7 days.
Short-term recovery:
- Metoidioplasty. The first 2 to 4 weeks, when patients resume light activity while protecting the surgical site.
- Phalloplasty. Around 4 to 6 weeks, with limited activity and some help with daily tasks.
Long-term recovery:
- Metoidioplasty. Full recovery, including strenuous activity and sexual function, from about 6 weeks.
- Phalloplasty. Final healed results in 4 months or more. Implant or revision stages can extend the timeline.
Arrange follow-up with a local clinician before you travel home, so any check-ups happen close to you.
What is sex like after female-to-male bottom surgery?
Both metoidioplasty and phalloplasty lead to fulfilling sex lives, though sensation and function differ by procedure.
- Metoidioplasty preserves the clitoral and genital nerves, so sensation stays and orgasm remains possible. It does not allow penetrative sex, but arousal, orgasm, and satisfaction are intact.
- Phalloplasty can include an erectile implant for penetrative sex. Orgasm stays achievable, though full sensation may take a year or more to return. In a 26-patient study, 88.5% reported erogenous sensation in the neophallus, and most of them found orgasm harder to reach than before surgery.
Ejaculation depends on how the surgeon routes the urethra and glands, so it varies from person to person. Genital surgery that removes the ovaries and uterus ends biological fertility, which is why fertility preservation, such as egg freezing, comes before surgery.
Expert Insight
"Most patients can have sex about 6 weeks after surgery, and orgasm is very much possible. Sensation can dip at first, and many say orgasm takes more effort than before. Those who choose metoidioplasty often keep strong sensation.
Remember that after phalloplasty the phallus does not grow in length and does not rise as much during an erection as in cisgender men. And penetrative sex is rarely possible with metoidioplasty alone." – Dr. Pichet Rodchareon, Board-Certified Plastic Surgeon, FTM Bottom Surgeon.
12.08.2026
Possible risks and follow-up care
As with any surgery, metoidioplasty and phalloplasty carry some risks, including:
- infection;
- bleeding;
- urethral fistulas or narrowing that affect urination;
- reduced sensation or numbness;
- skin graft issues after phalloplasty.
Most are manageable with the right care and follow-up.
Expert Insight
"Urethral issues are the part of phalloplasty patients ask about most. Pooled data put a urethral fistula or narrowing at about 49% after phalloplasty with urethral lengthening, and most are corrected with a minor secondary procedure. Put the other way, around half of patients heal without one. In the same analysis, about 91.5% can urinate standing afterward, and about 90.5% report a satisfactory outcome overall.
The regret rate for gender-affirming surgery is under 1%. Across surgery in general, average patient regret is about 14.4% – so far more people regret other procedures than gender-affirming ones." – Dr. Pichet Rodchareon, Board-Certified Plastic Surgeon, FTM Bottom Surgeon.
12.08.2026
Female-to-Male Bottom Surgery Results
- Improved quality of life. Surveys of post-surgical trans male patients reveal significant enhancement of overall quality of life. They report improvements in self-image, sexual relationships, dating, social interactions, and employment opportunities, as well as reductions in mental disorders and gender dysphoria.
- Low reversal rate. The journal of the American Society of Plastic Surgeons reported on 1,989 people who had gender-affirming surgery. Of those, 99.7% did not seek a reversal or transition back.
- Scarring. After phalloplasty, scar lines improve over time but do not disappear completely.
- Impact on fertility. Since bottom surgery involves the removal of reproductive organs, patients wishing to have biological children in the future are encouraged to explore fertility preservation options, such as egg freezing, before they undergo surgery.
- Revision surgery. Revision surgeries after female-to-male bottom surgery may be necessary to address specific concerns or enhance the outcomes of the initial procedures.
The bottom line
- Choose metoidioplasty for sensation, a shorter recovery, and lower cost. Choose phalloplasty for size and penetrative sex with an implant.
- Recovery follows the operation – weeks after metoidioplasty, several months and more than one stage after phalloplasty.
- Infection, bleeding, and urethral narrowing are the main risks, and most resolve with follow-up care.
- The regret rate for gender-affirming surgery is under 1%, and about 90% of patients report a satisfactory result after phalloplasty.
Frequently Asked Questions
Below are the questions patients ask most often before FTM bottom surgery.
How do erections work after FTM bottom surgery?
It depends on the operation. A metoidioplasty phallus erects naturally, while a phalloplasty phallus needs an implant fitted at a later stage.
Can trans men ejaculate after bottom surgery?
It varies. A built phallus makes no semen, though preserved glands can release a little fluid, and orgasm works either way.
How do trans men get bottom surgery?
Trans men get bottom surgery in stages – testosterone first, then an assessment letter, then the operation itself.
What does FTM stand for?
FTM means female-to-male – a trans man who lives as male and medically transitions toward it. Some prefer the word transmasculine.
How much does FTM bottom surgery cost?
About $4,000–$8,500 in Turkey and $7,000–$12,000 in Thailand, against a $15,000–$30,000 baseline in the United States.
Metoidioplasty vs phalloplasty – which is right for whom?
Metoidioplasty keeps natural sensation and erection in a smaller phallus. Phalloplasty builds a larger one that needs an implant.
All medical content on this page is prepared by authors with specialized medical education and reviewed by certified physicians in the relevant field. Medical review by Ergin Er, Plastic surgeon.
Last updated: August, 2026.
- Statistics: Figures are based on Bookimed’s internal database August 2026, which includes analysis of 12,450 patient requests across accredited clinics in .
- Pricing: Cost information is provided directly by Bookimed’s partner clinics and updated regularly to reflect current 2026 market conditions. Actual expenses may differ depending on case complexity, surgeon expertise, and clinic location.
- Clinical Data: Treatment outcomes and patient satisfaction figures are collected from Bookimed’s verified clinic database and supported by data from peer-reviewed medical sources such as PubMed, The Lancet, JAMA, and NEJM (2023–2026).
All data is provided for general informational purposes and may not represent individual results or experiences.