I, like a lot of trans guys, wasn’t sure if I wanted a penis.

Beyond derogatory, cisgender remarks wondering if I was going to “fully transition” (read: pursue genital surgery), I never considered whether I could, should, or would ever have a penis. Up until 2015, my main fixations were: growing a beard, dropping my voice, gaining a flat chest, and stopping the battle of hormones inside my body with a hysterectomy. One by one, and in that order, I completed my transition goals and was so happy to be on the other side of dysphoria. I must have subconsciously written phalloplasty (dick surgery) off entirely. They can’t make penises yet, right? I thought. Not good ones at least.

Post-hysterectomy, my perspective shifted dramatically when I came across information that detailed how nerve hook ups were being done to create sensation in phalloplasty. I was floored.

Wait, what? You can actually feel your penis?

That changed everything for me. Whatever I’d thought previously about bottom surgery not being viable was replaced with a kind of deep longing I could not ignore or unknow. It was so strong that I dove into the process that would consume a lot of my time and resources for the coming years.

What I felt was a deep conviction that if I were to interview myself in the future as an old man looking back on my life that I would regret not pursuing phalloplasty. What if I had a penis I could feel as my own?

I pored over the internet, read memoirs, watched vlogs, and found surgeons’ websites that showed results. As I searched, the details of how exactly my new penis would come about emerged. I wanted phalloplasty, and I wanted ALT.

Anterolateral Thigh (ALT) phalloplasty uses your thigh as the donor site for tissue and nerves for your new penis. Another common choice is Radial Forearm (RF) phalloplasty, which uses donations from your forearm.

In non-medical speak, surgeons are able to relocate nerve and skin tissue from your own body and attach that to your genitals in such a way that nerves grow over time from your genitals down the relocated nerve shaft. This gives you the potential to have sensation from the base to the tip of your penis as the nerve grows. I do say “potential”, because every individual’s body responds differently and not everyone experiences sensation the same way. What I found was it was more common to have some sensation than none at all.

I did not hear or see anyone talk about not being able to make themselves orgasm post surgery — regardless of nerve hookups being successful or not — a very important requirement for me. This is mainly due to the fact that your natal genitals (clitoris in particular) are buried inside of the new penis that is created. It is manually reachable externally from behind the new scrotum below the penis. For my body, it feels tethered to my penis such that when I am manually stimulating myself via my penis, I can feel sensation both at the nerve layer of my external skin as well as a kind of gentle pulling on what is my buried clitoris. Basically, everything feels connected.

***In 2017, armed with this new knowledge, I started the first stage of ALT phalloplasty with The Crane Center in Austin, TX. My surgeons were Dr. Santucci and Dr. Crane, supported by a team of doctors. They worked together to perform different procedures according to their specialties, which are in urology, plastic surgery, and tissue transplants. I chose this group because they had done many phalloplasty and related procedures before, I liked their results, and they were close to where I lived so that if something were to go wrong I could get immediate treatment and not have to coordinate care from another state. I opted for a longer process that would extend over a few years because I saw how difficult it was for some guys to heal when multiple procedures were combined together.

Over the course of four years, I had a number of procedures, sometimes with six to 12 months in between. The main ones included: vaginectomy (vagina removal using cauterization and closing of the vaginal opening), phalloplasty (hello, new penis), urethral lengthening (to pee standing up), scrotoplasty and testicular implants (balls), and an erectile device (boner).

The very first procedure I had included what the doctors termed a “delayed flap” procedure, which took the tissue from my thigh and essentially lifted it and put it back down in order to generate more capillary growth as it healed. I was told this helps increase blood flow as the tissue is transplanted and helps avoid necrosis (tissue death). At this time, I also had a vaginectomy performed. A year after this was done, and a year and half of hair removal sessions later (a big part of the process, especially for hairier individuals), I had my phalloplasty surgery in July of 2018.

This was the big one. It included a suprapubic catheter and multi-day stay with 24/7 care in a critical care unit where a doppler sensor was connected to my penis to ensure blood flow was happening throughout. I was barely coherent for this time, as I was on a lot of pain medication, including access to a morphine drip for the first few days.

I then opted to go into a rehab care facility for a week in order to offload any intense wound care from my partner and friends and to learn how to care for myself. I started to use a walker to aid with mobility at this time. After a week, I felt well enough to dress my wounds at home, so I returned to my house where I continued to be off work for about two months, using benefits provided by the Family and Medical Leave Act.

One relief through this process was that this was financially treated like any other surgical procedure covered under insurance because my employer-sponsored health care includes transgender health coverage. That means that for every year I was having surgeries, the most I paid was my out-of-pocket maximum, which was about $3500 for the high deductible plan that includes a Health Savings Account (HSA) option. The Crane Center worked with my insurance to get in-network health coverage due to the fact they could petition the insurance company to charge in-network rates by saying there were no equivalent doctors within the insurance network and in my area that could perform these procedures, which was accurate, and they succeeded in their request for in-network coverage. I would also use my HSA to buy some medical supplies like gauze and saline spray for wound care online or in pharmacies. I found I did not need much more than saline spray, gauze, and time to care for my wounds.

At this point in the process, I had a scrotum, new penis, and urethral lengthening. Over the course of the next few years, I would also have a variety of smaller procedures, like further cauterization of vaginal tissue, a z-plasty to loosen scar tissue from my leg, testicular implants, and coronaplasty (creating the head of the penis). Because ALT tends to be girthier, I also had about two or three penis liposuctions to reduce the girth from about 8 inches in circumference to about 5.5 inches, a size I am quite happy with now.

***It was a hard recovery. I was in a lot of pain, regardless of pain medication, and I was navigating a suprapubic catheter (so uncomfortable, this is a surgically-placed catheter inserted midway between the belly button and pubic area and is tethered with tape to one’s stomach, only to be removed once peeing from the new urethra is achieved after about three to five weeks). And trying to get around while elevating my penis so it would heal properly took a lot of patience and ingenuity.

Many guys talk about the penis rigs they create out of various medical accouterments in order to keep their penis elevated and still be able to walk around in public. I used lots of gauze to pack wounds, along with ace bandages tied around my neck and looped under my penis to give it lift. I wore lots of baggy sweats to try to mask the wild nature of what was going on inside my pants. This kind of discomfort lasted for many months, as healing progressed slowly.

Every time I entered into a new procedure, I would go through cycles of depression and patience training, keeping my eye on the end goal, which became harder as years went on. There were times I was not sure there would be an ending.

But in 2021, I had my final procedures, getting an erectile device placed and coronaplasty. It was a true relief and prize at the end of a very long medical journey. I also had some medical tattooing done after 2021 to blend flesh tones and create contouring.

There are countless ways in which this journey changed my perspective on my body and transness. I feel so connected to my body in a way I always longed for. I can feel my own flesh and blood penis penetrate my partners. My nerve hookup went great, and I am able to feel my penis tip to base. I don’t have to carry around equipment if I want to have impromptu sex. Prior to surgery, I was able to ejaculate, and my surgeons did not know much about that (typical of trans healthcare providers). They could not guarantee that I would still be able to ejaculate post-surgery, but lo and behold, I discovered I still can.

It was so important to me to be comfortable being nude in male spaces. While I can’t say I “pass” as cis while naked among men (maybe to some I do), I feel comfortable in a way that I did not before phallo.

What gives me the most confidence is that no one can tell me I don’t have a penis. It is indisputable. I love my dick, and I love the personal time I have with it and the time I share with others. No amount of haters out there can take that away from me.

Maybe this is a unique perspective, but before any surgeries, I never hated my body. I just saw potential future versions of me I was excited to discover and explore. I am trans and will always be trans. I am not running away from who I am by getting lower surgeries. I am more so always in a state of becoming. I think we — humans, but especially trans folks — all are.

This procedure is not for everyone. It is a deeply personal journey where the impact is felt internally, maybe even more so than externally. Unlike top surgery, lower surgery is for you in the sense that no one else might ever see it. Dick surgery can be really long and arduous for most people. It isn’t as quick a recovery as top surgery, and there are usually multiple stages to get things right. Setbacks are normal. Results are not immediate. Sometimes you backslide and have to redo procedures. There is still an ever-evolving landscape of newer methods emerging every year, improving the next guys’ phalloplasty journeys. Some risks are always present though, and they include: necrosis, where blood circulation is lost to part of your body and the tissue dies; fistulas, which are openings that occur internally or externally that often close on their own but require surgery to close them if they don’t; and strictures, the opposite to fistulas, where skin scars too well and can block the new urethra opening, which can require surgical intervention.

These are the most common setbacks, but it would be remiss of me not to mention that there are some guys whose body, for one reason or another, rejected their new penis and have had to start the process over using another donor site.

I don’t say this to steer anyone away but to really get across the gravity of the journey. It’s unknown until you enter the process and see how your body responds. This is not for the faint of heart.

Still, I would do it a million times over again. Same procedure with the same extended timeline that I chose. It is one of the most difficult things I have done in my life. I don’t know what other journeys I may embark on that will compare to how difficult this was.

But it was deeply satisfying and hard as fuck.