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Hospital Debates Penis Transplant in Transgender Patient

In a move that could revolutionize gender-reassignment surgery, hospital officials in Boston are considering whether to allow a first-ever penis transplant in a transgender man. Surgeons hope to attach a dead man’s penis to the groin of a patient born as a biological female.

“This would be a quantum leap if you were able to transplant a real penile structure. It’s certainly pushing the boundaries,” Curtis Cetrulo, MD, a plastic and reconstructive surgeon at Massachusetts General Hospital, told MedPage Today. “We’re ready to do it, and we could do it pretty soon if we get it approved. I’m hopeful we can do it. It would be super-helpful to a lot of these [transgender] patients.”

Surgeons in the U.S. and South Africa have only performed a handful of successful penis transplants, all in adult men who lost their genitals to cancer or trauma. Cetrulo led a landmark 2016 transplant surgery in a 64-year-old man who’d had a penectomy due to cancer. In a 14-hour procedure in 2019, Johns Hopkins University surgeons successfully attached a penis, scrotum, and parts of abdominal wall to a soldier who was severely injured in a bomb blast in Afghanistan. Surgeons reported successful recovery of urinary and sexual function in both cases.

There are no generally accepted penis-transplant guidelines nor agreement about whether the procedure is appropriate for transgender patients. MGH currently allows the transplant in men who have congenital penis defects or who lost their penises to injury or cancer. Officials are considering whether to expand the existing protocol to allow the surgery in a specific transgender patient, Cetrulo said.

The main objectives of penis transplants are to provide an aesthetic phallus, urinary function, and sexual function (including erections and “erogenous sensitivity”), he said.

While outcomes remain unknown, the prospect of penis transplants in transgender men is “huge,” California gender reassignment surgeon Marci Bowers, MD, told MedPage Today. “This is like a heart transplant to someone who has end-stage heart disease. It’s that big. Prior methods were just so substandard in so many ways.”

As Bowers noted, phalloplasties – in which phalluses are constructed from flaps of skin – have complication rates of 80% to 90%, and that’s not the only limitation. Oregon activist and author Jamison Green, PhD, a transgender man, told MedPage Today that phalloplasties “don’t have the same aesthetic appeal [as natural penises] and they don’t enlarge and get hard on their own. They’re always the same size.”

Metoidioplasties are another option for transgender men, but they also have limitations. In these procedures, surgeons form neophalluses out of clitoral tissue. The phalluses are disappointingly small, Green said. “You do have an erection and it can stay hard. Some people are capable of penetrating a partner, and some are not.”

Compared to these existing options, Cetrulo said, a penis transplant ideally will offer “fewer urethral complications, better cosmetic outcome, and better physiological sexual capacity.”

Still, limitations include the fact that transgender men who receive penis transplants will not be able to ejaculate since