Frequently asked questions

Female to Male FAQ | Phalloplasty

1. Can I procreate (father a child) after having phalloplasty?

No, this surgery will not allow you to father a child. The main objective of this surgery is to obtain the most natural as possible male external genitals. To have children, your body needs internal male structures like testes, where sperm is created, and a prostate, which makes secretions of male seminal fluid possible.
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2. Which methods are used to have biological children?

Depending on your goals and expectations, your doctor will be able to provide you with information and resources. Discuss your options with your doctor before surgery.
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3. What preparations are involved in having phalloplasty surgery?
- Hysterectomy including removal of the cervix (at least 6 months before the procedure);
- Permanent hair removal on the donor arm by laser and/or electrolysis (must be completed at least 3 months before the procedure);
- Smokers are not candidates for phalloplasty. If you smoke, you must stop using tobacco and products derived from tobacco at least 6 months before and after surgery.
These conditions are essential; without them, surgery will be postponed.
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4. Why do I have to remove the hair on my forearm?

The skin of the forearm will be used to construct the phallus. Removing the hair from the forearm is therefore necessary, otherwise:
- hairs may grow inside the urethra and cause complications;
- hairs may grow on the penis. In this case, it is possible to continue hair removal treatments once your wounds have completely healed.
During your preoperative appointment, your surgeon will confirm which arm’s skin will be used for surgery and will provide you with more information about the area to remove hair from. Following this appointment, begin your permanent hair removal treatments as soon as possible.

*If you wish, you can begin now to consult with an aesthetician to find out which permanent hair removal treatments works best for you, as well the estimated time to complete the treatment. You will then have this information with you during your preoperative consultation with your surgeon.

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5. Can I start permanent hair removal before the consultation with the surgeon?

The analysis of your file and the consultation with the surgeon are two essential steps before starting your permanent hair removal. Some medical conditions may require the surgeon to use another donor site such as the dominant arm. This can only be determined during the consultation.
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6. I currently have tattoos on one or both arms. Am I still eligible for phalloplasty?

Yes, the surgery can still be performed despite the presence of tattoos. However, these tattoos risk being found on the penis after surgery. The preoperative consultation is the appropriate time to discuss with your surgeon what options are available to you.
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7. How can I know which forearm (donor arm) will be used for the construction of my penis?

The skin is usually taken from the non-dominant arm unless you present a medical reason not to, or if you have tattoos that you do not want on your penis. During your preoperative appointment, your surgeon will perform a painless test to determine which arm will be the best donor and go over the alternatives with you. It is possible to use your dominant arm if necessary.
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8. Before surgery, should I work out to strengthen the muscles in my forearm ?

No, exercising the forearm before surgery will have no beneficial effect on the surgery, or on you postoperative recovery. It is, of course, important to maintain good overall fitness.

After surgery, you will have to perform specific exercises on the operated forearm to promote rapid and maximum recovery. The care team will inform you about these exercises and their frequency of execution.

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9. Will I have less feeling in my arm after surgery?

Because the nerves will be affected, the donor arm will no longer have the same sensitivity after surgery at the site of the graft. It is therefore important after surgery to pay particular attention to that region as the sensation of pain after an injury and the perception of temperature variations will be altered.
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10. Why do I have to wear a compression sleeve on my arm after surgery?

The compression sleeve helps reduce the appearance of scars on the donor arm. Once the wounds on the arm are completely healed, you will have to wear the compression sleeve 24 hours a day except in the shower, for a period of about 1 year. A medical prescription for this will be given to you during your recovery at Asclépiade.
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11. Can I tattoo the donor arm after surgery?

Yes, it is possible to get a tattoo on the operated arm about 1 year after surgery.
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12. Can I choose the length and size of my penis?

The length and size of your penis are determined according to the thickness and length of the skin of the donor site. The size of your phallus will be proportional to your morphology. Your surgeon will give you more information about this subject during your preoperative consultation.
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13. Can I undergo a phalloplasty without proceeding with the closure of my vagina?

No, it is not possible to have a complete phalloplasty without a vaginectomy because the tissues of the vagina are necessary for the construction of the urethra.

*If a vaginectomy is not performed, only the phallus can be constructed. It will then be impossible to construct the urethra that would allow you to urinate standing up or to construct a scrotum with a masculine appearance.

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14. Do I have to stop taking my testosterone before or after surgery?

No, you can continue taking your testosterone according to your regular schedule.
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15. Do I have to remove the sutures after surgery?

Two types of sutures are used. The first will be removed by a nurse or doctor 3 weeks after your surgery. The other sutures are “dissolvable stiches” and take 30 to 90 days to dissolve completely.
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16. Will I be able to have an orgasm after phalloplasty?

Yes, because the nerves of the clitoris will be released and freed during surgery, creating the possibility that they grow into the phallus. The clitoris is preserved and buried at the base of the phallus. Therefore, you will retain your sensibility allowing for sexual pleasure in this area, and possibly also on the phallus.

Nerve regeneration is significantly influenced by your age and lifestyle habits, such as smoking. The younger and healthier you are, the better the chances for nerve regeneration are. In the case where the nerves do not develop, the clitoris can still be stimulated in its new location at the base of the phallus. Your ability to achieve orgasm after phalloplasty remains essentially the same as before surgery.
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17. Will I be able to ejaculate after my surgery?

No, because internal male structures, such as the prostate, seminal vesicles, and glands are absent. However, a clear fluid from the Skene’s glands (preserved during surgery) may flow from the urethra in an amount that varies from one person to another.
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18. Can I choose the size of the my testicular implants?

The size of the testicular implants will be chosen with the surgeon and will depend of the available space in your scrotum. Your surgeon will advise you so you can get the best possible results depending on your physiognomy.
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19. Can I choose the length of my penile implant before having surgery to insert it?

The penile implant is available in different lengths, but will be chosen by your surgeon in the operating room according to the length of your phallus.
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20. After the insertion of my penile implant, will I be able to have sexual relations with penetration?

Yes, you can have sexual relations with penetration about 6 weeks after surgery as you will have satisfactory rigidity of the phallus. It is important to note that the penis will not grow in length and will not rise as much during an erection as in biological men.
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21. What is the lifespan of the testicular and penile implants?

The implants can be left in place as long as no complications arise. If you do have a problem, it will be important to contact your surgeon.
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22. What are the delays between the three steps of the phalloplasty?

You must wait at least 4 to 6 months between each step. This is the minimal delay that is applicable for healing process without complications. In case of complications or delayed healing, the recommended wait time will be adjusted depending on the progress of your healing. In addition, before step 2, permanent hair removal will be required, which could add some time to your preparation for this step.
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23. What preparation si required for step 2 – construction of the urethra?

It will be necessary to do permanent hair removal of a small portion of skin from the penoscrotal urethra in preparation for step 2. This hair removal is mandatory to prevent hair from growing inside the newly constructed urethra. Permanent hair removal must be completed at least 3 months before our team can assign you a surgery date. A picture of the area to be treated will be provided to you after your phalloplasty step 1.
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24. Can I do permanent hair removal of the scrotum (second step) during the preparation for the first step of phalloplasty?

It is impossible for us to determine the exact area where permanent hair removal will be required for step 2. You will receive the information after your first procedure, after assessment of the area.
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25. Is it possible to proceed to phalloplasty without construction of the urethra?

It is possible to have phalloplasty step 1 and 3 and not to do step 2 which is the construction of the urethra. You will be free to determine if and when you would like to proceed to step 2 once the healing process will have progressed well. Some people decide to wait a few years or even never to proceed to this step.

It is also possible to proceed to phalloplasty step 1 without doing the penile urethra. However, if you choose this option, it will never be possible to add a urethra to urinate standing up at a later time. This is a decision to take before your first surgery.

These options can be discussed during your consultation with our team.
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26. Can I change the order of step 2 and 3?

If you do not wish to proceed to step 2 – construction of the urethra, or if you would like to wait, you could have the insertion of penile and testicular implants done as a second surgery, at least 9 months after phalloplasty step 1 if your healing progresses well.
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27. What are the implants used at GrS Montreal?

We use different type of implants according to availabilities and authorizations from health autorities. We suggest you to communicate with our postoperative team when you will be ready for the insertion, to ask which implants are available at that time. You will then be able to chose which type of implant you would like and to discuss this with our team.
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28. Do you offer phalloplasty with using other donor sites ?

Our team can also proceed to abdominal and ALT phalloplasty. However, those procedures are not authorized by every provinces and access is more difficult due to limitations with the results. We recommend you to communicate with our team if you would like to discuss another option.
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29. How can I get a revision surgery?

Some complications may happen during your healing process. In case of complications, our team will provide you with treatment recommendations. If a revision surgery was necessary or if you would like to discuss a result that is not entirely satisfying for you, our team will proceed to a rigorous assessment to determine if a revision is possible and necessary. Some revisions are considered medicaly required and some others are not, which will influence the financial coverage of the procedure.
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Frequently asked questions

Female to Male FAQ | Phalloplasty

*If you wish, you can begin now to consult with an aesthetician to find out which permanent hair removal treatments works best for you, as well the estimated time to complete the treatment. You will then have this information with you during your preoperative consultation with your surgeon.