Non-Binary Options For Phalloplasty

People who identify as non-binary represent a substantial and growing population within the LGBTQ community. Historically, gender-affirming bottom surgery has been binary in nature: Female to Male or Male to Female. However, there's an increasing number of Phalloplasty Surgeons who offer an individualized approach to Phalloplasty for non-binary people seeking bottom surgery.

Non-binary individuals identify as neither exclusively male or female. The 2015 US Trans Survey, which included 28,000 participants, revealed that 35% of trans respondents identified as non-binary. Of those, 80% were female assigned at birth.

People who identify as non-binary may want hormones and surgery, hormones but not surgery, surgery but not hormones, or neither hormones or surgery. In one study, 77.2% of non-binary participants indicated that they had some interest in using hormones or surgery to alleviate gender dysphoria.

For non-binary people who are seeking gender-affirming Phalloplasty, there are a number of different surgical options to consider.

Vaginal Preservation with Phalloplasty
A common myth about Phalloplasty is that Vaginectomy is required but this is only partly true. If Urethral Lengthening is being performed, most surgeons will require Vaginectomy to reduce urinary complications. However, if one opts out of Urethral Lengthening, then they can also choose to keep their vagina (as well as their uterus.)

Surgeons who will perform Phalloplasty with Urethral Lengthening and without Vaginectomy include: Dr. Curtis Crane, Dr. Richard Santucci and Dr. Michael Safir, and Dr. Daniel Freet.

Shaft-only Phalloplasty
In addition to opting out of Vaginectomy and Urethral Lengthening, you also have the option of forgoing Scrotoplasty and implants.

Clitoral Preservation
It's typically buried in a standard Phalloplasty but the clitoris (and clitoral hood) can be left exposed, if desired. It can be placed either in front of or behind the scrotum.

Order of Surgeries
For those who prioritize Bottom Surgery over Top Surgery, is it possible to have Phalloplasty before, or without having, Top Surgery? "Absolutely!" says Dr. Gabriel Del Corral, a Phalloplasty Surgeon in Washington D.C. and Baltimore. "It is whatever the patient feels most dysphoria about. We often perform genital surgery prior to Top Surgery. Some patients also just don't want Top Surgery."

The WPATH Standards of Care do not specify an order in which different surgeries should occur; the sequence of surgeries should be done according to the patient's needs. (p58) There are some good reasons for pursuing the more common ordering of surgeries though. For example, having Top Surgery before Phalloplasty gives you the opportunity to experience what surgery recovery is like before having a more intensive surgery. Think of it as training for the big event. Dr. Jens Berli, a Gender Surgeon at OHSU in Portland OR, prefers patients to have Top Surgery with him before Phalloplasty so that a longer term doctor/patient relationship is established. Of course, if one doesn't feel they need Top Surgery to bring their body into alignment with their non-binary gender identity, then there's no pre-requisite to have Top Surgery before Phalloplasty.

Hormone Therapy Isn't Required For Phalloplasty

The WPATH Standards of Care criteria for having Phalloplasty are:

1. Persistent, well-documented gender dysphoria;
2. Capacity to make a fully informed decision and to consent for treatment;
3. Age of majority in a given country;
4. If significant medical or mental health concerns are present, they must be well controlled;
5. 12 continuous months of hormone therapy as appropriate to the patient's gender goals (unless hormones are not clinically indicated for the individual).
6. 12 continuous months of living in a gender role that is congruent with their gender identity.

Note the section in italics. If the patient has no medical need for Testosterone but does have the desire and medical need for Phalloplasty, then hormone therapy isn't required. For example, a non-binary individual could choose to not take Testosterone or to have a Hysterectomy, and could still have Phalloplasty.

Not every Phalloplasty Surgeon is comfortable offering non-binary options, but there's a growing number who are enthusiastic about providing truly inclusive care. An experienced Phalloplasty Surgeon will work with you to create a treatment plan that is specific to you and your needs.

 

Last updated: 04/08/20