Penis Transplants for Trans Men? Not So Fast.
A successful penis transplant was performed by surgeons at Johns Hopkins University in Baltimore in 2018. While this transplant was the first to include both a penis and scrotum, penis transplants have been reported four times, having been performed previously in China, South Africa and Boston. Every time penis transplants make the news, a barrage of click enticing articles get heavily circulated in news feeds asking, "could this be done for trans men?" The reality is that penis transplants for trans men are many years into the future—if at all. There are just too many barriers, scientific and otherwise.
Firstly, there's the cost. The U.S. military has spent millions researching medical breakthroughs for veterans who have sustained genital injuries in the line of duty. This latest transplant reportedly cost between $300,000 and $400,000 and was funded by Johns Hopkins. As an experimental procedure, no insurance company will cover this expense. Research grants could be used but they are limited.
"The cost, time and talent resources needed to execute a complex penis transplant are steep, making it challenging for members of a disenfranchised community, or youth wanting to benefit from such a procedure to afford it," says Dima Elissa, CEO and founder of VisMed 3D, a Chicago-based company looking at the future of 3D-printed body parts.
Another issue is the lack of a donor pool.
Finding a successful donor still requires finding an immunological match. "Most likely the huge percentage of people who are willing to donate [organs] will not be a match, so most of the time we won't speak with the family about it," says Litsa Williams, Director of Community Services at The Living Legacy Foundation of Maryland, the organ procurement organization that serves Johns Hopkins University.
"The initial discussion with the family is about the normal organs and tissue," she told Inverse, pointing out that genitalia — together with faces and hands — aren't normally part of that discussion.
What penis donation really comes down to, Williams says, is whether the donor's family think it's something the donor would've wanted.
Source: Inverse.com
Dr. Jeffrey Kahn, a bioethicist at Johns Hopkins has addressed whether the potential procedure would extend to transgender male candidates: "What do you say to the donor? A 23-year-old wounded in the line of duty has a very different sound than somebody who is seeking gender reassignment."
Moral critique of this comment aside, it's important to note that a donor's family doesn't have much control over who an organ donation goes to, says Williams. Nevertheless, she understands why men might be especially protective of their family jewels, and this is bound to keep the donor pool small.
Additionally, there's the risk of the patient's body rejecting the transplanted penis. Immunosuppressant drugs would have to be taken for life which can lead to increased disease susceptibility, and cancer, kidney or liver damage.
Dr. Richard Santucci, a Reconstructive Urologist and Phalloplasty Surgeon at the Crane Center for Transgender Surgery in Austin, Texas is cautious yet optimistic about the possibility of penis transplants for transgender individuals.
"In the South Africa center that did the first two successful [penis] transplants [in cis men], they are investigating penile transplant as a transgender surgery, arguing that the organ will be much more competent than a free flap from the forearm. Since they already have experience, I wonder if we'll see a transgender penile transplant coming out of South Africa in the future." (May 2019)
Dr. Santucci also acknowledged that the immune suppression drugs required for penis transplants are "really toxic" and not yet "ready for prime time".
Looking to the Future: Lab Grown Penises
"My personal feeling is that regenerative medicine will probably hold more promise than transplantation," says Dr. Loren Schechter, a surgeon who performs Phalloplasty in Chicago at one of the largest volume practices in the U.S.
A lab-grown penis, Schechter says, skirts all these issues because tissues from the patient himself would seed the growth of the organ. So the patient's immune system won't look at the new penis and try to destroy it as foreign material, and the patient himself might feel a stronger connection to the new organ.
Researchers looking into bioengineered penises haven't really begun thinking about how they might grow one for a trans male because, with current technology, it's impossible. People born with female bodies don't have penile erectile tissue cells, which scientists need from the patient if they're going to grow a complete, functioning penis in the lab. Mostly, lab-grown penises are being researched to heal trauma from injuries like the kind soldiers experience or cancer or birth defects.
Science might still find a way to grow penises for trans men, but it'll take many years — maybe many decades. Schechter says that at the very least, basic surgical techniques will continue to improve as doctors find better ways to connect tissues and nerves and increase sensitivity. The military medicine is helping with that. "But I don't see anything on the immediate horizon that will revolutionize it," he says, speaking of female-to-male confirmation surgery.
Source: Out.com
Closer on the Horizon: 3D-Printed Penises
The 3D-printed anatomical parts that Elissa and her colleagues at VisMed 3D are working on could be the more viable genital solution for transgender men in the shorter term.
"With 3D printing, I believe it will be years not decades, when we will realize and replicate anatomical parts at a much reduced cost, and a more tailored personal solution."
While penis transplants, lab-grown penises and 3d-printed penises are not yet realities for trans men—and may never be fulfilled—it's still exciting to think about how further scientific developments could benefit future generations! In the meantime, trans men have more access than ever before to the amazing procedure that is Phalloplasty. The fact that tissue can be moved from one area of the body to another with blood supply and nerves is incredible and the procedure is available now, not in some distant, foggy future. We can ponder what may come to pass, but let's also celebrate the massive scientific achievement of present-day Phalloplasty.
Related: Growing a New Urethra - Scientists implanted urethras engineered from the patient's own cells, restoring normal function.
UPDATES
A study published in May 2018 indicates that penis transplants for trans men might be feasible. Swedish surgeons set out to determine whether an en bloc surgical dissection can be performed in a male cadaver, in order to include structures necessary for penile transplantation (from a deceased donor male) to a recipient with female genitalia in gender affirmation surgery. The first two dissections failed. The third dissection however, succeeded in explanting the relevant structures: urethra, vessels, dorsal nerves, crura of corpora cavernosa, and bulb of corpus spongiosum. The study demonstrated the possibility to explant the penis and associated vessels, nerves, and urethra en bloc from a cadaver and suggests a surgical technique for en bloc explantation aiming for transplantation of the penis from a cadaveric donor male to a recipient with female genitalia. This, being a starting point for research into penile transplantation in trans men, will obviously need further research before becoming a clinical reality. Read the study here.
MedPageToday reported in October 2020 that officials at Massachusetts General Hospital hospital were considering whether to allow a first-ever penis transplant in a transgender man. The article didn't mention any new research. Phalloplasty surgeon Dr. Curtis Cetrulo commented that it would be "a quantum leap if you were able to transplant a real penile structure." The article also mentioned that "outcomes remain unknown" including the ability to have an unassisted erection. Given that a lifetime of immunosuppression would be needed, implantation of an erectile device would be contraindicated (because foreign material in the body poses a risk of infection.) Dr. Cetrulo said that penis transplants ideally would offer fewer urethral complications, however patients will still need urethroplasty performed so it's not clear how much the rate of urethral complication would be lowered as many urethral complications happen at the point of urethral joining. Another concern is that headlines about penis transplants will lead some men to retract permission for any of their organs to be donated. Read the article here.
Last updated: 10/09/20