I haven’t really changed my opinion about sharing personal details about decisions regarding lower surgery for myself, but I do want people to have access to as much information as they can about it. A lot of what I researched online is either out of date or not reflective of what Dr. Crane, at least, can perform.
I had a consult with Dr. Crane recently (January 2014), and I just wanted to share some general information I got out of it. I hope it’s helpful for other people who are trying to research lower surgery options.
If anyone has any questions, please feel free to ask or message me. I’m happy to answer general inquiries in a public forum and (potentially) more personal aspects of my experience via a private message.
It should go without saying but just in case it for some reason doesn’t, I am not a medical professional. This information was told to me by Dr. Crane and I’ve recorded it here to the best of my knowledge. It is provided as a means of offering information for those interested in both of these procedures as a starting point in their research on lower surgery. You should absolutely speak to a surgeon who performs these if you have questions regarding your specific situation and take their word over anything you see here if it differs from what I’ve written below.
Approximate cost: $26,000
- Cost includes the meta procedure, urethral lengthening, scrotoplasty, and vaginectomy; it will obviously be far less if you opt to skip any of these options (and Crane said it really was a “choose your own adventure” kind of ability with both this procedure and phallo…if it’s medically feasible, he will give you what you want, even if it’s not the “traditionally male” option)
- Unsure if this cost includes the hospital stay/operating room cost and anesthesiologist
- Hysto can be performed at the same time by an OB-GYN working in tandem with Crane, but costs more
- Unsure if a mons resection (monsplasty?) is included in that ballpark figure, but Crane did say the procedure could be performed at the same time as the meta if desired, just FYI.
Length of surgery:
- Anywhere from 2 to 6 hours (in specifics, if you just get a clitoral release, it’s a relatively short procedure. Adding urethral lengthening tacks on about 90 mins to the procedure; I didn’t ask about how long it took for other options)
- Outpatient, but Crane encourages 23 hour observation as an in-patient if you have the money/are able to get your insurance company to approve it
- Surprisingly (to me), Crane said the recovery time doesn’t differ very much between phallo and meta. He said he’d recommend 2 solid weeks off of work (probably because I was told the catheter in both phallo and meta for those who opt for urethral lengthening stays in for that long). He said no heavy lifting of 20lbs or more for at least 2 weeks, and you could return to exercising after about 4 weeks, if all goes well (6 weeks for phallo).
- Most of the information I got regarding complications related to the pros and cons of skipping the vaginectomy while having a urethral lengthening done (to allow for the ability to stand to pee). I was told there was a 10-20% chance of a stricture (scar tissue build-up in the urethra) either way. The increased risk came into place when opting to skip the vaginectomy and going forward with urethral lengthening in terms of fissures (holes developing in the urethral tube). With a vaginectomy, Crane said there was about a 20% chance of a fissure (meaning you’d be stuck sitting to pee or having to undergo another surgery in an attempt to close the fissure). If you opt out of the vaginectomy, he said the risk of a fissure increased to closer to 40%.
- If you choose to have a vaginectomy, you MUST have a hysterectomy, either as part of the meta procedure or prior to it (and with phallo you MUST have a hysto before it if you want a vaginectomy I was told, because the procedure is already 8-10 hours and who wants to be under general anesthesia for longer than 10 hours?). The reproductive organs drain through the vagina, I was told, so closing off that without removing them via hysto is impossible.
- Meta doesn’t increase your length; it simply releases the clitoral tissue from the pelvic wall. With urethral lengthening, you’re going to need to have a fairly sizeable growth as a result of testosterone, so Crane says he prefers patients who’ve been on testosterone for at least a year (even then, the point is to be able to clear your jeans when standing to pee, and some guys simply won’t have that growth, no matter how long they’ve been on T; in those instances, if you’re set on standing to pee, he recommends considering phallo; if you just want the clitoral release and other procedures that don’t involve urethral lengthening, that can be done, no problem, regardless of growth).
- If you choose not to have a urethral lengthening (I believe this is what he said but it might have been related to vaginectomy, not UL…sorry, my notes aren’t clear on this point) but do want scrotoplasty, Crane can do a graft to make the scrotum from the inside of your mouth/cheek as an alternate donor site.
- 100% of his patients reported experiencing sensation (tactile and erotic) after recovery.
- Patients are able to still wear a harness and strap-on for penetrative sex after meta (since generally meta doesn’t provide a long enough phallus to penetrate autonomously).
- This is a one-visit procedure. For patients who opt for scrotoplasty, I believe he said you’d have to stop by his office as an outpatient about 4-6 months (he might’ve said 6-8, not sure) after surgery to have the testicular implants put in.
- Meta allows for the ability to get erect when aroused without the need for a penile implant.
Approximate cost: $68,000-78,000
- Cost includes phallo, vaginectomy, urethral lengthening, glansplasty and scrotoplasty; it will obviously drop your cost to opt out of any of these
- Unsure if this cost includes the 5 days required as an inpatient at the hospital, the operating room fee, or anesthesia
- Cost does not include hysterectomy, which MUST be performed prior to getting phallo (if you want a vaginectomy as part of the procedure)
Length of surgery: 8-10 hours
- In-patient – 5 days; recovery is similar to meta, with 2 weeks recommended off of work, no heavy lifting of higher than 20lbs for 2 weeks, but no exercise for 6 weeks.
- I’m sure there are more that I don’t know about, but see what I wrote above for meta. The only thing I was told that’s different is that instead of a 40% chance of a fissure related to urethral lengthening if you keep your vagina, it’s more like a 30% chance of fissure.
- Again, you can pick and choose the procedures you want. Crane said he’s performed phallo before where the patient didn’t care about standing to pee, so he didn’t do a urethral lengthening. He’s left vaginas intact during phallo, and has had patients who decided not to get a scrotoplasty. The only requirement based on these choices is you must have a hysterectomy performed prior to phallo if you want a vaginectomy.
- While recovery time is similar between procedures, phallo is generally considered a more major surgery because it creates a penis out of skin from a donor site elsewhere on your body. Crane recommends the lateral forearm because he says there are some great nerves and veins (I believe he said veins) to reattach to the penis. There’s also the ALT donor site, which is on the thigh. He said since there’s more fat on the thigh, results often end up getting you something that looks more equal parts wide as it is long (like a soup can, he described it as). The ALT donor site still allows for good sensation, although he can’t sculpt the glans at the same time as the rest of the phallus so that’d be a procedure you’d need to come back for. He also does the dorsal flap (under your arm down to your hip, I believe), although that one is less certain about retaining sensation. He said the forearm was best. Also note that in any of these cases, if you want a smooth penis, you’re going to need to have body hair removed prior as well.
- In terms of retaining sensation, Crane said 100% of his patients (excuse me, but WOW) retained tactile sensation at the very least. He reported 85% of his patients experienced erotic sensation.
- You can’t get erect without a penile implant, which he can install (along with adding the testicular implant) on an outpatient basis about 9 months after surgery takes place. I believe Crane prefers the non-pump option for penile implants (I’m going to suck trying to describe this, but it’s basically just a bendy piece of material, so you’ll always be semi-erect if you have it, but you’ll be able to bend/straighten it as desired for penetrative sex without the need of a saline pump, which has a higher likelihood of complications or breaking)
General info about obtaining a consult with Dr. Crane for lower surgery:
- Cost: $150
- Cost to reserve a surgical date: $1000 (note: I heard this through another Tumblr user and didn’t actually ask while there myself because they’re currently not scheduling any more lower surgeries until about June 2014…and the dates of the actual surgeries take place in 2015 and beyond, FYI; **update: I’ve also heard the cost is $2000 more recently, although check with Crane’s office since I haven’t been able to verify this on my own); this fee can be applied to the overall cost of the surgery you get, btw.
- Insurance: I’m sure he takes other insurance carriers, but I only asked about my own, Anthem Blue Cross. I received confirmation that he is now an in-network provider for Anthem. Huzzah.
- Crane will do consults via webcam, although I personally went into his office since I’m local so can’t speak on that particular experience.
- You’ll need a letter from a therapist (unsure if licensed social workers are OK) and an MD who prescribed you testosterone or is in charge of your transition care prior to surgery (and probably some other requirements I forgot at the moment…if anyone wants it, I have an attached doc with more requirements and general information about both procedures)
- His office is moving from San Francisco to Greenbrae (North Bay area, north of San Francisco) on February 1.
Any other questions? Feel free to ask. Sorry if I was unsure of some of the information. I tried to make note of the information I wasn’t 100% certain I’d heard correctly as clearly as possible though.
I also highly recommend the Hung Jury anthology. It provides testimonies from transmen who’ve undergone some form of lower surgery (from the mid-90s to present), as well as some selections from their cisgender partners (all women, unfortunately, for those of us who identify as gay), and even selections on the historical background relating to phalloplasty and FtM pioneers during the 70s and 80s.
July 2014 update: I received a call from Dr. Crane’s office around the first week of June saying they were now scheduling lower surgeries for late 2015. Since I’ve decided to wait until 2016, I didn’t schedule anything myself but I thought this timeline might help people understand where they’re at, in terms of scheduling upcoming surgery dates. I don’t think this timeline applies to top surgery, which can be scheduled much earlier on, I believe.