What is phalloplasty?
Phalloplasty is the creation or reconstruction of a penis using someone’s own tissue.  Some transmasculine (assigned female at birth but having a masculine gender identity) or nonbinary people choose to have a phalloplasty as part of gender affirmation treatment.  Phalloplasty is also an option for people assigned male who lose their penis due to accidents or illness, or for masculine-identified people who are intersex or have other developmental differences that cause them to be born without a penis. 
People may choose phalloplasty surgery to make their body’s appearance match their internal identity, to have a functional penis that lets them have penetrative sex, to give them the ability to pee standing up, or all the above. 
Phalloplasty surgery steps
Phalloplasty is a complex procedure that’s often completed in several steps.  Each patient’s treatment plan is unique and decided in collaboration with their surgical team; for some people, phalloplasty involves many different steps, while others may opt to have fewer procedures depending on their ultimate goals. 
Here are some common stages involved in phalloplasty:
1. Creation of the penis (aka “neophallus,” or “new penis”)
A “new” penis or “neophallus”  is created using skin from a donor site (usually the forearm, thigh, or lower torso) on the patient’s body. A urethra (the tube that moves urine out of the body from the bladder) may be created at the same time using tissue from the patient’s groin or the inside of their mouth or vagina.  Hair removal is usually done on the donor site well in advance of phalloplasty surgery. 
2. Lengthening of the urethra
3. Penile implant insertion
If the person having phalloplasty surgery wants to be able to have penetrative sex, an implant can be added in a separate procedure after the penis has had time to heal. This typically happens about a year after stage 2. 
Some people who have a phalloplasty choose to have a glansplasty, an additional surgery that adds a glans, or “head,” to the penis. 
How much does phalloplasty cost?
When phalloplasty is done as part of gender affirming “bottom surgery,” other procedures like scrotoplasty (the construction of a scrotum), vaginectomy (removal of the vagina), oophorectomy (removal of the ovaries), and hysterectomy (removal of the uterus) may also be performed and present additional costs. 
Depending on your insurance provider, gender affirming care may or may not be covered. 
Most people who have phalloplasty surgery are happy with the results.  Whether someone can have penetrative sex or pee standing up after phalloplasty depends a lot on the specific techniques and procedures used, but many people do achieve these results, and find that phalloplasty surgery helps to relieve their gender dysphoria. 
As with any surgery, phalloplasty comes with the risk of complications. Some of the most common complications include urinary tract problems like urethral fistula (when urine leaks out of the urethra into another area of the body) and urethral stricture (when the urethra closes and prevents urine from passing through), as well as wound healing issues and infections. 
Not every transmasculine or male-assigned person who doesn’t have a penis chooses to undergo phalloplasty. Some people may choose not to have phalloplasty due to concerns about the cost of the procedure, an underlying medical condition that increases their risk of complications, or because they want to avoid a major surgery and hospital stay. Others may choose not to have phalloplasty because having a penis isn’t an important part of their identity.
Whether or not to have phalloplasty surgery is a very personal decision that should be made based on your unique needs, values, and goals in collaboration with a knowledgeable, compassionate healthcare provider.
The bottom line
Phalloplasty surgery often involves a complex series of procedures requiring a big investment of time and financial resources. For people who were born without a penis or who lost their penis due to an accident or illness, phalloplasty is an option that can help them feel more comfortable with their bodies, relieve feelings of dysphoria, and enhance sexual function.