There are several different types of genital or ‘lower surgery’ for trans men and each has its own advantages, disadvantages and risks to consider. It's a good idea to speak to people who have had surgery.
You may find it helpful to join sites such as Transbucket or the Yahoo ‘ftm-uk’ forum. These have photographs of surgery results and may help you to consider what you want from the surgery before going ahead.
Lower surgery for trans men in the UK
Lower surgery is available on the NHS, or privately where it costs around £50,000. The advantages of this surgery are that it creates an adult-sized penis that, with erectile devices, can get hard and which can allow standing urination.
In the UK, you will not usually be put forward as a candidate for lower surgery unless you have been on hormones for at least two years and have had top surgery. Referral for lower surgery on the NHS is through a Gender Identity Clinic.
If you're a private patient, either in the UK or abroad, you'll need to speak to your surgeon to find out their particular criteria. It's likely that you'll need a referral from two consultants (NHS or private) and to have been on hormones for at least a year (more often two).
Many surgeons will not consider you for lower surgery (on the NHS or privately) if you're a smoker or are overweight to an extent that the surgery would be dangerous.
Different lower surgery procedures:
This surgery releases the clitoris from its ligaments and lets it hang further out and forward from the body creating a small penis.
The clitoris will have grown if you've been taking testosterone and when released from the hood can resemble a small penis of about one to two inches in length.
Testicles can be fashioned from the skin of the labia with implants placed inside. If you choose, you can have your urethra (the tube you pee through) extended so you can pee from the end of your new penis.
The advantages of this surgery are that you have full sensation in your penis and a lack of scarring elsewhere on the body.
The disadvantage is that the penis will be relatively small.
This surgery involves taking a graft of flesh from another part of the body to create the length and shape of the penis. Different surgeons use different graft sites - usually the abdomen and forearm but some surgeons will consider using the thigh if the forearm is not suitable.
The clitoris can be tucked inside the graft with a nerve extended into the length of the penis giving some erotic sensation throughout - although sensation will be reduced. Alternatively the clitoris can be left outside, and will be positioned under the base of the penis with no change to sensation.
If you want to have penetrative sex, an erectile device can be inserted into the penis. This will be either a pump or a bendable rod.
The advantage of the phalloplasty is a more realistic-sized and shaped penis, which can be used for penetrative sex.
The disadvantages are that scars are larger - and if you have the urethra extended scars are more visible as it's usually created from skin on the arm, whether the main graft is taken from there or not.
Another disadvantage is the risk of reduced sensation if you tuck the clitoris into the penis.
The phalloplasty is a much longer process involving around two to five surgeries (depending on the surgery team) with at least a year in between for recovery before moving onto the next stage. The phalloplasty can give trans men a realistic-looking penis. It was first developed for cis gendered men who had lost their penis from injury or illness. However, it will never look or feel entirely like a cis male penis.
It's important that you know what to expect from this surgery to avoid disappointment.
It's important to note that it's not essential to have the urethra extended whichever type of surgery you have. This has a risk of infection and complication.
More advice about lower surgery for transmen:
If you want more advice about surgery, the Gender Identity Research and Education Society (GIRES) is a good starting point.
They have also produced a detailed guide to lower surgery.