Doctors at Massachusetts General Hospital are contemplating performing the first-ever penis transplant surgery on a transgender man.
If the procedure is given the green light, surgeons would attach an organ donor’s penis to the “groin of a patient born as a biological female,” according to MedPage Today. It’s worth noting that even if you sign up to be an organ donor, certain types of tissue, including genitalia and faces, can’t be harvested without permission from the donor’s next of kin upon death.
“This would be a quantum leap if you were able to transplant a real penile structure,” Curtis Cetrulo, MD, a plastic and reconstructive surgeon at Massachusetts General Hospital, told MedPage Today. “It’s certainly pushing the boundaries.”
He added: “We’re ready to do it, and we could do it pretty soon if we get it approved. I’m hopeful we can do it. It would be super helpful to a lot of [transgender] patients.”
Massachusetts General surgeons performed the first penis transplantation in the U.S. in May 2016. The successful procedure was done on a patient whose penis was partially removed during surgery to treat penile cancer. After recovery, the patient reported “overall health satisfaction, dramatic improvement of self-image, and optimism for the future,” according to a study on the surgery in the Annals of Surgery.
For transgender males, the possibility of penile transplants could be equally life-changing. Currently, phalloplasty — which involves using a patient’s skin, typically from the arm and thigh, to reconstruct or create a penis — is the “mainstay of masculinizing bottom surgery” for all groups, including transgender men, penile cancer or trauma survivors, and those with congenital disorders affecting the genitals, according to Dr. Devin O’Brien-Coon, an associate professor of plastic and reconstructive surgery and chief medical director of the Johns Hopkins Center for Transgender Health.
An alternative procedure is metoidioplasty, which involves lengthening the clitoris through testosterone therapy. But that procedure has “greatly decreased in popularity since insurance began covering bottom surgery,” O’Brien-Coon, who is a surgeon on Johns Hopkins’ penis transplant team, tells Yahoo Life.
Historically, phalloplasty has had a “bad reputation,” says O’Brien-Coon, because of its “very high complication rates.” He explains that the procedure, which actually requires multiple surgeries, continues to be “one of the most complex surgeries there is.”
That said, O’Brien-Coon notes that in the past few years, the majority of patients who have the procedure at high-volume centers are able to get a “satisfactory result, i.e., realistic appearance, being able to urinate standing and having penetrative sexual function.”
But penile transplantation could be a significant leap forward. Cetrulo told MedPage Today that the procedure could mean “fewer urethral complications, better cosmetic outcome, and better physiological sexual capacity.”
Like any surgery, there are risks, including vascular thrombosis (blood clots) in the micro blood vessels that are reattached to the recipient of the transplant, which would cause “total loss of the organ,” explains O’Brien-Coon. “There are other less severe risks like urinary leakage or narrowing.”
However, O’Brien-Coon says that “lifelong immunosuppression” carries the “biggest chronic risks.” He explains: “While our immunomodulatory protocol developed at Johns Hopkins Medicine decreases the number of drugs required to prevent rejection, long-term immune suppression is associated with increased rates of cancer, infection and several other diseases. We also don’t know how the function of the transplants will last as patients age.”
There’s still much the medical community has to learn about these types of transplants. “Defining ‘success’ is the main challenge because we still don’t know how well penile transplants work yet for cis-men,” O’Brien-Coon tells Yahoo Life. “In cis-men, the penis transplant is often more being ‘reconnected’ to the original remnants of the penis — the urethra [urinary tube] and attachments of the corpora [erectile cylinders] to the bone — which is a much different scenario than with the anatomy in a transgender male. The technical details for the latter are different and have not yet been optimized.”
O’Brien-Coon says that understanding how the procedure might work in transgender men is “important” because the “biggest advantage for a penile transplant over phalloplasty is the possibility of having spontaneous erection without a prosthetic device, as well as orgasm with ejaculation. While there are no data yet, it is much less likely that this can be achieved for a transgender man which would be a limitation to the transplant benefit.”
However, he points out that other potential advantages of the transplant surgery include more “favorable aesthetics” — in other words, a potentially more realistic-looking penis.
“The role of penile transplant versus phalloplasty is dependent on weighing these advantages versus the risks of transplant immunosuppression,” O’Brien-Coon says. “But we are still at the earliest possible stage of understanding those tradeoffs.”
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