Final Phase

Constructing Male Genitalia and Urethral Realignment

In the transformative journey of gender reassignment from female to male, the culmination involves the construction of male genitalia and the realignment of the urethra.

This critical phase signifies not only the technical complexity of the procedures involved but also marks a pivotal moment of personal fulfillment for many transgender men.

The journey to this stage is one of meticulous planning, medical expertise, and the patient’s unwavering resolve.

Surgical Preliminaries and Patient Readiness

Before embarking on this final surgical phase, comprehensive medical evaluations are essential to ensure the patient’s suitability for the complex procedures ahead.

This evaluation includes an examination of previous surgical sites, particularly the newly created urethral tube in the forearm, alongside a thorough physical examination and laboratory tests to identify any potential anomalies.

A halt in male hormone therapy two weeks prior to surgery, bowel preparation, and a ban on smoking to prevent blood clotting issues are among the preoperative requirements.

Moreover, patients are educated on post-surgical self-care, emphasizing the importance of leg exercises to mitigate the risk of blood clots.

Surgical Teams and Procedure Overview

The intricate surgical process is undertaken by two specialized teams working concurrently. The first team focuses on sculpting the male genitalia from forearm tissue, preparing it for attachment, and extending the urethra.

Concurrently, the second team lays the groundwork in the genital area for the forthcoming transplant, ensuring the proper connection of nerves and blood vessels.

The Forearm Technique for Urethral Construction

One innovative approach involves using the patient’s forearm tissue to fashion a new urethra, addressing the significant challenge of urethral stricture and leakage.

This method benefits from the forearm’s tissue availability and its ease of integration with the existing urinary system. However, the potential for visible scarring on the forearm and the need for meticulous post-operative care are considerations that patients must weigh.

Post-Surgical Journey and Rehabilitation

Following the surgical procedure, patients embark on a recovery process characterized by close medical monitoring to detect and address any complications promptly.

The healing of surgical wounds, particularly in the forearm and genital areas, requires vigilant care to prevent infection and ensure successful grafting of the new tissues.

Challenges and Complications

Despite the advancements in surgical techniques, the risk of complications, such as blood flow issues to the newly constructed genitalia or the development of strictures in the urethra, remains.

These complications necessitate a proactive approach to post-operative care, emphasizing the importance of regular medical follow-ups and, in some cases, additional corrective surgeries.

Physical and Mental Rehabilitation

The physical and psychological impacts of the final phase of gender reassignment surgery are profound.

Patients must navigate the physical discomfort and limitations associated with recovery while also contending with the psychological ramifications of their transformed bodies.

Support from medical professionals, including psychiatrists, plays a crucial role in facilitating a smooth transition and addressing any emotional challenges that arise.


The journey to creating male genitalia and realigning the urethra in gender reassignment surgery is a testament to the extraordinary lengths to which individuals and medical professionals go to align one’s physical body with their gender identity.

This final surgical phase, while complex and fraught with potential complications, represents a beacon of hope and fulfillment for many transgender men, offering them a chance to live authentically and with dignity.

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