When people ask "do transgender men have male genitalia," they’re usually looking for a simple yes or no. But biology is messy. Life is messy. If you're looking for a one-size-fits-all answer, you won't find it because transgender men aren't a monolith. Some do. Some don't. Some have something that sits right in the middle of what we typically categorize as male or female.
It's complicated.
A trans man is someone who was assigned female at birth but identifies as a man. For many, the journey of transition involves aligning their physical body with their internal sense of self. This can include hormone replacement therapy (HRT) and various surgical procedures. However, not every trans man wants surgery. Not every trans man can afford it. Some are perfectly happy with the bodies they have, while others feel a profound need to change their primary sex characteristics to alleviate gender dysphoria.
The Role of Testosterone in Physical Changes
Before we even get to the operating table, we have to talk about hormones. For most trans men, testosterone is the "holy grail" of transition. When a person assigned female at birth starts taking testosterone, their body goes through a second puberty. It’s wild how much a single hormone can do. The voice drops. Hair starts sprouting on the face and chest. Fat moves from the hips to the belly.
But the most significant change regarding genitalia happens to the clitoris.
Under the influence of testosterone, the clitoris undergoes what medical professionals call "clitoral growth" or "bottom growth." It’s basically a mini-penis. It can become several centimeters long, it can become erect, and it functions very similarly to a natal penis in terms of sensation and blood flow. For many trans men, this growth is enough. They feel that their genitalia is now effectively male, even without surgery. It's a natural, hormonal shift that fundamentally changes the anatomy.
Why Surgery Isn't Always the Goal
You might assume that every trans man wants "the surgery." That’s a common misconception. In reality, the decision to undergo gender-affirming bottom surgery is deeply personal and often influenced by factors that have nothing to do with identity.
First, there's the cost. These surgeries are incredibly expensive, often running into the tens of thousands of dollars. Even with insurance, the out-of-pocket costs can be soul-crushing. Then there's the recovery. We're talking weeks or months of healing, multiple stages of surgery, and the risk of complications like urological issues or loss of sensation.
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Some guys just don't feel the need. They might have "bottom dysphoria"—a disconnect with their genitals—but decide that the risks of surgery outweigh the benefits. Others find that testosterone provides enough change to make them feel comfortable. Honestly, the idea that a man is defined solely by what’s in his pants is a bit dated anyway, right?
Understanding Phalloplasty: Constructing a Penis
For those who do choose surgery, there are two main paths. The first is phalloplasty. This is the "big" one.
In a phalloplasty, surgeons use a skin graft—usually from the forearm (radial forearm flap) or the thigh—to create a penis. It’s a marvel of modern medicine, really. They take the skin, nerves, and blood vessels and shape them into a phallus. This procedure allows for several things:
- Urethral Lengthening: This is the part that allows a man to stand up to pee. It’s a huge deal for many trans men.
- Scrotoplasty: The surgeon creates a scrotum using the labia majora. They can then insert silicone testicular implants.
- Glansplasty: This creates the "head" or glans of the penis to give it a more natural appearance.
- Erectile Implants: Since the new penis doesn't have erectile tissue (the corpora cavernosa), an implant is needed to achieve an erection. This is usually a pump or a malleable rod inserted in a later stage of surgery.
The result is a penis that looks and feels very much like a natal one. It has sensation—often erotic sensation—thanks to the nerve hookups performed during the graft. But it’s a long road. It usually takes three or more separate operations to get the final result.
Metoidioplasty: Working with What You’ve Got
The second surgical option is metoidioplasty. Remember that "bottom growth" from testosterone we talked about? Metoidioplasty takes that growth and gives it a boost.
The surgeon releases the ligaments surrounding the enlarged clitoris, allowing it to "drop" and hang more like a penis. Because the tissue is already erectile, the person can get natural erections without an implant. It’s a less invasive surgery than phalloplasty, with a shorter recovery time and fewer risks.
However, the result is much smaller than a phalloplasty. Usually, a metoidioplasty results in a penis that is 1 to 3 inches long. While many men can stand to pee after this surgery, some find it difficult depending on their body type and the amount of growth they had. It’s a trade-off. You get natural erections and a faster recovery, but you don't get the size or the same "typical" appearance that a phalloplasty provides.
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The Complexity of Sensation and Function
One of the biggest fears people have when discussing whether transgender men have male genitalia is the loss of sexual function. It's a valid concern. Any surgery carries risk.
But here’s the thing: most studies show that the vast majority of trans men who undergo these surgeries report high levels of satisfaction and the ability to achieve orgasm. In phalloplasty, surgeons specifically connect the nerves of the graft to the existing nerves in the groin. In metoidioplasty, the nerves are already there; they’re just being repositioned.
Sensation is a spectrum. Some guys have incredible erotic sensation throughout the entire phallus. Others might have more localized sensation. It varies wildly based on the surgeon's skill, the person's healing process, and the specific technique used. It’s not a "broken" version of a penis; it’s a reconstructed one that functions for the person living in that body.
The Myth of "The Surgery"
We need to kill the phrase "the surgery." It implies there is one single event that turns a "female" body into a "male" one. Transition is a mosaic.
A trans man might have a chest reconstruction (top surgery) but keep his original plumbing. Another might get a metoidioplasty but decide against testicular implants. Another might get a full phalloplasty but keep his ovaries just in case he wants to use his eggs later.
There is no one way to be a man, and there is no one way to have "male" genitalia. If we define male genitalia as "parts that belong to a man," then any trans man’s genitals are male, regardless of whether they’ve had surgery. But if we’re talking about strictly anatomical definitions, the answer depends entirely on where that individual is in their transition.
Legal and Social Realities
It’s also worth noting that in many places, your "legal" sex isn't necessarily tied to what your genitals look like. Many trans men change their birth certificates, passports, and driver’s licenses to "M" without ever having bottom surgery.
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In the eyes of the law, they are men. In the eyes of their partners, they are men. In their own eyes, they are men.
The obsession with what’s under a trans person’s clothes is often more about the curiosity of others than the actual health or identity of the trans person. For most trans men, their genitalia is a private matter between them, their partners, and their doctors.
What Research Says About Outcomes
If you look at the data from institutions like the World Professional Association for Transgender Health (WPATH) or studies published in the Journal of Sexual Medicine, the outcomes for gender-affirming surgeries are overwhelmingly positive.
Regret rates are incredibly low—often cited at less than 1%. Compare that to knee replacements or cosmetic nose jobs, and you’ll see that gender-affirming care is one of the most successful areas of medicine in terms of patient satisfaction.
The "male" genitalia created through surgery or hormones serves its purpose: it reduces dysphoria. It allows men to feel at home in their skin. It allows them to use public restrooms without fear. It allows them to have intimate relationships where they feel seen as who they truly are.
Actionable Insights for Moving Forward
If you are a trans man considering your options, or if you are someone trying to be a better ally, here are a few things to keep in mind:
- Educate yourself on the terminology. Understand the difference between phalloplasty and metoidioplasty. Know that "bottom growth" is a natural result of testosterone.
- Respect privacy. Unless you are someone’s doctor or intimate partner, the state of their genitalia isn't really your business.
- Acknowledge the cost and access barriers. Many trans men would love to have surgery but simply cannot access it due to systemic inequalities in healthcare.
- Support comprehensive healthcare. Gender-affirming care is life-saving care. Supporting policies that make these procedures accessible and affordable is crucial.
- Value the person over the parts. A man’s identity is not located in his groin.
Ultimately, the answer to "do transgender men have male genitalia" is that they have their genitalia. For some, that looks exactly like what you’d expect on a cisgender man. For others, it’s a unique anatomical bridge that reflects a complex journey of self-discovery and medical science. Both are valid. Both are real. Both deserve respect.