My metoidiplasty consultation with Dr. Miriam Hadj-Moussa, in Ann Harbor Michigan, was by far the most safe, straight-forward, and educational consultation I’ve ever had. So, lets start from the top.
I found out about Dr. Hadj-Moussa from a Facebook meta group that I’m in, two other gents live in Michigan and were talking about their experiences with her, and Michigan is by far the closest state to me (other than Illinois) for bottom surgery. I will not consider Dr. Loren Schechter because I’ve heard some very bad things about his bedside manner, follow-up, and that sort of stuff is 101... and if they can’t get that right, I’m not interested.
Anyway, before my actual consultation day, I started by jotting down my goals, as this is something a surgeon will want to know to make sure that they can do what you’re asking. Simply put, my goals are: sexual function (not being “tied down”), visibility, and STP. I then did some research in common terms for meta surgery, what sort of things I could get or might want with my goals and it came down to wanting: a full meta = dick release, vaginectomy, urethroplasty, scrotoplasty and possibly testicular implants.
When I met with Dr. Hadj-Moussa, she was so unbelievably kind. Started with some small talk and then rolled into asking what my goals and needs were so she could further explain her procedural techniques, what sort of issues arise, etc. Sexual function is not a problem, and some report back with greater sexual satisfaction. Visibility is also possible with getting a mons resection (removal of excess skin and fat right above the vulva/ dick area) but I don’t have a whole lot of either, so she’s going to suture it up instead. With STP, she said most guys will be able to depending on their length and the most common issue down the road comes with “spraying” which is where the urine from the new urethral area sort of comes out like a whirlwind instead of a stream and causes it to “spray out”. We talked a bit about optimal pre-surgery length which came to pumping. I’ve been pumping 1-2 times a day, now up to 25-30 minutes, for a year and it’s significantly helped with growth. It’s a lot like stretching your years out, the more you do it the more the skin expands. After we went through all my questions, she did a quick examination to see what she’d be working. I’m currently just over 8 cm in length (3 inches) flaccid, which is great news!
After getting through my questions and doing the quick 1-2 minute exam, we decided that I’m going to find a surgeon in my state to do the vaginectomy (removal of the vagina*) and then we will do the metoidioplasty in August, and thereafter see if I will need testicular implants or any other fixes. From what I was told, most surgeons will perform the metoidioplasty with a vaginectomy in one procedure, but by Dr. Hadj-Moussa has found that by separating these into two, it significantly reduces the complications of fistulas (holes) or strictures (which is blockage).
Here were the questions I asked and her response:
Recommendations for optimal pre-surgery length? Pumping, (DHT) cream? Definitely pumping, almost all of my patients have pumped both pre and post-surgery and are still experiencing change. There aren’t any articles or research about it, but from all the men I’ve asked they have experienced significant change over time.
Is hair removal needed, or recommended? No, this isn’t necessary for bottom surgery and only for phalloplasty.
Experience with this operation? I’ve been a urologist for over 8 years and have been in this department since I started my residency/ fellowship. In my residency time, we worked alongside many trans* patients and that was where the passion really bloomed. I took over this role when the previous urologist wasn’t interested in moving forward with doing metoidiplasty.
Do you perform this operation regularly? Yes. (though she didn’t give a specific number as to how many patients she does this for, ie: on a “regular” basis. Has done a handful though)
How many procedures do you suggest for out-of-state patients? (2, 3?) What is completed in stage 1, 2, or 3? If getting a vaginectomy here in Michigan, two procedures at the minimum. One for the vaginectomy and after 3 months of healing, the other for the metoidioplasty. Another procedure can be done 6 months after if wanting implants and getting revisions. If a vaginectomy is performed in your state, then we would plan for 1 surgery with the possibility of another for implants and revisions.
What is your success rate, and how often do your patients experience any problems? (cant remember the percentage she gave) But very high, the main problems are from fistulas (holes under the penis).
Placement: How is it determined? This is predetermined by how much length you have. Once the ligaments are cut on the side to release the penis, that will determine where it will sit and how much excess skin needs to be reduced on the sides or above.
What can you do about length / girth? Pumping. I cannot stress enough how impactful this tool is. If it is something someone can perform, do it now, it’s never too late. I have post-op guys who are still continuing with pumping and seeing extremely positive results.
Skene's glands, do you leave them intact? (ejaculation) I don’t do anything with them, so yes they stay put. As far as “female ejaculation” goes, if that’s possible for you then that can happen with the new urethral hook-up.
What kind of implants do you use/ offer (saline vs silicone: saline = smooth, silicone = rough on the outside) We only use saline and either size small or extra small. Often, then the labia majora is rotated, there is enough fatty tissue that if a patient still wants implants to not cause bladder issues the impants should be smaller.
How is best size determined? Saline allows for ease of “going up in size” by inserting liquid, so that is an easy adjustment as we go.
For implants, do you use tissue expanders to prepare the tissue to accept implants? No, tissue expanders are sort of outdated and primarily used if someone is wanting to go with a silicone implant.
What kind of scrotum do you do? (joined testicular sac? v-y?) How is it best determined? I use a slight variation og the v-y, where we will rotate the labia majora 90 degrees and shift down to create a hanging sac. It is not joined, but if a patient wanted to have one that was joined I would be willing to accommodate.
How can I contact you if I have more questions? Through our patient portal, you can send me a medical message any time.
How long do I/we need to stay in the area after the hospital, post stage 1? 1 night at the hospital and 3-4 days in town would be best. Then, in 4 weeks we will have you come back to test out your new urethra and go from there.
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