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Older Trans "Young girls? LOVE your vagina; it won't kill you, but trans bottom surgery might!"


by, Scott Newgent

I had a woman reach out to me the other day about a transman she had started dating that told her she was scheduled to have bottom Surgery in a week. I sent her to my blog to read this article, which was somehow unpublished.

So here is the republish!

I wrote this over four years ago, and many things have changed. As I read this, it's fascinating to see my sentiments and thoughts transform. The ongoing issues and difficulties from this Surgery would change the tone. But I did not change it; I kept it the same. But the rewrite would be very different telling these young girls to LOVE their vagina; it won't kill you, but trans bottom Surgery might! In fact, that's the new title!



"The Wild, Wild West of Surgery" 2019

Phalloplasty - Flagship Bottom FTM Surgery - Wild Wild West of Trans Surgeries

by, Scott Newgent

Deciding to get a Phalloplasty is a personal journey. The Surgery itself is a hot button in the transgender community, and I believe it will continue to be for quite some time. I'm not a doctor, just a patient, so these explanations, experiences, and opinions will be with my limited knowledge from a clinical perspective. Some incidents are mine, some I have read in medical malpractice cases, and others I listened to over coffee with friends. Excuse the vivid account, but I want to put the complexities and expectations into a realistic viewpoint; it would have benefited me when I started this journey.

Let's start with a quick synopsis of the most popular FTM bottom surgeries and then finish with the, "Flagship," the Phalloplasty.


Release The Clitoris

Like somehow, it's being held down by forces unknown to us; quite comical because medically, it just about covers how women have been treated since the beginning of time.

Once the clitoris is released, the Surgeon wraps around the labia minora skin to create a little penis. A scrotoplasty can be designed to give an even more realistic atheistic, and a urethra lengthening can be added to give the patient the ability to pee while standing.

Metoidioplasty was developed in the '70s and is a far less mysterious surgery than Phalloplasty. You get a realistic-looking little penis and can stand to pee. But, let's face it, penetration is most likely out of the question. With testosterone treatment, the trans man does grow a more extended and more enormous clitoris, but having one grow big enough to penetrate is a rumor that I have not been able to clear up. I have had a couple of FTM patients tell me they can penetrate, but I have always questioned that.

Pros: Cheaper $5,000-$20,000 depending on what you choose to do, and if you add on a urethra lengthening and a scrotum, there is less downtime and fewer chances of complications. The Surgery is relatively short, 2-5 hours, depending on what doctor or website you read.

Cons: Just one, penetration…NOPE.


The Centurion was invented and performed by Dr Peter Raphael in Dallas, Texas. I had my top Surgery and a couple of other things done by Dr Raphael. This guy is an artist. He has an impressive background; his father was a surgeon, and his mother a talented artist, and he twists that into one in Plastic Surgery. If you walk by his office, sometimes you can catch him sculpting implants, trying to figure out better ways to create the most realistic scrotum — great guy, sincere with helping people in the transgender community, careful and adept. Dr Raphel is a little more costly but worth the investment. This procedure can also add urethra lengthening, allowing the patient to pee and a scrotum.

Pros: It's a Metoidioplasty on steroids, more prominent and more realistic. Cheaper than a Phalloplasty $8,000-$20,000

Cons: Again, sorry, guys, penetration is not an option.

Ok, so now let us get to the "Flagship" of female-to-male bottom Surgery, the……drum roll, please.

Phalloplasty. Researching this bad boy online will make you think you hit the jackpot. Realistic penis, penetration, and pee while standing an all-around winner-winner chicken dinner. But things are not always what they seem to be, especially with marketing experts and the capricious powers of the internet, creating smoke and mirrors.


In the 1940s, Sir Harold Gilles was the first Surgeon to take skin from another part of the body to create a penis, but the first Surgeons to try and tackle this colossal Surgery didn't happen here in the USA until the 70s.

With this Surgery, the Surgeon takes skin from two different sites on the body; one harvesting area is cut into more profound and full recovery to the skin's initial appearance is never regained. The Surgeon then creates a urethra lengthening procedure, takes the skin from the site where it is harvested, and moulds and stitches a penis. Once completed, the skin is re-attached and put back onto the body.


Awwww, penetration, maybe?


Wow. Well, first, the Surgery can take anywhere from 10-20 hours to complete process you can have anywhere from 2-22 operations, depending on complications, which are vast, numerous, and frequent. Since the skin cannot become erect, the actual penis is long and cumbersome. Recovery is brutal, not a "Hey boss; I need a couple of weeks off to have surgery." NOPE! This recovery is months, if not years, depending on the type of complications you have. This expensive Surgery costs $50,000 on the super-low end up to hundreds of thousands. If your insurance does cover this Surgery, make sure they will cover the additional operations to complete the Surgery and all the complications that may arise.


So, if you still want to get a Phalloplasty, the idea of penetration is just something you have to have. Sure, I get it, and that's why I did it too, as well as my ex-wife wanting the evasive "Penetration." I get it; the allurement is appealing, but the draw can change many things you need to be aware of in your life.

This Surgery, guys, is no joke. But, when I first was looking into Phalloplasty, I obsessively searched the internet, and the plethora of information that popped up was like Disneyland for the FTM. Oh, my God, it's too good to be true. Cinderella married the FTM with a Huge Penis, and they lived happily ever after, enjoying penetration after penetration.

As you open different sites, a handful of surgeons become the most relevant and look esteemed with awards, dual residencies, and success after success. If you dive deep into investigations, you can find fictitious accolades and awards that boast the potential Surgeon's competencies.

If you base your decision to have a Phalloplasty on what is on the internet, you are making an ignorant decision with lots of moving parts. Imagine skipping down the yellow brick road like Dorthey from the Wizard of Oz. Do you recall who was behind the curtain? Do you? Now imagine deciding something as drastic as a Phalloplasty with a couple of clicks of a mouse. It's dangerous and downright insane.

Be sure your Surgeon behind the curtain doesn't resemble the all-Powerful Oz from the wizard of Oz.

If you research some of these doctors, you will find medical malpractice cases, but you must do your homework; more than merely checking doctors' state board licenses is required.

Malpractice cases can be hidden by settling or leaving the state and starting a new one. If you investigate, you will find that the decision to get a Phalloplasty obliterated quite a few people's lives. The complication rate is enormous. Prior patients have been shattered physically and spiritually and left in financial ruin.

Having a giant penis, you can use to penetrate with is not a fair trade for having to wear a colostomy bag for years or even the rest of your life, not in my estimation. Again, I'm not revealing anything about my experience; I read about this in a malpractice case.

First, let us take the skin that needs to be removed to create the penis. You have three choices, the forearm, the thigh, and the upper back. To use the leg for harvesting, the patient needs to have a specific body-to-fat ratio for the procedure to work; this skin also must have a certain elasticity. Depending on the age and body fat of the patient, this might or might not be an option. The benefit to the thigh is that the harvesting sight on the leg can be covered; this part of your body will never look the same; you need to understand this. You will look like a burn victim; it's just where you will look like you got burned. The con is that it's not the best site for sensation, it's not the gravest, but you could or could not be able to orgasm. I'm not bullshitting you; this is your life. You need to understand this stuff.

The second place for harvesting skin is from the upper back. Again, this area can be covered, but the sensation is less. You're, odds of orgasming go down even further. Who wants to go through all this pain, money, and suffering to have a penis that doesn't allow you to orgasm?

The last area is the forearm, and the pros to this area are the sensation is great; the bad news is that your arm will never look or work the same. For some reason, this information is almost nonexistent when you search the internet. The Surgeons web sites quickly skim through this as if it's no big deal. You can google images, though, and these are realistic, look at these, don't ignore these, these pictures of what you will be putting your arm through.

My Surgeon downplayed using the forearm site to the point I allowed myself to feel silly for being troubled about questioning whether or not I should use the forearm. As I look back, my Surgeon was the pivotal point in my decision to get the Phalloplasty. Sure, my wife wanted it, but if I knew what I know now, I would have never decided to have a Phalloplasty. My Surgeon had this arrogance and gave me such little time, it pushed me into the belief that I should believe him, and because of that, I did. It reminds me of a cult where the followers start to question things, but they look around, and everyone else is so obedient and faithful that they figure it's just them. Little do they know in the background the leader is shuffling people and rumors around, so they don't eventually meet up and figure out the leader is full of shit.

The authenticity, for me, is that my arm will be handicapped for the rest of my life. It hurts to type on the computer, I can't play sports, and my hand remains swollen years after the Surgery, and it hurts all the time. Not the pulsing pain that ravages you, the "Damn, my hand hurts, and I have a hard time holding a fork to eat" type of pain. Pain that gives you a glimpse into what your body might feel like as a 100-year-old man, but just in your arm. It's depressing I can't lie.

Another predicament is nerve damage; the Surgeon cuts so deep that nerve endings are exposed, and they may never close for the rest of your life. I must wear a brace because a scrape on my forearm skin sends me through the roof with shock.

Another delicacy is that the skin I spoke about is not all that needs harvesting. Another area is used to gather more skin, usually the thigh, but it's less deep, so the scar is relatively unnoticeable. But talk about a road rash gone wild, hurts, hurts and hurts some more. The good news with this harvest sight is that the pain concedes in six weeks.

Donor site information was leapt over and lessened by the Surgeon's and surgeons' websites when you have the consultations. I encourage you to google pictures of the parts of the body and how they harvest the skin. Look at those images with both eyes open. If you are speaking with a surgeon and they minimize skin harvesting, I would be worried because this is not a walk in the park and can leave you damaged in many ways if you make the wrong decision for yourself.

Another predicament is nerve damage; the Surgeon cuts so deep that nerve endings are exposed, and they may never close for the rest of your life. I must wear a brace because a scrape on my forearm skin sends me through the roof with shock.

Are you prepared for the daily and never-ending question you will get if you leave your arm exposed, "What happened to your arm question?" You can come up with your own response. But I like to say, "Oh, I used the skin to create a penis. It doesn't work right because I was born with a vagina. But my wife wanted me to be able to penetrate her and pee, standing up. She didn't want me to embarrass her if I was ever in a gym locker with any of her friends or family. One always has to look after their reputation.

Don't you agree?

Recovery from the harvest area on the forearm is years, and from my experience, you never get the full use of your arm again, so if you choose your arm to, be prepared to look like a burn victim and be ready to have a disabled forearm for life.

So, you want to pee standing up? Who wouldn't? What a convenience to pee standing up; if I had the choice, I would pee standing up too. But think about this: going from a female urethra to a male urethra is tough. The urethra has to lengthen and run through the skin used to create a penis. Creating something in Surgery is much more complicated than cutting something off. When you make it, you create the opportunity for complications, and the Phalloplasty generates many different things at once in one Surgery. The Phalloplasty complication rate ranges between 39% - 95%. The complications vary depending on the desired penis and urethra length. My on-the-street poll for complication rates with Phalloplasty is 100%. 100% of the people I have talked to and read about have had complications.

If you google surgeons with Phalloplasty in their wheelhouse, you will be pleasantly surprised by websites bolstering 100% success rates and limited explanations of complications and risks. Do not be fooled. My inquisition question would be to ask them, "at what cost?" If I told you, "Hey bud, ride your bike 10 miles to the next town, " the probability you will get hit by a car and maimed for life is between 39%-95%. Now, you may have up to a 95% chance of getting hit, but if you hang in there and endure having Surgery up to 22 times, we guarantee that 100% you will pee standing up. Are you ducking nuts, man?

The most frequent complication of Phalloplasty urethra lengthening is Fistulas. Aw, fistulas, those little inconveniences, inconsiderate small holes that develop between where the vagina was and the new path up to the bottom of the penis. These tiny holes cause significant problems and pain; my God, the pain can be horrendous and cause severe infections and a detectable stench of urine that drains out of the holes throughout the day. Fistulas cause pain, swelling, incontinence, and the embarrassment of smelling like an infant or 100-year-old man that needs to have their diaper changed. The problem is the stench will be coming from you, and you will have to learn how to carry diapers so that you can change them several times a day. Take that as a confidence boost and an excellent intimacy motivator between you are your lovers. Sexual spontaneity will most likely be nonexistent. Good news, you might be able to pee standing up, but your fistula will dribble urine on the floor.

Last fistulas have a high probability of not being successful in Surgery. If you do need additional operations, be prepared to continue the process several times to get the issue resolved. But, in the end, you may still have to remove the urethra lengthening and re-route it back to the same place you started. Peeing will again require that you sit down. Yup, that's right, peeing sitting down. I hope you can still reach orgasm because that would be a real bummer!

Infection, hell yes! Imagine having your skin ripped and burned from your body and placed on tables where a doctor creates a male organ and re-attaches to your opened body carcass. The area where this exposed organ is being held together by stitches and gauze will be exposed to the outside elements for weeks and weeks. The wounds that need to heal are located inches from where you defecate. If you develop a fistula, urine will also meet the wound. Are you afraid of touching a bathroom doorknob? Hell, honey, hold your breath, be strong and if it gets to you to bad, break out the Xanax and don't think about it. Better yet, THINK ABOUT IT and the risks.

For weeks you will have what is called a super pubic tube; this is a tube that comes out of the side of your body, travels inside you, and is inserted into the bladder to allow your Phalloplasty to heal. Some surgeons are ok with removing it after 4-6 weeks, and some won't remove it for months and months. It's uncomfortable but the least evasive part of the Surgery. Enjoy no middle-of-the-night bathroom breaks.

Sepsis, ever heard of this medical delight? With the evasiveness of this Surgery, which is mildly covering the bases of the severity. I like to gauge the bench of a Phalloplasty as inhuman and grotesque. In any case, the odds of getting an infection are high. If you add a sepsis infection, it can knock a patient back light years in recovery. Sepsis feels like you went ten rounds with Mike Tyson in the day, and the spar ends with Bruce Lee jumping in the ring adding a roundhouse kick that catapults you back into the bed that is made up of steel nails. The least amount of movement feels like you are moving a house with your bare hands. Psychologically you feel defeated by having to change the channel on TV with a remote; it's bad guys. Sleeping is something you can forget about with irritable leg symptoms. You can look forward to the gaze of insomnia as it sets in, which leaves you feeling hopeless and lost.

Surgeons? So, what's with the surgeons that get into this field?

Let's think about that.

What part of society do we represent to people other than our friends and family? What would that say to us if we thought about facts and not how we wished our culture was? As transgender people, we are often exposed to mockery, bigotry, loathing, and judgment and treated with the lowest form of virtue. How many times can you count when you have been out and overheard a joke about the transgender community, only to watch the wine glasses click together with hilarity and approval Until? Recently, we were the red-headed stepchild of the LGBT community. The last letter in the acronym of the least accepting society in the world. Even our kind, the LGBT community rejected us, derided us and only left a crack in the door for acceptance. It has only been since Jenner that we have been revered as even a species of the human race, and that was only 5 or 6 years ago.

So, what surgeons go into this line of practice?

Don't live in the fantasy Phalloplasty land. Let yourself be in denial about the kind of person you are married to, pick up the size 30 waist jeans and convincingly tell yourself these would fit you great. But not with Phalloplasty and not with the Surgeon you choose. The people in a part of society are considered less than is protected less. Why do you think serial killers with the longest careers target and kill indigents and prostitutes? Why? Because most people don't give a shit about them. I say most because there are good people in the world, but fewer than what you think. It's human nature to act like Puranas feasting on a wounded fish in the water. That is why racism will never leave our world; it will always be there. Face it guys we are low-hanging fruit to be mistreated; know that and understand you have to protect yourself because no one else will. That includes picking a competent Surgeon.

You must ask yourself; Why would surgeons choose this type of Surgery to perform?

A general Surgeon averages a $220,000 salary a year. A specialized Cardiologist almost doubles that at $512,000. A standard appendectomy in the USA costs $21,000. A Phalloplasty with a scrotum, urethra lengthening and pump averages $85,000-$200,000, and insurance covers it now. Think of the complicated revenues from Phalloplasty alone. It might even be worth it to skimp here or there in Surgery because who's going to care? It's just a transgender person, and the additional revenue could be a plus.

You can figure out the reason why this field is selected. A surgeon that is not good at anything else can jump into this area of practice and make a fortune, be sought after, have articles written about them, and have a narcissistic personality fed like royalty. To perform this Surgery, you don't have to have any specialized education other than being a general surgeon. I can't find any medical guidelines or regulations or checks and balances. It's like the wild, wild west of Surgery.

In my opinion and experience with going through this Surgery, I believe Phalloplasty surgery should be illegal until regulations and roads are in place to assure the surgeons administering the operations adhere to a strict set of guidelines.

Since it is still legal, and there are incredible and genuine surgeons like Dr Marci Bowers <----(I would not send a sick squirl to Dr Bowers Now 2023) and Dr Peter Rapheal, (still trust Dr Rapheal 2023) you need to ask your possible surgeons questions. If your potential Surgeon is arrogant, doesn't allow you to see additional pictures of past patients, or denies a request to speak to a previous patient, move on to another that will. Ask questions like, "How many medical malpractice cases have you filed against you," not ones you have paid off, so they are not on your record. How many have been filed? Check the medical boards on your potential Surgeons license and review the superior courts where your doctor is practicing. Look up medical malpractice cases on the Surgeon you are working with; read them. Ask your potential Surgeon if they are creating the male organ themselves or if they pay another surgeon to do it. In business, subcontracting and the responsibility for issues that arise tend to be ping-ponged back and forth between the Surgeons. Who will be in the room during the operation, and who are the Doctors? Ask if a specialized arm Surgeon will be doing the work needed to harvest the skin. How much medical malpractice insurance do you have? Do you know that surgeons don't have to carry medical malpractice insurance?

Crazy huh?

In the end, if you do choose a Phalloplasty, be smart about it; you are worth it, at least I think you are. A person who endures the most life obstacles can offer society the most. Being different affords tremendous barriers, and you have a lot to show the world. You are worth a great surgeon; you are worth a great life; you are worth all your hopes and dreams. Unfortunately, most of our society will not feel the same way; it's just the facts. Protect yourself, love yourself, and count on yourself because, in the end, it's all you have.

Scott Newgent

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Jan 21, 2023

This is the very article I have been searching for. Great information. I wondered about your arm in "What is a Woman", because it was just glossed over. My niece had life-saving ostomy surgery. She ASKED the doctors what to expect. She searched for photos and asked them if that's what she would endure. They glossed over it, and told her the photos were extreme. They called the procedure a "Barbie Butt". Sounds cute, right?

She was so traumatized after surgery. In pain for months. And remember, this was not elective--she would have died from cancer if she had not had this surgery. And the doctors still lied to her. People deserve to know the truth.

Thank you, Scott.


Iris E
Iris E
Feb 14, 2022

"How many times can you count where you have been out and overheard a joke about the transgender community ?" Never. Zero. I have literally never heard people make a joke about transgender people. However, if I try to tell people about the medical experimentations and torture the state is allowing on a vulnerable population, i.e. transgender people, they tell me to shut up, that I'm a hateful transphobic bigot and all the rest. Right.


Iris E
Iris E
Feb 14, 2022

If you're smart about it, you DON'T choose it AT ALL. This SHOULD be illegal, as you say. The state should not allow doctors to perform medical experiments on people, much less a vulnerable population. The state must protect people from this medical abuse. It's the height of cruelty and irresponsibility to subject people to lifelong disabilities and to let taxpayers be stuck with the bill for the enormous costs associated with the monstrous mutilations that are called "transgender medicine."


Scott Newgent

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