Four years ago, in a fluorescent-lit dissection lab in Gothenburg, Sweden, a hand-picked team of skilled surgeons and researchers specializing in transplant and gender-affirmation surgery gathered around a table draped with green medical paper to gaze in awe at the thing they’d just removed from the cadaver in the room.
Laying on the table like a chewed-up dog toy was a disembodied flaccid penis. It was accompanied by parts most of us never see: the urethra, some major blood vessels, a bundle of dorsal nerves, the crura of its corpora cavernosa and its corpus spongiosum, all embedded within a thick chunk of skin, fat and fascia that had been removed from the cadaver in much of the same way you might remove a plant from its soil to repot it.
In the medical community, the thing on the table would be referred to as an “en bloc explantation of male genitalia,” but to the team gathered around it in the room, it was a piece of history. The liberated penis was the first to have ever been dissected from a cadaver for the purposes of transplanting it onto a cisgendered female body (also deceased) — a pioneering step forward in the advancement of gender-affirmation bottom surgery for trans men.
If you know anything about the phalloplasty (the type of bottom surgery that involves constructing a penis), you might have some idea why there’s a growing need for disembodied, transplantable penises like the one above. Available phalloplasty methods like radial forearm flap phalloplasty and metoidioplasty are good for manufacturing a penis out of existing tissue on a person’s body, but they cannot, in their current state, fashion one that ejactulates or gets hard on its own. They’re also not particularly sensitive to touch, and as prominent gender reassignment surgeon Sherman Leis tells me, they can be extremely difficult to make. This is especially true when it comes to extending the urethra, a process that can be both painful and have many complications.
“The currently available techniques for penile reconstruction aren’t satisfactory for the entire trans male population,” says Gennaro Selvaggi, the transplant surgeon who performed the penis dissection and directs Sahlgrenska University Hospital’s Transgender Surgery Program. “Although some men who choose conventional techniques like radial forearm flap phalloplasty are happy and reduce their gender dysphoria, many others don’t go for penile reconstruction at all because they don’t believe that currently available techniques could give them optimal results.”
That’s perfectly fine if you’re a trans guy who doesn’t want bottom surgery or is satisfied with what options are currently available, but if you’re anything like Ianthe9, a redditor who commented on a discussion thread I started about Selvaggi’s procedure on r/FTM, you live for the day that a better option comes along. Something, perhaps, like a penis transplant. “I’ve been saying I’ve been waiting for phallo to get to the point of being able to John Bobbitt something, and here it is,” he says. “I don’t want phallo at its current state because of the graft and the urethral issues, so if this solves both of those, sign me the fuck up.”
According to the 2018 study Selvaggi and his team published about the dissection in BioMed Research International, a transplanted penis would, indeed, solve both of those problems. The question is, what new problems might it provoke?
For starters, the process of obtaining a transplanted penis would likely be the same as any other transplanted organ, meaning it would (probably) come from a deceased person and recipients would have to be placed on a waitlist that they’d stay on until one that matched their blood and tissue type became available.
A slight problem remains, though: Just like with other transplants, you wouldn’t necessarily get your pick of the litter. That’s rarely an issue with internal transplants like livers and kidneys, but when it comes to organs with an external portion — particularly one that’s constantly being judged for its beauty or lack thereof — how it looks might actually matter. If a penis is something you’ve wanted all your life but the one you get isn’t the shape, size or skin tone you envisioned, it’s possible you might not be too happy with the results. “If you’re 5-feet tall, you’re probably not going to want a foot-long penis,” says Leis. “But I’d imagine you’d have to take what you can get.”
On the other hand, you might be like Logan, a 29-year-old hairdresser in L.A., who says he’d just be happy to have a penis at all. “I don’t give a shit what my penis looks like,” he says. “If having my own, functional dick means that dick is 10 shades lighter than my skin, so be it! I’ll be like Michael Jackson, just with vitiligo of the peen. A penis is a penis, and I’d be grateful to whoever donated me theirs.”
In that vein, you also don’t get to pick who your penis was attached to. Again, not a dealbreaker for other donated organs like tendons and lungs, but for many people, trans or otherwise, penises hold a different cultural and symbolic weight. To many people, they’re tube-shaped stand-ins for masculinity, not all forms of which are particularly redeeming or friendly to the trans community. “What kind of life did my dick-donor lead?” ponders maybebenji in the Reddit discussion before he launches into a thought-provoking musing on the unknowable origins of transplanted dongs. “It’d be ironic if a transphobe had their dick removed post-mortem and given to a trans guy. They signed up to be an organ donor but didn’t specify which organs and who to.”
“I’d love to have a transphobe’s dick,” adds BlorpusChristie. “I bet I’d get way more pussy than the guy who had it before.”
What, too, of the age of the donor? Will transplants be getting what maybebenji describes as “grand-dad dicks”? What about the person’s sexual experience level? Would it be possible that the donor is a virgin but the recipient is not? “That’s so strange,” maybebenji writes. “Now I can’t stop thinking about how if I got this surgery, I wouldn’t know where my dick has been. I was thinking this is cool, but now I’m thinking about how uncomfortable I’d be with another man’s dick attached to me.”
On a medical level, the possibility of transplant rejection is a problem as well. Recipients would have to be blood- and tissue-typed to match their donors, and they’d have to take immunosuppressants for the rest of their life, something that can be extremely risky as it opens the door to all kinds of opportunistic disease like cancer and pneumonia. “Immunosuppressants ruin your immune system,” says Leis. “People take them for heart or kidney transplants because they’ll die without a donated organ, but when the situation isn’t life-or-death, it’s usually not worth it to be on them.” (Though it’s worth mentioning that surgical transitions are actually life-and-death for some trans folks — the depression and body dysphoria that often accompany having a gender identity you feel is incongruent with your anatomy can dramatically increase the risk of suicide. But yeah, immunosuppressants do suck.)
“Lifelong immunosuppressants will make it a big no for me,” says antiquedoge, echoing the sentiment of most of the people involved in the discussion. “It’s not worth it if you can avoid it.” Imsorryforallofit agrees: “LMK when they’re researching growing dicks from my own tissue because there’s no way I’m taking transplant pills the rest of my life.”
Meanwhile, other trans guys like Logan and EscapeInDarkness don’t really care how it looks, where it came from or what kind of drugs they have to take. They just want a dick, ideally one that gets hard. “Personally, I’d gamble with death for maybe just a couple of good months where I can feel 100 percent okay with myself,” says EscapeInDarkness.
“I’ll take any pill you want me to, I just want to be able to get an erection,” echoes Logan.
Thankfully for them, transplanted penises would be rarin’ and ready to go (hopefully). Since the procedure would connect nerves and major blood vessels from the transplanted penis to the those of the recipient’s body, sensation would be normal and erections would be possible. In fact, in the only permanently successful penis transplant to have ever taken place (between a cis male donor and a cis male recipient in South Africa), the recipient was able to achieve natural spontaneous erections, and even got his partner pregnant. So far, Selvaggi’s method doesn’t include structures relevant to sperm and semen production, so transplants wouldn’t be fertile or be able to ejaculate, but they would be able to perform most of a penis’ executive functions.
Which brings up yet another interesting question: What if you just didn’t like your dick? Gender identity totally aside, what if you had a penis, it irked you for some reason, and you simply wanted a new one? Wouldn’t it be possible to perform this very same procedure on Any Man™ for the esteemed purposes of penile self-confidence?
Funny you should ask. In addition to the one mentioned above, two other known penis tranplants have taken place (also on cis men), but all were surgical reconstructions following physical trauma. So far, zero penis transplants have been conducted on a man who just didn’t like the way his Johnson looked, but Selvaggi says that if his procedure ever makes it into operating rooms, it would be perfectly possible to accommodate that request.
Whether or not that’s ethical is up for discussion, but for the moment, that’s beside the point. Surgical penis replacements are so far from being a hospital menu item that no one’s even debating their ethics yet, and Selvaggi says the procedure has to go through clinical investigations to see if it’s even safe for human patients to undergo. Not to mention, since there’s currently no one bankrolling the necessary further research that would speed up that process, the whole thing is going to take some time.
Still, the ramifications of a technique like that aren’t to be understated. We’re talking about a surgery that could apply a penis to anyone who wanted one, a technique that, up until a few years ago, seemed more sci-fi than science. What would the world be like if everyone was happy with their penis, or at least happier than they are now? Might we have less depression? Less shame? Less performance anxiety? Less transphobia? Less anger misdirected at others over body issues?
None of these questions are answerable today, but when I pose them to Logan, a total non-authority on the topic, he comes back with this: “I don’t have a penis now, but I know what it’s like to feel incomplete without one. I know I’d be a happier, more sane person if I felt all my body parts were intact, and I know many, many men who feel a different penis would allow them to be, too.”
Nevertheless, Leis is skeptical about penis transplants, and, dare I say, unimpressed. “You can transplant anything from one cadaver to another,” he says. “It’s a cadaver, so how do you know it’s going to function? Until you do it on an animal — probably a rat or a monkey — you don’t know what sort of immunological situation you’re dealing with, nor can you be sure you’ve connected all the nerves and blood vessels in a way that’ll ensure the promised results.”
Plus, he adds, no one’s ever been able to transplant the tiny blood vessels that emanate from the hip bones to vascularize the penis. That would involve transecting and transplanting parts of the cadaver’s hip bones into a recipient, then sewing together a fine, mesh-like network of nearly microscopic vessels.
A much better option that’s also on the horizon, he says, are stem-cell injections shot directly into the neophallus (the surgically constructed penis that comes from a phalloplasty) or even a 3-D printed penis made from a person’s own tissues. But for those still hooked on transplants, there’s also some promising research being conducted on a specialized medical bath that would strip donated organs of their cells, leaving behind a tissue scaffold that could be seeded with human stem cells from the patient in need. This would prevent their body from rejecting the organ, and allow them to live on with their transplants sans immune-suppressing drugs.
If a technology like that made a penis transplants safer and more effective, even Leis says he’d gladly integrate them into his practice. “As long as it’s possible to construct a pretty good, aesthetic-looking penis using a transplant, a certain percentage of trans guys will be happy to have the procedure, and I’ll be happy to do it for them,” he says.
And when that day comes, it’ll be as Logan says, “One small penis for man, one giant penis transplantation for mankind.”