Which bottom surgery GRS technique should I choose?

Dr. Bowers performs a Simple Metoidioplasty (SM)and the Ring Metoidioplasty (RM). She does not perform Phalloplasty.

  • The Simple Meta creates a penis from local testosterone-enlarged tissue but does not include urethral lengthening. It is good for thin-to-medium build guys who seek a near complication-free procedure that looks great, is inexpensive (less than $6k) can be used for penetration, retains full sensation and allows GRS completion for documentation changes. It is also completed entirely as an outpatient.
  • The Ring Meta  IS NOT BEING OFFERED AT THIS TIME.  It offers similar results but with the advantage of allowing guys to stand to pee through their new equipment. The disadvantages of the ring meta are that it is a much more difficult procedure to perform, more expensive (less than $17k) and runs the risk (20%) of fistulae (leaks) or stricture (narrowing)  which require at least one more additional procedure to fix .Good news is that the leaks can be fixed, if present, without charge at Scrotoplasty, which is offered after 3 months recovery. It is also performed as an outpatient.
  • Phalloplasty is still the best GRS procedure for gentleman that are heavy/stocky with significant pelvic/pubic fat (which would obscure the more modest meta results), despite the disfigurement of the donor site.  Our office does not yet perform phalloplasty. Phalloplasty is very expensive (30k), requires hospitalization and also has significant associated potential complications.

Can I have the Simple Metoidioplasty now, and the urethral lengthening later?

Phalloplasty following metoidioplasty is possible. Urethral lengthening for a SM is not likely due to the trimming of labia minora which accompanies SM leaving little tissue to accomplish the urethral lengthening later. Better to do the RM first if standing to urinate is an important goal.

What types of hysterectomy are offered?

Bay Area RH offers the following Hysto types, all come with BSO (ovary and tube removal):

  • Abdominal Hyst-BSO: Conventional. Leaves an abdominal scar and longer recovery. Allows excellent visualization of pelvic structures.
  • Vag Hyst-BSO: Entirely vaginal approach. The ultimate minimally invasive hysterectomy. NO incisions. Not always possible to perform.

Will insurance cover my Hysto? Metoidioplasty?

As of 2014, all insurers in California are required to cover transgender-related surgeries as part of their health Plans. Similarly, the US is seeing ever more insurers cover trans surgery. Some have caps in coverage altho all of our FTM procedures are covered and price well under any cap. Janet can check benefits. Our office will completely pre-authorize insurance coverage so that no patient is required to pay in full up front if covered by insurance. Thanks to HRC who require corporations to cover trans surgery in order to receive a 100% corporate rating.


What length can be achieved with a metoidioplasty?

Normally, the phallus/clitoris will grow in response to testosterone. Usual length for guys is 3-8 cm with an average of 4-5 cm. You can determine how much length you will have with a Meta by measuring from the front of the pubic bone to the tip of the clitoris/phallus. Once freed from the labia minora, this length is often substantial and enough for some — but not all — guys.

How soon can I have sex after Meta?

Typical man, asking about sex. 4 – 6 weeks

Can I have receptive (vaginal Intercourse) after Simple Meta? Ring Meta?

Yes, both procedures can allow receptive intercourse. This should be a part of your decision-making and discussion pre-operatively with Dr. Bowers. The RM does include some narrowing of the vagina due to its use in the urethral lengthening but can be minimized or maximized, depending upon future wishes for the canal.

Can Vaginectomy be performed at the time of Metoidioplasty?

Dr. Bowers currently does not offer Vaginectomy. We anticipate re-offering this surgical procedure as part of either hysterectomy or metoidioplasty following our August 2014 trip to Belgrade.

Will leaving the vagina increase my chances of fistula?

No, this opinion attributed to one surgeon is not based upon any knowledge of our metoidioplasty technique. The only fistulae we see are distal and well away from the vagina.

Do I need to undergo hysterectomy prior to having a meta?

No, this is not strictly necessary altho the RM can narrow the vagina making paps and access to the cervix difficult.

Can I deliver a baby vaginally after Meta?

Yes, although this should be discussed prior to agreeing to Meta so that your results accommodate your future plans. Still best to complete childbearing before undergoing Meta.

Can I get Testicle implants (Scrotoplasty) at the time of Meta?

Yes, this is possible with the SM only or with Hysterectomy. With the RM, we cannot do scrotoplasty at the same time so ask that it be staged at a 3-month interval after RM. Fistulae, if present, can also be fixed at this surgery (without additional cost).

Can I get a Meta at the time of Hysto?

Yes, absolutely — this is commonly scheduled as a combined procedure.

How do I purchase DiHydrotestosterone? I have heard it is better for trans male penis growth.

A: Strategies to increase the size of the phallus in trans guys beyond testosterone are suctioning, traction or, some say, use of dihydrotestosterone (the active form of testosterone) applied directly to the phallus. Whether any or all of these strategies do work is subjective and has not been quantified, to my knowledge but, anecdotally, all can be of benefit.


FTM Hospital Stay (for patients having Hyseterectomy with or without Metoidioplasty)

1. Q: Are family members allowed to stay with me in the hospital?

1. A: Yes! Mills-Peninsula allows visitors during regular visiting hours (8 AM-8 PM) but does allow a single friend or family member to remain in the room with our patients. You will be allowed to sleep in the room in a window seat type bed—not exactly Ritz-Carlton accommodations but adequate for most.

2. Q: How convenient is it to find Dr. Bowers office/Hospital?

A: In 2014, we have moved to our new office location at 345 Lorton Avenue, Suite 101, Burlingame, CA. This will put both Mills-Peninsula Hospital and our office within 10 minutes of SFO by car/taxi.

3. Q: What are my transportation options while in the Bay Area?

A: Taxi service with Burlingame Taxi Service (650-245-0389), Luxor Cab (650-344-1455), and Broadway Taxi Cab (650-200-6378 are options for getting to and from Dr. Bowers’ office and the Hospital. There are also numerous quality rental car options in Burlingame if you do not wish to rent at the airport.

4. Q: Does Mills-Peninsula have Wi-fi?

A: Yes, absolutely.

5. Q: How is the food at Mills-Peninsula?

A: The hospital kitchen actually has a chef. The menu is completely a la carte and unlimited. Not that our hospital food is gourmet but, as hospital food goes, it is very good.

6. Q: Will the hospital staff be sensitive to my needs?

A: Dr. Bowers has worked very hard to gain the respect of the staff—it shows. The staff like us and we like and appreciate them. They adore working with our patients and, with rare exception, will treat you with kindness. Diversity is our strength—hey, it’s the Bay Area!

7. Q: What is your current after care facility?

A: At present, we do not have an aftercare facility per se. This will change soon but, for now, patients will can stay in any of several local hotels which offer discounts. The Staybridge Suites is a great option, and we have many other hotels in the area for you to choose from.  We provide a list and instructions on how to get the discounted rates, as part of your pre-operative packet.

Frequently asked Questions: Follow-up and after care

1. Q: Do I need a gynecologist following GRS or will my primary care doctor be sufficient?

A: The best advice is to continue to see the provider with whom you have had a long and trusting relationship. If specialty care is needed, referrals can be made. Some patients prefer to see a GYN once GRS is completed. GYN’s are generally more comfortable with post-surgical care but seeing a GYN following surgery is not automatic.

2. Q: When should I see my doctor following surgery?

A: 4 weeks normally, unless problems arise.

3. Q: What happens if my primary care doctor has questions after seeing me?

A:  Call us, by all means. We are here to help.

4. Q: What if I have problems after GRS? Questions?

A: For problems, Dr. Bowers and Robin will provide you with their respective cell phone numbers located at the bottom of your discharge instructions prior to departing the hospital. Texting has become our standard method of communicating for each of us due to time constraints. You may also call although this we would ask be in the unlikely event of an emergency. Michelle is also a valuable resource and a great source of reassurance in the clinic if you have any concerns during business hours. We normally hear from very few patients following surgery so please! Communicate with us if you have concerns of any kind. We are with you all the way! 911 is always a last resort, of course, but true emergencies are as rare as being paid in pennies, gold coins or Silver Certificates.

Where can I find a therapist? Primary care doctor?

Robin maintains an active data base of mental Health professionals and primary care physicians/providers. Most medium to large size cities across the US now have trans friendly professionals who can assist in either mental health support or for patients needing general care prior to and after surgery.

Does Dr. Bowers perform chest surgery for FTM patients? If not, can she recommend someone?

Dr. Bowers does not perform chest surgery. She recommends the following surgeons:

Does Dr. Bowers Perform Phalloplasty?

She does not. Recommended surgeons for this procedure are as follows:

Dr. Bowers recommends the following surgeons for the Ring Metoidioplasty:

  • Dr. Djordjevic, Serbia
  • Dr. Meltzer, Scottsdale, AZ

I recently inherited a substantial sum of money. Are there charitable organizations that Dr. Bowers recommends?

Yes! And thank you. Depending upon one’s income level, charitable donations, the lifeblood of any non-profit organization, can cost individuals less than .35 on the dollar. Dr. Bowers serves on the national board of directors of GLAAD ( http://www.glaad.org/tags/donations) and TLC (Transgender Law center-http://transgenderlawcenter.org/donate-). She also recommends donations to the Southern Poverty Law Center (anti-hate organization), Lambda Legal and The Jim Collins Foundation (which provides surgery funding for Transgender individuals requiring financial assistance)


My family came to accept me gradually and credited shows like “Sex Change Hospital” for helping them to understand. Will Dr. Bowers be doing any more television shows?

Dr. Bowers has been approached by literally scores of media organizations looking to develop trans programming with her as the lead character. Dr. Bowers though emphasizes her role as physician and surgeon first but is currently planning another upcoming show with the creators of SCH. She also continues to offer expert commentary when asked by news media organizations.