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A: No, it's a lot expensive. Top surgery alone can run upwards of $7000. Bottom surgery, depending on the type and the surgeon, can run into the tens of thousands of dollars.
Q: Aha! Bottom surgery! That's like where they make you a penis, right?
A: Well, yeah. But it's more than that. Often times it also includes a hysterectomy, oopherectomy (removal of ovaries), and either a total vaginectomy or a simple vaginal closure.
Q: So, just how realistic is it?
A: Not very. The three options available aren't exactly great. The one most people think of first is called a phalloplasty, where skin and muscle tissue is harvested from another area of the body and used to shape a crude phallus. It's non-functional, and requires a penile implant like those used for impotent genetic males to achieve an erection. Silicone testicles are also implanted. As far as realism goes, it's about as realistic as super-gluing an Oscar Meyer weiner to your crotch. The next option available is known as a metoidioplasty. While on testosterone therapy the clitoris grows into a small phallic structure, and this is what the surgeon utilizes in this instance. The clitoral suspensory ligaments are detatched, releasing additional length from within the pelvic region. The surgeon then uses the available tissues from the labia minora to add some girth to the neo-phallus, and as with the phalloplasty silicone testicle implants are inserted into pouches crafted out of the labia majora, which are sutured together to form a sort of scrotal sac. Again, the phallus is non-functional, but unlike the phalloplasty, the meta is sexually responsive, and fully erectile. In some cases, enough length is achieved to allow penetration. The third option is a form of metoidioplasty known as the Centurion. This surgery, developed and performed exclusively by Dr. Peter Raphael and his assistant, Dr. Tex McFadden in Plano, Texas. Drs. Raphael and McFadden are able to achieve more girth and length than in a standard meta. In all three surgical options, the urethra can and usually is lengthened to allow the patient to urinate standing through the new phallus.
Q: Wow. That's alot to put yourself through. Is it really worth it?
A: To feel at home in your own body? Absolutely.