He Wanted Male Genitals. Getting Them Would Take Years

As Benjamin Simpson describes it, the realization came like a thunderclap. "[Expletive]! I’m trans! I gotta go!" It's what he shouted to the friends he was having drinks with in Manhattan in 2015, an understanding that came after years of probing "why something in his life always felt off," as Jamie Lauren Keiles writes in a lengthy piece for the New York Times. Keiles' focus is on the final step of the transition that followed: phalloplasty, the surgery that constructs a penis, and one that is increasing in popularity, with at least 1,100 completed in the US in 2019. Keiles recounts how a 2017 incident in a bar's men's bathroom—Simpson's transition had included "top surgery" by this time—convinced him that what he would gain in safety by having a penis would make up for "any complication that would arise, including dying."

It's a serious commitment. Keiles explains that phalloplasty isn't one surgery but a series of them, and the procedures that make up that series are unique to the patient and his goals in four areas: being able to urinate standing, aesthetics, erectile function, and sensation. In Simpson's case, four stages would see the penis created, the neo-urethra constructed, and the erectile implant put in place. That meant a two- to three-year timeline, and not an easy one. Keiles describes him living "for more than seven months with his penis splayed open" like a "hot-dog bun" and spending "a month at half-staff" following the implant surgery. The complications rates are thought to be staggeringly high (as much as 70%), but so are the initial satisfaction rates. (Read the full story for much more, including a recounting of the world's first known gender-affirming phalloplasty.)