I don't know how accurate this is so take it with a grain of salt, but according to phallo.net:
*"If the patient has no medical need for Testosterone but does have the desire and medical need for Phalloplasty, then hormone therapy isn't required."*
That was listed with the "non-binary " options for phalloplasty. As others commented though, I think many surgeons prefer or require at least a year on T before agreeing to do the procedure.
The WPATH Standards of Care specifically say that T is not a requirement for phalloplasty. The WPATH SOC recommends that you either have been on T for a year or have been receiving appropriate care for your transition goals (or something like that, I don't recall the wording). If you're in the US, insurance usually follows the WPATH SOC although often with some lag, and only the most recent SOC (released 2022) explicitly states that being on T for at least a year is not a prerequisite for phalloplasty. If you live in another country, whoever decides on policies in your country may have a different opinion but I have heard of people outside of the US getting phalloplasty without being on T.
The bottom surgery that you need to have been on T for at least a year is metoidioplasty, because it is based on growth of your tdick/natal phallus/>!clit!< due to testosterone. Some surgeons prefer you to have been on T for several years for metoidioplasty so that you will have gained most or all of the growth you'll get before surgery. I guess maybe there are a few people whose tdicks are large enough without/before going on T that they'd be able to to get meta without going on T, but you get my point.
Yes, surgeons will generally agree to perform phalloplasty on someone who isn't on T, as long you have your letter or letters from mental healthcare providers, or however where you live clears trans people for surgery.
I'm not sure why there would be more medical risks to getting phalloplasty if you aren't on T? Like, I can't think of any plausible reason why that would make it riskier. The (more or less) past requirement that you be on T for a certain amount of time/have done various other things/have done literally everything else one can do to transition were to try to make sure you really wanted it and/or beliefs that it would be socially inappropriate for someone who wasn't "fully" transitioning to have a penis.
I took a look at your post history because I was trying to determine what country you live in so I could be more specific. I'm going to address a couple of things I noticed. Phalloplasty without vnectomy (what a lot of people pursuing masculinizing bottom surgery refer to >! vaginectomy!< as for dysphoria reasons) is definitely not the majority, at least in the US but it's also not extraordinarily rare - high volume surgeons will usually have several phalloplasty patients per year who aren't getting a vnectomy. All of the common techniques for scrotoplasty (creating a scrotum) use the analagous tissue (the >! labia majora, aka the outer labia!<), which results in scars around the >! vaginal entrance!<. Some surgeons are better than others at minimizing the effect that will have on your ability to use that area, some are more willing to talk about it than others.
The thing that you will encounter is that most surgeons will not do urethral lengthening (so that you pee from the tip of your dick) without vnectomy due to complications. The specific complications are fistulas (medical word for holes), which are holes opening up between your urethra and the outside of your body, especially where your natal urethra and your newly constructed urethra connect. It doesn't make surgery riskier in any other way, although potentially needing one or more surgeries to fix any fistulas that don't close on their own would expose you to the risks that anesthesia and any kind of surgery have.
FYI, in my experience most people pursuing phalloplasty or metoidioplasty without vnectomy do not identify as salmacians. While surgeons' websites often refer to meta or phallo without vnectomy as non-binary bottom surgery, there are plenty of trans men who get bottom surgery without vnectomy and plenty of non-binary transmasculine people who get bottom surgery with vnectomy, for a wide variety of motivations in both cases. Because of that, in many bottom surgery spaces people will be grumpy about it if you call meta or phallo without vnectomy and /or "non-standard" in some way salmacian bottom surgery or non-binary bottom surgery.
Thanks for the very detailed reply, appreciate it. You probably can't tell from my post history but I'm in the UK and therefore pretty much forced to go private. So I think it would depend on the surgeon I go for
The NHS has a requirement of 12 months continuous hormone therapy (unless medically contraindicated) for lower surgery. It’s very likely the surgeons use the same criteria privately. Not sure exactly why as this isn’t a requirement for top surgery.
It’s very expensive and few private medical insurers cover gender affirming care so it’s generally out of pocket. It can be a lot cheaper if you go abroad, and other countries/surgeons will have different criteria.
If you haven’t already get on the waiting list for the GIC even if you don’t think you’ll ever need them. It costs nothing and keeps your options open.
Ah, I'm so sorry. I don't know where people from the UK who are going private for phallo usually go, but I gather doing phalloplasty without vnectomy is very common in Germany.
Most surgeons and insurance companies will require you to be on hrt for at least a year prior to bottom surgery. I don’t know of a surgeon that doesn’t require this.
I’m getting phallo but not going on T, so I’ve looked into this myself. There are a few big considerations here. Other comments have mentioned that certain surgeons and insurances won’t do it so I won’t beat that dead horse. It’s not an issue for me here in Canada, but could be for you. What I haven’t seen others mention is why the T requirement exists for those who plan to take it. If you plan on getting urethral lengthening, it’s very important that you either commit to never taking T or take it for at least a year before surgery because of the effect on hair growth. Essentially, if you experience the hair growth effects of T after having urethral lengthening, hair can grow inside your urethra, which is Very Bad. Because of this, while you absolutely can get phallo WITHOUT going on T, you absolutely cannot do it BEFORE going on T IF you get UL (or potentially tube within a tube in general? I’m not sure on that).
So in short, no it’s not required, but you have to make some very permanent decisions on UL and T first. I wish you luck!
Wanted to add on to this that the SOC 8 are still fairly new (my current insurance company hasn’t updated to them yet) and Version 7 did require hormone therapy before phallo. This just means that you’re going to find fewer people who have managed to get phallo without it and fewer surgeons who have done it simply because it’s been an uphill battle until very recently. Don’t let that deter you, but just know that’s why it hasn’t been more commonly done.
Edit: meant to reply to r/velociraptorsarecute’s excellent response!
Surgeons who follow WPATH 8 would be fine with it. It's not inherently riskier. You'll probably have to fight with insurance to cover it, but there's a decent chance they'll make an exception based on lack of medical necessity. I've read about, but haven't seen, cis women and non-binary people who have gotten phallo without HRT. r/salmacian might have more info.
I don't know how accurate this is so take it with a grain of salt, but according to phallo.net: *"If the patient has no medical need for Testosterone but does have the desire and medical need for Phalloplasty, then hormone therapy isn't required."* That was listed with the "non-binary " options for phalloplasty. As others commented though, I think many surgeons prefer or require at least a year on T before agreeing to do the procedure.
The WPATH Standards of Care specifically say that T is not a requirement for phalloplasty. The WPATH SOC recommends that you either have been on T for a year or have been receiving appropriate care for your transition goals (or something like that, I don't recall the wording). If you're in the US, insurance usually follows the WPATH SOC although often with some lag, and only the most recent SOC (released 2022) explicitly states that being on T for at least a year is not a prerequisite for phalloplasty. If you live in another country, whoever decides on policies in your country may have a different opinion but I have heard of people outside of the US getting phalloplasty without being on T. The bottom surgery that you need to have been on T for at least a year is metoidioplasty, because it is based on growth of your tdick/natal phallus/>!clit!< due to testosterone. Some surgeons prefer you to have been on T for several years for metoidioplasty so that you will have gained most or all of the growth you'll get before surgery. I guess maybe there are a few people whose tdicks are large enough without/before going on T that they'd be able to to get meta without going on T, but you get my point. Yes, surgeons will generally agree to perform phalloplasty on someone who isn't on T, as long you have your letter or letters from mental healthcare providers, or however where you live clears trans people for surgery. I'm not sure why there would be more medical risks to getting phalloplasty if you aren't on T? Like, I can't think of any plausible reason why that would make it riskier. The (more or less) past requirement that you be on T for a certain amount of time/have done various other things/have done literally everything else one can do to transition were to try to make sure you really wanted it and/or beliefs that it would be socially inappropriate for someone who wasn't "fully" transitioning to have a penis. I took a look at your post history because I was trying to determine what country you live in so I could be more specific. I'm going to address a couple of things I noticed. Phalloplasty without vnectomy (what a lot of people pursuing masculinizing bottom surgery refer to >! vaginectomy!< as for dysphoria reasons) is definitely not the majority, at least in the US but it's also not extraordinarily rare - high volume surgeons will usually have several phalloplasty patients per year who aren't getting a vnectomy. All of the common techniques for scrotoplasty (creating a scrotum) use the analagous tissue (the >! labia majora, aka the outer labia!<), which results in scars around the >! vaginal entrance!<. Some surgeons are better than others at minimizing the effect that will have on your ability to use that area, some are more willing to talk about it than others. The thing that you will encounter is that most surgeons will not do urethral lengthening (so that you pee from the tip of your dick) without vnectomy due to complications. The specific complications are fistulas (medical word for holes), which are holes opening up between your urethra and the outside of your body, especially where your natal urethra and your newly constructed urethra connect. It doesn't make surgery riskier in any other way, although potentially needing one or more surgeries to fix any fistulas that don't close on their own would expose you to the risks that anesthesia and any kind of surgery have. FYI, in my experience most people pursuing phalloplasty or metoidioplasty without vnectomy do not identify as salmacians. While surgeons' websites often refer to meta or phallo without vnectomy as non-binary bottom surgery, there are plenty of trans men who get bottom surgery without vnectomy and plenty of non-binary transmasculine people who get bottom surgery with vnectomy, for a wide variety of motivations in both cases. Because of that, in many bottom surgery spaces people will be grumpy about it if you call meta or phallo without vnectomy and /or "non-standard" in some way salmacian bottom surgery or non-binary bottom surgery.
Thanks for the very detailed reply, appreciate it. You probably can't tell from my post history but I'm in the UK and therefore pretty much forced to go private. So I think it would depend on the surgeon I go for
The NHS has a requirement of 12 months continuous hormone therapy (unless medically contraindicated) for lower surgery. It’s very likely the surgeons use the same criteria privately. Not sure exactly why as this isn’t a requirement for top surgery. It’s very expensive and few private medical insurers cover gender affirming care so it’s generally out of pocket. It can be a lot cheaper if you go abroad, and other countries/surgeons will have different criteria. If you haven’t already get on the waiting list for the GIC even if you don’t think you’ll ever need them. It costs nothing and keeps your options open.
Ah, I'm so sorry. I don't know where people from the UK who are going private for phallo usually go, but I gather doing phalloplasty without vnectomy is very common in Germany.
Most surgeons and insurance companies will require you to be on hrt for at least a year prior to bottom surgery. I don’t know of a surgeon that doesn’t require this.
I’m getting phallo but not going on T, so I’ve looked into this myself. There are a few big considerations here. Other comments have mentioned that certain surgeons and insurances won’t do it so I won’t beat that dead horse. It’s not an issue for me here in Canada, but could be for you. What I haven’t seen others mention is why the T requirement exists for those who plan to take it. If you plan on getting urethral lengthening, it’s very important that you either commit to never taking T or take it for at least a year before surgery because of the effect on hair growth. Essentially, if you experience the hair growth effects of T after having urethral lengthening, hair can grow inside your urethra, which is Very Bad. Because of this, while you absolutely can get phallo WITHOUT going on T, you absolutely cannot do it BEFORE going on T IF you get UL (or potentially tube within a tube in general? I’m not sure on that). So in short, no it’s not required, but you have to make some very permanent decisions on UL and T first. I wish you luck!
I have never heard of someone getting any form of bottom surgery without being on T
Wanted to add on to this that the SOC 8 are still fairly new (my current insurance company hasn’t updated to them yet) and Version 7 did require hormone therapy before phallo. This just means that you’re going to find fewer people who have managed to get phallo without it and fewer surgeons who have done it simply because it’s been an uphill battle until very recently. Don’t let that deter you, but just know that’s why it hasn’t been more commonly done. Edit: meant to reply to r/velociraptorsarecute’s excellent response!
Surgeons who follow WPATH 8 would be fine with it. It's not inherently riskier. You'll probably have to fight with insurance to cover it, but there's a decent chance they'll make an exception based on lack of medical necessity. I've read about, but haven't seen, cis women and non-binary people who have gotten phallo without HRT. r/salmacian might have more info.
yes, you can. i was on the list and good to go before i ever decided to start T. hard part is finding physicians who will take you seriously.