Gender-Affirming Genital Masculinization: Part 3 of the Plastic Surgeon's Perspective of Gender-Affirming Surgery.

Over the last few decades, great strides have been made in surgical techniques and access to care for transgender and nonbinary individuals. An important step for many transgender patients is the ability to undergo masculinizing bottom surgery. This allows improved alignment of physical appearance with gender identity and improvement in symptoms of gender incongruence. The main options involved in transmasculine bottom surgery are metoidioplasty and total phalloplasty. The surgical decision is adapted to the patient and their preferences along with the clinical opinion of the provider. While bottom surgery is complex and may require multiple operations, gender-affirming surgery decreases rates of gender incongruence, depression, and suicidality, and significantly improves quality-of-life measures.