Surgeons create penis for transgender man, 28, using skin from his forearm that allows him to urinate and orgasm

June 29, 2018  23:42

Surgeons have created a penis for a transgender man using skin from his forearm - allowing him to feel full sensation of the organ.

According to The Daily Mail, Elijah Stephens, 28, was assigned female at birth but started transitioning to male at 18, having 'always felt different'.

Ten years ago, the process was much more taboo in America - a cash-only affair done on the fringes of medicine. But in 2016, a policy change meant gender-reassignment could be covered by Medicare and Medicaid.

In February, Stephens, who recently got engaged to his long-term girlfriend Alicia, became the first person to undergo the operation in New Jersey, and one of a growing number across the United States.

Four months later everything is working well: he has perfected the art of standing to urinate and even achieved an orgasm via nerves connected to the clitoris. 

The next step will be to implant a pump so he can achieve an erection.

'For me, it's the thought of wholeness – to be complete. When I looked at myself in the mirror, there were parts missing,' Stephens said. 

'Thanks to Dr [Jonathan] Keith, I feel whole.'  

The operation was performed at the Saint Barnabas Medical Center in Livingston, New Jersey in February - the inaugural operation for the new team of surgeons at the Rutgers Center for Transgender Health, which launched on January 1, 2018.

It was conducted by Dr Jonathan Keith, founder of the center, who is an expert in microsurgery - or, as he puts it, 'moving skin from one part of the body to another'. 

He started his career with a seven-year residency in one of the nation's most respected plastic surgery programs at the University of Pittsburgh, where one of his first training operations was a vaginoplasty.

In 2012, slightly ahead of the curve in the US, he went to Ghent, Belgium, to train with esteemed gender-reassignment surgeon Stanislas Monstrey, who wrote the only so-called 'textbook' on the principles of transgender surgery in 2007.

By the time Dr Keith returned to the US to join Rutgers New Jersey Medical Center, the wave to recognize gender-reassignment surgery as a mainstream procedure was on the cusp of gaining momentum.

In fact, as soon as he came back, his colleagues already had a backlog of calls from people wanting him to perform top and bottom surgery - including one from Stephens.

'Elijah called my partner Edward Lee in 2012, before I had even come back from Ghent asking if he could perform this surgery. Edward said "no, but I know someone who can".'

Stephens said he found Dr Lee during one of his hours-long research sessions, as he desperately searched for a surgeon near his home in New Jersey. 

'It was like two in the morning and I came across plastic surgeons at Rutgers and I thought... this could be it,' he told DailyMail.com. 

'I emailed Dr Lee right then at 2am asking if he could perform the surgery or knew someone that could. He got back to me at 9am, putting me in touch with Dr Keith.' 

It was the step he'd been waiting to take for years.  

'I had been looking since I was 18,' Stephens told DailyMail.com. 

'Growing up in the environment I did in New Jersey in the 90s, there wasn't even a word that I knew to describe how I felt. I didn't feel like a "lesbian", that didn't describe who I was. 

'I didn't hear the word "transgender" until I was 18 - it wasn't in the news or on TV. People just said "sex change". As soon as I heard that I started investigating it and I realized "oh, transgender, that's what it is". It was a sigh of relief! I felt like... something fits. Instead of feeling like an outcast. I felt like: there are other people like me.'

The lengthy process of gender-reassignment surgery is expensive, but at the time it was very rarely covered by insurance. 'I didn't care,' Stephens said. 'I just thought: whatever it takes, whatever cost.'

The closest center Stephens could find was the Mazzoni Center in Philadelphia, where he started psychological screening straight away. 

During those first couple of years, he met Alicia, his now-fiancee, who has been his pillar of support throughout. 

In 2014, once he had connected with Dr Keith to plan his upcoming surgeries, he started taking testosterone therapy.

In 2016, Dr Keith performed his 'top surgery' - a double mastectomy and reconstruction to make the chest look 'masculine'.

A year later, a colleague in the gynecology department performed Stephens' 'bottom surgery'. Bottom surgery starts with a hysterectomy to remove the uterus, before then removing the vaginal canal in a vaginectomy. The labia and urethra are left, since the labia will be used to create scrotum and the urethra is essential for urinating. 

The next step is a phalloplasty.

A phalloplasty is the construction of a penis using skin flaps. Nerves can be connected to a reconstructed urethra, and the clitoris can be repositioned to sit at the base of the penis. Sexual intercourse is possible post-surgery, sometimes using a prosthesis to create an erection, though some patients say that is not necessary.

For Stephens' operation in February this year, Dr Keith used skin from Stephens' left forearm to create 'a tube within a tube' - i.e. a skin-based prosthesis extending the length of the already intact urethra.

He then grafted the skin's nerves to a nerve from the clitoris so that Stephens can feel sensation in the new organ.

The skin's veins were connected to the main arteries in the femur so that blood can circulate through the new phallus, and the leftover labia was used to create scrotum.

Thigh tissue was used to replace the removed forearm tissue. 

But getting there was a years-long process.

Stephens had been asking Dr Keith about phalloplasties since they first met. He was hardly the only patient in the tri state area of New Jersey, New York and Connecticut. But compared to the removal procedures he had already undergone, it required more steps.

'Patients kept asking me for it but anyone who asked for a phalloplasty I had to say no,' Dr Keith told DailyMail.com.

'I told them at the time that, while I could perform it, I didn't have the right team in place. It's irresponsible to perform that kind of operation without the right team. You need a gynecologist, urologist, psychiatric care and medical care. I said to the patients "I will do it, but give me time to set up this team".'

It took Dr Keith just shy of three years to get the team intact, contacting colleagues of various specialisms to see if they would offer their services. 

Red tape pushed back the launch from 2017 to 2018, but finally, in January, they were ready to go.  

Stephens was the first patient from who Dr Keith's new team created a phallus using their own skin and tissue.

Thanks to the clitoral nerves, Stephens is able to orgasm, though it is a different process to the kind of ejaculatory orgasm that a natural penis would experience. 

Dr Keith hailed the move as a landmark step for the state, and yet another milestone for transgender surgery nationwide.

'Now, New Jersey's transgender community doesn't have to go across rivers or state lines to receive cutting-edge care,' he said. 'Rutgers is pushing the needle forward for everyone.'

He told DailyMail.com the move was both a significant step for New Jersey and for the country. 

'The more centers that can offer this to their patients the better,' he said. 

'It means the patients don't have to travel across state lines or internationally. I often have to deal with cosmetic surgery patients who have had procedures done internationally and they come home and suffer complications. It's challenging for the patient and for the surgeon. If it can be done closer to home, that's where the patient has their support, their home. 

'More and more patients are able to get this surgery on insurance. The more centers offer it, then we can pool our information and make it safer and better.' 

For Stephens, you now works as the operations manager for a junk removal company, sharing his story is an opportunity to reach others that might feel trapped as he did.

'Honestly, knowing how far I've come, I really do hope that I can help anyone who is right now where I once was to find the strength in themselves to do what's right for them,' he said. 

'I know people who live in fear of coming out, of retaliation, of the backlash on social media that I now get. But it shouldn't intimidate them. These people on the internet, they don't know you. There is nothing more scary than hiding from yourself.' 

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