Reply: What Is the Ideal Neophallus? Response to Frey et al. (2017): An Update on Genital Reconstruction Options for the Female-to-Male Transgender Patient: A Review of the Literature.

We would like to thank Dr. Elfering et al.[1] for their comments regarding our article “An Update on Genital Reconstruction Options for the Female-to-Male Transgender Patient: A Review of the Literature.” Like these authors, we agree that there is no solitary, ideal neophallus and that goals for each procedure should be individualized to each unique patient. By discussing the characteristics of the “ideal” neophallus set forth by Drs. Hage and De Graaf[2] in 1993, we address the aspects of neophallus creation that are commonly thought to be most fundamental in the construction of a functional and aesthetic neophallus. With this in mind, some patients may prioritize certain of these characteristics or even other characteristics not listed by Drs. Hage and De Graaf, in their reconstruction. Although standing urination may be paramount for 1 patient, limitation of donor-site morbidity may be for another. With this in mind, each treatment plan and reconstructive modality should be tailored to each individual presenting for neophallus creation. It is with this in mind that we call for improved patient-reported outcome measures examining which reconstruction best addresses each aspect as well as validated tools to assess what aspects are most important to patients themselves. The lack of such information in the literature is further addressed in our article examining comparative outcomes with metoidioplasty and radial free forearm flap phalloplasty.[3]

We concur that the question you pose, “To what degree does a surgical treatment fulfill the need and expectations of a well-informed transgender man undergoing this treatment?” is perhaps the most imperative as we move toward patient-centered transgender care. We look forward to learning more about the decision-making tool that your institution is developing along with outcomes associated with its utilization.

Again, we would like to thank you for your comments regarding our article. It is through multi-institutional and cross-cultural collaboration that we can continue to improve outcomes in gender conforming surgery, providing the highest quality, evidence-based, and individualized care to gender nonconforming individuals moving forward.