Surgeons have created a penis for a transgender man using skin from his forearm – allowing him to feel full sensation of the organ.
Elijah Stephens, 28, was assigned female at birth but started transitioning to male at 18, having ‘always felt different’.
Back then, the process was much more taboo – 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, 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 to be able to achieve an erection.
‘I feel whole’: Elijah Stephens, 28, (left) started transitioning at 18. In February, he became the first person in New Jersey to receive a phalloplasty. The operation was a resounding success and Stephens, who recently got engaged to his long-term girlfriend (right), now has full sensation in the new phallus
‘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 microsurgery expert Dr Jonathan Keith, founder of the center, who started his career with a seven-year residency in one of the nation’s most respected plastic surgery programs at the University of Pittsburgh.
In 2012, slightly ahead of the curve, 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 he returned to the US, 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 had someone that could perform this surgery. Edward said “no but I know someone who can”.’
It was the final step for Stephens, who began on testosterone therapy at the Mazzoni Center in Philadelphia 10 years ago.
First, Dr Keith performed his ‘top surgery’ in 2016, and his gynecology colleague performed Stephens’ ‘bottom surgery’.
Top surgery involves a double mastectomy and reconstruction to make the chest look ‘male’.
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.
The next step is a phalloplasty, which Stephens received in February.
Stephens’ surgeon was Dr Jonathan Keith, something of a pioneer in the field. Dr Keith launched Rutgers University’s Centers for Transgender Health in January this year, and this is the first phalloplasty in the state
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, 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 femor 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 phalloplasty since they first met in late 2012, early 2013. He was not the only one. But compared to the removal procedures, 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.
Stephens was the first patient in his new team in New Jersey to receive a phallus made from their own skin and tissue.
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.’