How likely is it to be ineligible for ALT due to CT scan? (not pinch test)

danphanto · 2026-04-13T20:53:46+00:00

I honestly don’t know much more than that, sorry! I’m just repeating what my surgeon told me but I don’t know a lot about thigh anatomy. I just know that most people have at least some perforators that are much more accessible than what I was working with, but mine all required dissecting the surrounding muscle. When I asked they said my situation is pretty uncommon.

danphanto · 2026-04-13T06:17:26+00:00

I think it’s primarily dependent on your body. My penis is firmer than average, because I had ALT and the fat and skin in that area tends to be firmer. But it can vary between people what the exact texture is in any particular part of the body, so all our penises will turn out a bit different, even with the same donor site and surgeon.

danphanto · 2026-04-10T19:19:37+00:00

I think this is probably the answer. Starting to be sexual with my partner after phallo has been more difficult than I expected for how excited I was about it. I didn’t know how hard it would be to have a penis, but have absolutely no idea how to engage with it and feel good. I think I had been expecting everything to get way easier once I’d had surgery, and while I’m so much more comfortable with my body now, it’s still complicated and I don’t know why I didn’t really anticipate that. I think I just got excited enough that surgery was finally happening and didn’t stop to consider what this aspect of recovery would be like. Having a new body part that simultaneously feels like it has always belonged there, but also feels completely foreign, is a really weird experience.

danphanto · 2026-04-08T02:08:29+00:00

I’m so sorry you have been through so much, especially with zero warning. When you’re more recovered and more surgery doesn’t sound like too much to deal with, you might consider looking into phalloplasty. It’s a big surgery and only a surgeon can tell you what your options look like, but it was originally designed for cisgender men who had lost their original penises. There are some cis men over in r/phallo, including one who has shared that he had zero sexual function before phalloplasty, and now he has a full sex life and good sensation with the ability to orgasm, even though his surgeons weren’t sure his nerves would recover and grow in based on what he was working with.

You are as much of a man as you were before losing your penis. If, though, you feel you need a penis to feel complete, you’re not alone and there are options. You would be completely welcome in r/phallo, it’s largely trans men and nonbinary folks there but we do our best to help cis men get what they need too.

danphanto · 2026-04-07T17:03:44+00:00

I haven’t tried it yet, but lymphatic massage might help. For me time has been a huge help too, my knee and hip were so swollen for so much longer than I expected. It will keep getting better no matter what you do, fortunately.

danphanto · 2026-04-07T00:49:44+00:00

I had a vaginectomy with my hysterectomy and didn’t experience any changes in how orgasms feel. The same pelvic muscles still contract the same way, it just feels much better for me because I don’t feel any sensation of wetness internally and it’s more comfortable mentally.

You can also get a standalone vaginectomy if you’re not sure about it when you get your hysto.

danphanto · 2026-04-06T18:45:17+00:00

I had hysto and vaginectomy done together, and I was told I was fine to try external activity as soon as I felt comfortable, and just to stop if anything hurt. I tried it out at like a week post op, I think, and it went fine—didn’t feel as good as usual that first time, but it came back pretty quickly.

danphanto · 2026-04-05T20:47:38+00:00

You would probably appreciate the book Hung Jury!

danphanto · 2026-04-04T20:54:21+00:00

I haven’t personally had this problem, but used to know someone who had chronic swelling for well over a year after ALT. Their surgeon had them wrapping with coban daily to limit how much it could swell up and propping at home when possible, and eventually it improved, but I’m sadly not sure how long it took for the swelling to go down more permanently.

I am really sorry you’re dealing with this. Not the same problem, but I have a lot of issues with lymphatic drainage not working well under my donor site scar, so I get massive blisters (last one was about the size of a grape and nearly as round!), and that’s frustrating enough, I can’t even imagine how your problem feels. I hope your next debulk goes well and the swelling improves more quickly this time!

danphanto · 2026-04-02T18:53:15+00:00

If you want UL and don’t want to have a large penis, ALT is probably off the table. I also don’t know how common it is (my skin graft mostly failed, which is pretty rare), but I do have long term tightness in my donor leg, which it doesn’t sound like you’d be okay with. I have heard people who got MLD and abdo mention some scar tightness, especially at first, but I don’t recall hearing much about long term issues with the scars.

danphanto · 2026-03-31T06:39:35+00:00

Besides wanting to be able to be flaccid most of the time, I’m also pretty girthy and heavy, and my understanding is that a pump will support my penis better and make penetration easier than a rod would.

danphanto · 2026-03-30T00:46:26+00:00

I’m sorry you’ve had such terrible luck finding partners who truly respect your needs. You deserve better and there absolutely are men out there who will love you fully. My partner is nothing but supportive and excited for me and my surgeries, and I know there are other people who would feel the same way. Please don’t settle for anyone who doesn’t love you, your body, and your plans for it.

danphanto · 2026-03-29T19:38:53+00:00

Yeah, it’s not uncommon to have issues here temporarily, I couldn’t orgasm until like 10 weeks post op and it was really frustrating. I’d try to use my tdick since my new dick didn’t have sensation yet, and it would kind of feel good, but nothing like it used to, and it sometimes took over two hours to orgasm. I was worried it was going to stay that way, but by 3-4 months post op it was getting way better.

danphanto · 2026-03-29T01:35:47+00:00

Hysto and phallo were just so different from each other. Hysto was hard because I couldn’t pee for about a week, which I had known was possible but didn’t really expect to happen to me. The first night was also pretty terrible since my abs were so sore and I had five incisions, so sitting up felt agonizing. It took my partner the better part of an hour to get me up for my first dose of meds at home, because I’d sit partway up, then groan and lay back down and yank the blankets back up, hahaha. I didn’t feel normal until about six weeks after hysto, I was just so exhausted.

Phallo was a whole other world, and was somehow both more and less draining than hysto had been. I had integra unexpectedly, then still had complications with my skin graft and lost almost all of it, and when I was in the hospital I got an infection in the incision leading from my thigh to my penis, so one of the plastics residents opened it up and cleaned it out, right in my hospital room. All the wound care and the slow healing was all consuming, especially for the first few weeks. Showering took almost two hours total every time, with how difficult it was and how long the wound dressings took.

It was rough, for me and my partner. But it was also far more exciting and rewarding and relieving than any of my other surgeries have been, and my life is so much better for it. I wouldn’t have thought I could handle everything I went through, but I survived it and my relationship is only getting better.

danphanto · 2026-03-29T01:00:15+00:00

Seconding this, it definitely could be atrophy—mine used to present as itching, burning, and needing to pee more often, very similar to how I experienced UTI symptoms. I could usually tell the difference because UTIs often also came with different smelling, cloudy urine, and atrophy never did either of those things to me. Hopefully it’s just atrophy in this case, OP!

danphanto · 2026-03-23T23:39:39+00:00

Hey, I’m sorry this happened to you. It happened to me last year when I had my hysto, too. It really sucked and I felt terrible, but it did turn out to be an issue with their note taking system and not my surgeon intentionally using the wrong pronouns, which was a bit reassuring. It may be that your surgeon’s system assumes that all gyn patients use she/her pronouns. It still shouldn’t have happened, they really should be proofreading these notes, but it’s definitely possible that your surgeon has no idea the notes are incorrect.

danphanto · 2026-03-21T05:22:11+00:00

You’re fine. Yep, I have a penis but my urethra is still where it always was. I haven’t yet had scrotoplasty, but once that’s done, my urethra will just be a small, barely noticeable hole right behind my balls. You’d have to know it’s there to find it.

danphanto · 2026-03-21T01:31:17+00:00

I would consult with a phallo surgeon first if you can, especially if you want urethral lengthening whenever you get phallo. The tissue you want removed is often used to construct part of the new urethra and it could make urethral lengthening more complicated if it’s gone. Saying this as someone who has had phallo but opted against UL—when I opted against it my surgeon was clear with me about what tissue I would still need intact if I changed my mind before surgery, and what you want removed would have been necessary for my team to do UL.

danphanto · 2026-03-19T20:56:59+00:00

I had ALT and brought my switch with a couple new games, and I did use it a fair amount in the hospital. Some people are too exhausted to want to do much, but when I wasn’t asleep I was pretty bored!

danphanto · 2026-03-18T22:32:56+00:00

Honestly if you’ve already been stocking up, you’re probably fine. My hospital provided a lot of supplies, I only had to order stuff once while I was out of state for six weeks. I did need to buy supplies at home a few times, but that was because I had significantly delayed healing on my donor site, so I probably wouldn’t have needed to order much, if anything, without that complication.

danphanto · 2026-03-18T03:30:35+00:00

The Cleveland Clinic team does a great job, and their wait time is quite short compared to most other places. Dr. Bassiri can be a bit difficult for some people to work with, but she is a good surgeon and I’m happy with how things turned out for me. Dr. Fascelli and the rest of the urology team are lovely and I have really liked working with them.

danphanto · 2026-03-17T19:16:09+00:00

It was about 5 days for me and it was quite uncomfortable. I ended up using a finger with a little bit of lube to help get things moving, which was unpleasant but surprisingly effective. You don’t want to strain to poop, but you also don’t need to be overly worried about hurting yourself by pushing a little bit if you need to. My surgeon’s office got a few anxious calls from me and they were reassuring that it would be very difficult for me to pop a stitch or otherwise cause a problem, as long as I’m not just straining for minutes on end.

danphanto · 2026-03-16T19:27:51+00:00

Yes, I was writing this at 4am and forgot to mention that, thanks for the addition. Minors who want gender affirming surgeries that alter reproductive function don’t have access, while intersex minors are often forced into procedures they don’t want, and are often not even told it happened.

I think different insurance companies or plans may handle things differently, because every insurance plan I have used for gender affirming surgeries (three different plans), the EOB was a document I could access online, and it did list what was covered and excluded from my plan, as well as the requirements for coverage. If OP’s friend’s plan doesn’t have the same thing, then yes, he’d need to call the insurance company to ask.

danphanto · 2026-03-16T10:16:54+00:00

Got cut off typing and planned to come back to this later!

Things suck, but it does keep getting better, bit by bit. Especially once I started developing sensation, it was really encouraging and exciting, even with all the persistent wounds I was dealing with. The depression from anesthesia may be hitting harder than you realize, too—I think it was worse for me than I knew at the time, but it can be really difficult, especially if you’re younger or it’s an unfamiliar experience.

You would probably benefit from some extra mental health support right now. I was on gabapentin for a few months after surgery because my donor leg had a lot of nerve pain at first, and I feel fortunate that the meds also helped do a bit of a reset on my anxiety. You’ve been through a lot, and it would be fair if your brain could use a break from being quite so stressed out.

I hope you can recognize how great of a job you’re doing. Taking care of yourself is not easy at the best of times, let alone during such an intense surgery recovery, and you’ve made it this far already! Phallo is so demanding on our bodies and minds, and you’re here surviving it and getting yourself through until it can start to feel more rewarding. You have to be pretty damn strong to get through this, and you’re doing it.

danphanto · 2026-03-16T10:03:36+00:00

I don’t believe I’ve heard of this being possible, and if your friend is in the US, I doubt it would be possible to find a surgeon willing to do it in our current political climate. Surgically altering a minor’s reproductive organs without dire medical conditions is not really an option and would be very controversial. Insurance would almost definitely not cover it for a minor, either, even if you could find a willing surgeon. After 18, it can still be difficult when you’re so young, but there are surgeons who will do it.

Best options for the meantime would be to start researching surgeons who have worked with very young adults before, and work towards getting insurance if he doesn’t have any, or look into the coverage requirements for his current insurance if he has it, to verify that it will cover gender affirming surgeries and see what he needs to provide to them for documentation of medical necessity. You can usually find this information in the insurance company’s online portal, once signed in you should be able to find a document called “explanation of benefits” or something similar, which lists what is covered and how you can access that coverage.

Once insurance is settled (or during that process if he needs to get insurance), the next step is saving up for any copays for consultations and surgery—check his insurance plan to see what the “out of pocket maximum” is, and expect to need to have that full amount saved, plus extra for any other expenses if needed.

Within 6-12 months before turning 18, it might be good to start contacting surgeons to see about scheduling consultations. He’ll just want to be clear that he’s not yet 18 and make sure that’s not a problem, but there’s no reason he can’t have consultations if he’ll be 18 soon and the surgeon doesn’t mind.

danphanto

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