The first study of long-term effects of radial forearm flap phalloplasty was published just this month. The aesthetics, functionality, and health status of the donor site on the forearm was examined. This study was reported by researchers at the Center for Sexology and Gender Problems at Ghent University Hospital in Belgium.

Does “radial forearm flap phalloplasty” sound like gibberish? Let’s break it down. Phalloplasty is one of the genital procedures available for trans men (the other is metoidioplasty, which we’ve previously covered). In a phalloplasty, tissue from elsewhere on the body is used to make a penis. “Radial forearm” refers to the part of the body used: a section of forearm, including blood vessels and nerves. “Flap” means the tissue from the forearm is removed completely from the body then put on in another location. “Flap” is in contrast to “pedicle”, where the tissue remains connected in one spot. So a radial forearm flap phalloplasty, essentially, is where tissue from the forearm is used to make a penis. At the same time, hysterectomy and bilateral oophorectomy are done.

As with any surgery involving a graft, both the donor and receiver tissues are damaged. This procedure leaves a scar on the forearm where The researchers report that scarring, reduced bone density, limited range of motion, decreased finger/hand strength, loss of graft, delayed healing, and sensory changes have all been reported. But how common are they? Enter the current research.

Who participated in this research? 44 trans men who had had the procedure. They were an average of 9 years post-surgery, with a range from 9 months to 22 years. Six had a metoidioplasty before their phalloplasty. The median age at surgery was 28. All participants were on hormone therapy, and had been for an average of 10 years; most on a mix of testosterone esters delivered intramuscularly (which is fairly standard practice). The trans male participants were compared to a control group of cis women. There was no weight difference (BMI) between the two groups, but there were more tobacco smokers in the experimental (trans men) group than in the control group (cis women). The control group was not on any metabolic or hormonal altering treatment. In addition to general questions (e.g., tobacco use, medications, medical conditions), the forearm scars of participants were assessed. Questions relating to scar pain, stiffness, and sensation were included. Bone density and body mass were also measured.

The results are very clear. The researchers found no differences in physical activity, lean mass (muscle and bone) of the forearm, or bone health between trans men and cis women. No bone breaks in the donor forearm were reported. In other words, there were no functional problems with the donor forearm. Most (70%) scars had enough blood flow. No itching or pain was reported. The age of the trans man at the time of surgery did not appear to be associated with any negative outcomes.

Best of all, most trans men were satisfied with the way their forearm scar looked. Here’s the breakdown:

26% satisfied

21% very satisfied

30% neutral

19% unsatisfied

5% very unsatisfied

None of the trans men reported regretting their surgery because of their forearm scars. The threat of damage to the forearm itself from this procedure appears to be less than previously thought, though as always it’s not risk-free.

I have to object, however, to using only cis women as controls for a group of trans men. Trans men are not women. The trans men in this study had been post-op for as much as 22 years, meaning no ovaries, so very low levels of “female” sex hormones. Combined with testosterone therapy, their hormone levels much more closely resemble that of males than females. It just doesn’t make any scientific sense. Worse, it carries the subtext that trans men are women, not men. Brain evidence and anecdotal evidence from trans people themselves indicate otherwise, and that such attitudes are extremely harmful.

This research was published in the Journal of Sexual Medicine.

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