Cid Isbell hadn’t been nervous about the seven-hour operation until the day before he went into the hospital. But once he made it to his San Francisco hotel room, he began burning sage for good vibes.



“Advanced surgery for female-to-males has been way behind male-to-female until now,” Isbell said. “The surgeons always told me, ‘it’s easier to make a hole than a pole’ but now we’re catching up.” And catch up he did.

Inside the operating room, a surgeon lifted up a six-inch length of flesh that looked exactly like a penis but had been crafted out of a chunk of Cid’s arm. He handed it, almost ceremonially, to the lead surgeon, who began sewing it between Cid’s legs, just above where his vagina used to be.

The whole procedure took most of the day, and when Cid finally woke up and glanced down, he said: “Wow, I have a penis! That looks freakin’ amazing.”

An nurse named Kerry works to prepare Cid for surgery while he talks with anaesthesiologist Chris Shaffer. Photograph: Talia Herman/The Guardian

Cid, an IT consultant, travelled from his home in Santa Fe for the operation. It was his 50th birthday present to himself.

Fifteen years ago, Cid had a double mastectomy as part of his transition, and was taking testosterone. But like many female-to-male transgender men, he had never bothered with “bottom” surgery to alter his female genitals.

In the last few years, techniques to craft a functioning penis of five or more inches in length – a penis that can pee and get an erection – have advanced in leaps and bounds, with fewer complications and more tactile and sexual sensations.

Cid’s lead surgeon, Dr Curtis Crane, now performs two or three such operations a week at the California Pacific Medical Center, and has done about 150 in all. That’s a tiny count by surgical standards, but far ahead of the one or two other surgeons in the US with the necessary skills in urology and plastic surgery.

The operation costs $100,000 but after a long fight, Cid’s health insurance is paying for it.

Cid Isbell’s tattoo and surgical markings moments before his surgery begins. Photograph: Talia Herman/The Guardian

The operation began with a large flap of skin being meticulously harvested from Cid’s forearm, along with some fat “to help give it girth”, according to the surgeons.

Micro-surgeon Dr Bauback Safa then rolled up the flap into the shape of a penis, and raised a little band of flesh at the end to make a “head”. The resemblance was uncanny.

While Safa and his team were poring over the arm, Crane and his surgical crew were preparing Cid’s urethra and clitoris with its bundle of potent erotic nerves. They connected them to the penis, and attached it a few inches above where they shut the vaginal opening (Cid had a hysterectomy in February).

After nine months of healing, Cid will return to the hospital so that doctors can put an implant into the penis, which is connected by a pump hidden in Cid’s scrotum. A supply of saline in a plastic reservoir is embedded in the abdomen. Squeeze a ball and voila, you have an erection. No sperm, of course, but urinary and sexual function a go-go by all accounts.

After the surgery, Cid was cleaned up and the swarms of nurses and doctors, buzz of medical chatter, acres of surgical bedsheets and nests of tubes and machines receded like a wave.

Cid looked serene, his hairy chest rising and falling, his penis lying neatly to one side as he snored loudly. They wheeled him out.

Cid Isbell’s arm and surgical team working to harvest part of Cid’s arm to make him a penis. Photograph: Talia Herman/The Guardian

Over an Italian dinner in downtown San Francisco two nights before the surgery, Cid explained why having the surgery was so important to him. “I want to be able to undress freely in the locker room at the gym. And what if I have a car accident and they cut my clothes off and the paramedics freak out and won’t treat me? That’s happened to trans friends of mine. I want to unzip my fly and just take a whizz standing up – and not all over my shoes. I’d like to penetrate a partner sexually and feel that sensation in my own penis.”

Outside his home, he’d always worn a soft latex phallus in his underwear.

“You go through the scanner in the airport and they say ‘Sir, there’s something in your pants!’” Cid said, giggling and rolling his eyes. “I’m pretty direct about these things. I say: ‘I’m a transsexual.’ But you don’t want to be taken off to the little room for a big search, you don’t want to be looked at like a freak.”

Cid was raised as a girl named Diana. He remembers posing in front of the mirror with balled-up socks down his pants when he was four, and never grew out of being a tomboy. “When my breasts arrived I was absolutely horrified. I always hated them,” he said.

His transition to manhood came in stages. In his teens and 20s, he was a butch lesbian, and didn’t have a lot to do with men.

“I didn’t really like men very much and then I became one. It was quite a shock,” he said.

He dug out a picture of himself at 30, back when he was into bodybuilding and living in New York. He was taking testosterone to boost his workouts, and was becoming increasingly masculine in both physical characteristics and self-regard.

He recalls: “I was standing on a corner in Brooklyn one night, waiting to cross the road, and a guy came up alongside me to cross the road. We glanced at each other and he just said: ‘Yo, chief.’ And I thought, holy shit, I’m really over on the other side. I was stunned, but I also felt good about it.”

Did he feel as though he’d defected?

“Not exactly – I felt like a spy,” he said.

Not long after, he went to a conference on transgender issues in Ithaca, New York, and met a female-to-male transgender man for the first time.

“I was, like, oh. That’s me, that’s what I need to be.”

Cid Isbell talks with his stepmother Judy Siggins as he prepares medications and supplements to help him recover from his phalloplasty and scrotoplasty. Photograph: Talia Herman/The Guardian

Cid changed his gender on his driving license and had “top” surgery – at age 35. He felt much more comfortable with himself by then, even better than the bodybuilding had made him feel.

“But I realized I knew nothing about male culture from a man’s perspective. So I made a point of getting to know men and understanding more about them as passionate, emotional beings. It helped me ‘pass’ as a man as well as make friends,” he said.

He looked apologetic as he explained what happened next.

“I was instantly offered better jobs and paid about 40% more than I had been for the same kind of job before, while my qualifications hadn’t changed. I’m not kidding. And my credentials weren’t questioned at interviews in the way they always had been.”

He noticed that some guys at work now shared dirty jokes and chauvinistic remarks with him. At first he was tempted to indulge his new privilege and join in in order to fit in – but it felt alien and rude, he said, and he made a conscious decision not to “go there” but to challenge it when he felt that was necessary.

“I promised myself I wouldn’t forget what it was like to be a woman. Being a girl, being a woman, that’s part of my experience and it will never change for me,” he said.

This kind of wording angers some transgender advocates, who would argue that Cid was always a man, born with incongruent body parts. But Cid said: “I’m pretty loose around language. For me it’s not that cut and dry.”

He added that in his experience, some people who transition are very bitter at having been forced to live as the gender they knew instinctively they were not. The anger, post-transition elation, or mix of both can lead to what he calls “over-compensation” stereotypes – the very macho trans man, the ultra high-femme trans woman – which may give way to a more nuanced attitude later on.



Cid dated bisexual women for a while, then married a straight woman in 2004. They recently got divorced but are good friends, Cid said.

He wasn’t macho enough for his wife, he said. It wasn’t a genital problem, it was an emotional problem.

“She thought of me as a dude, but she wanted the strong, silent type. I’m very chatty, I have to express myself, otherwise I feel trapped,” he said. He now regards himself, in his words, as an effeminate man. Maybe a bisexual one, even – he’s been feeling attracted to gay men of late and thinks he might go in that direction when his penis is all geared up and ready for action.

Ruslan Nachoy, an RN, changes Cid Isbell dressing on his arm in a hotel room. Photograph: Talia Herman/The Guardian

Growing up, Cid recalled wanting to be a boy and suppressing that urge – not so much because society or his parents wanted him to conform, but because his mother was a strident feminist, often criticizing the patriarchy and insisting girls could do and be anything they wanted to be.

“She made it sound like, why on earth would you ever want to be a boy? I felt guilty about it,” he said. When Cid began taking male hormones and transitioning in his 30s, however, she supported him, and now campaigns for transgender equality issues.

His parents split up a long time ago and Cid’s father, Bill, and stepmother, Judy, flew across the country from their home in Binghamton, New York, to support him during his surgery.

Bill Isbell, 72, is an archaeology professor. Until the age of nine, Cid moved home frequently between the US, Peru and Bolivia, where his father was researching early Andean communities.

“He was such a cute little girl,” Bill said. “But very, very stubborn. We were living in Lima when Diana was four or five and she would sneak out of the house and we were terrified she would be kidnapped. We’d lock the doors and she’d crawl out of the window, we’d chain the window, but she just would not listen, she was going to do what she wanted to do.”

“I don’t remember her saying she wanted to be a boy. I do remember the first time she met an obvious lesbian – one of my students came to the house for a meeting, and Diana was 14 and she was transfixed. I saw it, it was like a light bulb going off.”

Over the years, Bill has gradually accepted Cid’s identity. “The thing that’s most convincing to me is that he was very unhappy for years, especially in his 20s, and every time he made a change, had a surgery or an identity change, he’s been so much happier,” he said.

Cid pondered this. Had he felt very detached from himself?

“Oh yes, totally. I’ve been very detached every since I was little.” He dated it back to moving constantly between cultures as a child, upended and never sure how to fit in. The gender-body incongruence was, of course, also a factor.

Cid Isbell on his bed 13 days after his surgery. Photograph: Talia Herman/The Guardian

This feeling was exacerbated when Cid was raped by a man at 19, back when he was a lesbian and had moved to a rough part of Cincinnati with a girlfriend.

It was an almost stereotypical attack – a stranger forced Cid into an alley. “He threatened to kill me if I wouldn’t shut up and let him fuck me. He was way too strong for me. It’s crazy, all he had was a pen but he held it at my throat and I knew he could shove it straight into my jugular if he wanted, I was really scared,” he said.

Afterwards, Cid was traumatized and so ashamed that he had been overpowered so easily that he barely told anybody.

His reaction was to drink heavily for the next six years – a blur of alcoholism and failed jobs – before he went to rehab and got sober. (In true Cid iconoclastic style, he eschews the 12-step idea of no alcohol and is now happy to enjoy a glass or two of wine with dinner.)

The bodybuilding began as a reaction to being raped, ending up in a confluence with his evolving gender identity.

“I’m acutely aware that my penis can be a sexual weapon that can be used to violate a woman. That’s just another irony to this whole thing,” he said.

‘I’m acutely aware that my penis can be a sexual weapon.’ Photograph: Talia Herman/The Guardian

The day after his surgery, Cid is groggy but in high spirits.

Never shy, he pulls back the covers to show off his penis. It doesn’t have a dressing, so that it can be checked every hour to make sure the blood supply is working.

“I called the nurse to say a tube was stuck to my scrotum and then I thought, wait, I have a scrotum? Cool!” he said.

Laughing hurts, but Cid is joshing anyway. “I’ve decided I’m a virgin again. I have a few woman friends who are arguing about deflowering me. Then I had some gay men who are, like, I want to be the first. I might just auction myself on eBay.”

He can’t feel the arm wound through the narcotics, but he just had the dressing on his thigh changed and it stings like hell. He’s now dreading the nine long months of healing ahead before he gets the penile implant, but is excited about getting rid of the catheter and being able to pee out of his penis in a few weeks.

He’s tired and needs a little nap. He thanks the Guardian and says he wants to spread the word about the state-of-the-art surgery and trans rights.

Then he grins again and concludes.

“Well, I just turned 50. Maybe I’m having a midlife crisis. That must be it. I could have gotten a sports car – but I got a cock.”