Bottom Surgery

For transmasculine individuals seeking “bottom surgery” as part of their gender affirming process, phalloplasty is one of the primary surgical options. Methods for phalloplasty include radial forearm and anterolateral thigh flaps.

The choice of technique will depend on the your body build/physique and goals. We will discuss this with you at the time of your first consultation.

Before Your Appointment

Before your appointment, we advise that you contact your insurance carrier to determine whether gender affirmation surgery is a covered benefit. After you have had your first appointment, we can contact them to obtain a pre-authorization prior to the surgery.

Insurance companies use the pre-authorization process to ensure that your surgery is covered. This process can take up to six months depending on your insurance provider. Our team will keep you in the loop as we receive status updates. However, you can always call your insurance for updates too.

For any questions about the pre-authorization process, please call us at 801-213-2195, option 1. If you reach our voicemail, please leave your:

  • name,
  • phone number, and
  • date of birth.

If our providers are not in-network, ask your insurance company if you would qualify for a gap exception. A gap exception can sometimes be granted as a covered service if there are no other in-network providers in the area that offer that service.

You can check our insurance information to verify whether University of Utah Health is in your network of coverage. If you do not have coverage, we will provide you with an out-of-pocket cost estimate. For those patients desiring removal of ovaries, you will consult separately with one of our gynecologists.

Please note that we are actively working with all of the payers in Utah to advocate for medically necessary care as a covered benefit. 

WPATH Standards of Care

The providers follow the WPATH Standards of Care, which require TWO letter from qualified mental health care professionals prior to the surgery.

Criteria for Phalloplasty in FTM Patients

  1. Persistent, well documented gender dysphoria;
  2. Capacity to make a fully informed decision and to consent for treatment;
  3. Age of majority in a given country;
  4. If significant medical or mental health concerns are present, they must be well controlled;
  5. 12 continuous months of hormone therapy as appropriate to the patient’s gender goals;
  6. 12 continuous months of living in a gender role that is congruent with their gender identity.

Although not an explicit criteria, it is recommended that these patients also have regular visits with a mental health of other medical professional.

Hear From Our Patients

When River Jude August arrived for surgery, they faced yet another challenge in their long journey to align their body with who they know they are. River, who identifies as agender—or outside the female/male binary—had already changed their legal gender to X. They had transitioned socially, opted for several medical treatments, and now faced their biggest surgery yet. River was about to undergo phalloplasty, the construction of a phallus. 

Read River's Story

Picture of patient River August who underwent phalloplasty surgery

We Want Your Feedback

We are constantly evolving as a program and welcome any feedback from the community that will help us meet our mission to provide safe, gender-affirmative care at University of Utah Health. Please email us at