Procedures for testicular prosthesis implantation in transgender men have changed over time, scientists report in the Journal of Sexual Medicine.
During gender affirmation surgery, transgender men generally undergo phalloplasty (surgical creation of a penis using tissue from elsewhere in the body) or metoidioplasty (creation of a penis from the clitoris, which enlarges during previous testosterone therapy).
A neoscrotum can be developed with fat tissue, but testicular prostheses are a closer match in shape and size to natural testicles. However, the long-term outcomes of testicular prosthesis surgery are not thoroughly addressed in the medical literature.
The current study focused on surgical outcomes using retrospective data from 206 transgender men who received testicular implants at one institution between January 1992 and December 2018. Information on demographics, surgical details, and complications was obtained from the men’s medical charts.
Over those years, three different surgical techniques were used, with the most recent being a secondary surgery after genital gender affirmation surgery (“scrotoplasty according to Hoebeke”). The methods were described as follows:
(i) In the method described by Hage et al, a reversed V-incision is made in both labia majora. A dorsally based skin flap is created, and testicular prostheses are immediately implanted if space and skin laxity are sufficient to do so. Subsequently, the skin is closed in a Y-like matter. When there is insufficient space to do so, testicular prostheses are placed in a later stage. (112 men)
(ii) Dorsally based reversed V-shaped bilateral labia majora flaps are closed in the midline to create a scrotum with a less bifid appearance. In a later stage, testicular prostheses may be placed. (42 men)
(iii) In the Hoebeke method, 2 cranially based bilateral labia majora flaps are rotated medially and combined with a horseshoe-shaped, bilaterally vascularized prepubic skin flap to create the neoscrotum. In a later stage, testicular prostheses may be placed. This is the authors’ current technique for scrotal construction. (52 men)
In total, 412 testicular prostheses from various manufacturers were implanted. Over time, smaller implants were used.
Men who required explantation usually did so in the first few months after their surgery. Almost 21% of the patients needed one or both prostheses explanted because of “infection, extrusion, discomfort, prosthesis leakage, or urethral problems,” the authors reported.
Among the 52 patients who underwent the most recent (Hoebeke) procedure, six needed explantation of one or both prostheses.
The researchers identified smoking as a risk factor for infection-related explantation. Prosthesis dislocation was more common for patients who underwent the Hage method.
They pointed out that while more transgender individuals are interested in gender affirmation surgery nowadays, the number of testicular implants at their institution has not followed in step. It’s possible that new scrotoplasty methods that use autologous tissue for augmentation decrease the need for implants.
“Our data suggest that testicular prosthesis implantation is a safe procedure with acceptable complication rates, which can be performed in an outpatient setting and in combination with other surgical (genital) procedures,” the authors wrote, adding that “scrotoplasty techniques and testicular prostheses preferences have changed.”
The Journal of Sexual Medicine
Pigot, Garry L.S., MD, et al.
“Surgical Outcomes of Neoscrotal Augmentation with Testicular Prostheses in Transgender Men”
(Full-text. September 6, 2019)