FTM bottom surgery typically costs between $25,000 and $150,000 or more without insurance, depending on the procedure, surgeon, and location. That wide range reflects the fact that “bottom surgery” isn’t a single operation. It can involve several different procedures, often performed in multiple stages, each with its own price tag.
Phalloplasty vs. Metoidioplasty Costs
The two main options for FTM bottom surgery are phalloplasty and metoidioplasty, and they differ significantly in complexity and cost.
Phalloplasty creates a full-sized phallus using a skin flap taken from your forearm, thigh, or another donor site. It’s a major reconstruction that often requires three or more staged surgeries over the course of a year or longer. The total cost for phalloplasty ranges from $25,000 to $150,000 or more. That total reflects surgeon fees, hospital or surgical facility charges, anesthesiology, post-surgery medications, compression garments, and any lab tests or imaging you need along the way.
Metoidioplasty is a less extensive procedure that works with existing tissue grown through testosterone therapy. Because it involves fewer surgical stages and shorter operating times, the cost is generally lower, often falling in the $20,000 to $50,000 range. Some people choose metoidioplasty as a standalone procedure, while others view it as a step before phalloplasty.
What Drives the Total Cost Up
The sticker price for the primary surgery is only part of the picture. Several additional procedures and expenses can push the total well beyond initial estimates.
Multiple stages. Phalloplasty is rarely completed in a single operation. The first stage typically creates the phallus itself. Later stages may include urethral lengthening (so you can urinate while standing), scrotoplasty with testicular implants, and glansplasty to shape the tip. Each stage means another round of surgeon fees, facility costs, and anesthesia charges.
Erectile implants. A penile implant, which allows for penetrative function, costs an additional $10,000 to $20,000 without insurance. These devices carry a 6% to 13% risk of needing repeat surgery due to device deterioration or other complications, so the implant may not be a one-time expense over your lifetime.
Revisions and complication repairs. Complications after phalloplasty, such as urethral fistulas, catheter problems, or implant issues, are relatively common and may require corrective surgeries. These aren’t always predictable, and each one adds cost.
Pre-surgical hair removal. Before phalloplasty, you’ll need electrolysis or laser hair removal on the donor skin site. Your surgical team will give you a template showing exactly which areas need treatment. Depending on the donor site and your hair growth, this process can take 6 to 12 months and cost several hundred to a few thousand dollars out of pocket.
Travel and recovery. Only a limited number of surgeons perform these procedures, so many people travel for surgery. Flights, hotels, and extended stays during recovery (which can last weeks near the surgical center) add up quickly and are rarely covered by insurance or grants.
What Insurance Covers
Many major insurance plans now cover gender-affirming bottom surgery, including employer-sponsored plans, Medicaid in certain states, and some marketplace plans. When coverage exists, it can reduce your out-of-pocket cost dramatically, sometimes to just copays and deductibles. But getting approved requires meeting specific criteria.
Most insurers follow guidelines based on the World Professional Association for Transgender Health (WPATH) standards. For genital surgery, these typically require:
- Persistent, well-documented gender dysphoria
- Capacity to provide informed consent
- Being the age of majority in your country
- Any significant medical or mental health concerns being reasonably well controlled
- Two mental health assessment letters, one from a licensed therapist and one from a doctoral-level provider (PhD, PsyD, or psychiatrist), both written within 18 months of surgery
- A letter of support from your primary care provider or hormone prescriber, if applicable
Even with insurance approval, coverage gaps are common. Some plans cover the primary surgery but not the erectile implant, testicular implants, or revision procedures. Others impose limits on the number of staged surgeries they’ll pay for. Read your plan’s specific exclusions carefully, and ask your surgeon’s billing team which procedure codes they’ll submit before you schedule anything.
Paying Without Insurance
If you’re uninsured or your plan excludes gender-affirming care, the full cost falls to you. Some surgeons offer payment plans or work with medical financing companies that let you spread payments over months or years, though interest rates vary widely.
Grants exist but are competitive. Point of Pride runs an Annual Transgender Surgery Fund specifically for people who cannot afford gender-affirming surgery. To qualify, you need to demonstrate financial need and show past attempts at covering the cost, whether through saving, fundraising, or trying to get insurance coverage. Applications open November 1 each year with a November 30 deadline. If selected, you have 18 months to schedule your surgery with a U.S.-based surgeon. The grants cover healthcare expenses only, not travel or lodging.
Crowdfunding through platforms like GoFundMe is another common route. Some people also negotiate self-pay rates directly with surgical centers, which can be lower than the billed rate insurers see.
Budgeting for the Full Timeline
The total financial commitment for FTM bottom surgery extends well beyond the operating room. From first consultation to final revision, the process commonly spans two to three years. During that time, you’re paying for hair removal prep, multiple surgical stages, time off work for recovery (each stage may require weeks to months), follow-up appointments, and potentially complication repairs.
A realistic budget accounts for the primary surgery cost, at least one or two additional staged procedures, an erectile implant if desired, pre-surgical hair removal, and a contingency fund for revisions. For someone paying entirely out of pocket and opting for phalloplasty with all stages, total costs can realistically reach $100,000 to $200,000 over the full course of treatment. With good insurance coverage, the same journey might cost a few thousand dollars in copays and uncovered extras.