Metoidioplasty is a type of gender-affirming surgery that creates a small-sized neophallus, or new penis, from an enlarged clitoris. Gender-affirmation surgeries are procedures that alter a person’s body, typically sexual characteristics like the genitals, to align a person’s sex with their gender identity so that they can move through society more comfortably. Such procedures treat gender dysphoria, which is the distress or discomfort that may be felt by transgender people. Transgender people’s gender identities differ from the genders they were assigned at birth, usually conflated with the sex they were assigned at birth. As opposed to a phalloplasty, a procedure where a neophallus is created using tissue from other areas of the body and not just the existing genital tissues, metoidioplasty allows transgender individuals to have a penis with less noticeable scarring, preservation of erogenous sensation, and, if the patient desires, the ability to urinate while standing. The technique was first suggested in 1973, then performed in 1974, however, doctors and researchers did not refer to it as metoidioplasty until 1989. Since its implementation, several modifications have ensured lower risks and better results for patients. Metoidioplasty improves the quality of life for people seeking gender-affirmation surgery by treating gender dysphoria.

In 1989, physicians Henk Asscheman, Louis J. G. Gooren, and P.L.E. Eklund published the article “Mortality and Morbidity in Transsexual Patients with Cross-Gender Hormone Treatment,” hereafter “Mortality and Morbidity,” in the journal Metabolism. The authors presented clinical data regarding patients with gender dysphoria who were actively undergoing gender-affirming hormone replacement therapy. The data highlighted frequencies of various side effects of the treatment, including high blood pressure, blood clots, mood changes, as well as varying risk percentages of osteoporosis and cardiovascular disease, as those side effects are typically common in conventional hormone replacement therapy. According to “Mortality and Morbidity,” few scientists were studying the long-term effects of estrogen and androgen treatment for transgender people at the time of publication. The retrospective study was one of the first to research the long-term effects of hormone treatments on transgender individuals and found health concerns, such as more frequent blood clots and weight gain, in those undergoing gender-affirming hormone treatment.