First operation in New Jersey creates penis for transgender man
Lindy WashburnThe first operation in New Jersey to create a penis for a transgender man has enabled a 28-year-old Camden County resident, born female, to stand to urinate, feel sensation in the organ, and finally know that the person he sees in the mirror is his true self.
"It's hard to put into words," said Elijah Stephens, of Magnolia. "I feel whole, complete — happy beyond happy."
The 14-hour operation created a phallus using skin and tissue from the patient's forearm.
It was performed at Saint Barnabas Medical Center in Livingston in February by surgeons from the Rutgers Center for Transgender Health, a newly formed group that includes psychiatrists, plastic surgeons, ob/gyns and urologists and handles both female-to-male and male-to-female transitions.
Growing up, Stephens said, "I always felt different. Nothing ever felt right."
He didn't feel like a girl, but "there was no word for who I was or how I felt," he said. He never knew a transgender person.
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When a friend's father mentioned something about a "sex-change operation," Stephens began to research what that meant. As he learned about the transgender world and the medical options available, he said, it was "cool to know that there are other people who feel this way."
Stephens started his transition with hormone therapy — testosterone — at age 18, in the care of the Mazzoni Center in Philadelphia. Eventually, his search for surgery led him to contact Rutgers Newark Medical School.
He first met with Dr. Jonathan Keith, a plastic surgeon, four years ago, and "we just talked and talked about everything," Stephens said. "It was easy to open up with him."
The surgeon explained the operations involved and their risks. "He was more of a friend than a doctor," Stephens said.
Stephens started with "top surgery" — a double mastectomy and modifications to make his chest look more masculine — in 2016 at University Hospital in Newark.
That was followed by "bottom surgery," beginning with a hysterectomy and vaginectomy — removal of the vaginal canal, leaving only the labia and urethra — last August.
Saint Barnabas and University Hospital are the only hospitals in New Jersey that have been granted privileges to perform these procedures.
Finally, in February, Stephens underwent an operation called a phalloplasty to create a new penis.
"There's no textbook written on this," said Keith, who led the operating room team, which included eight surgeons and seven other physicians. As a plastic surgeon specializing in microsurgery and transplants, Keith had studied the procedure during a fellowship in Belgium.
With this first case in New Jersey, Keith mapped out the area of skin and tissue to be removed from Stephens' left forearm. He used it to create "a tube within a tube," extending the urethra to carry urine to the tip of the penis.
He also grafted nerves from the forearm to a nerve from the clitoris to bring feeling to the new phallus. And he transferred arteries and veins from the forearm, attaching them to the femoral artery to enable the blood to circulate. Labial tissue was used to create a scrotum. Finally, tissue from Stephens' thigh was grafted to his forearm to replace what had been removed.
Some of the stitches used suture thread that was thinner than a human hair.
Stephens recovered very quickly. After some trial and error, he said, he mastered the art of urinating while standing. He achieved orgasm. And he hopes to have additional surgery in August to implant a pump that can be inflated, creating an erection.
He is engaged to his longtime girlfriend, who has been with him since before his transition, he said.
While Stephens was the first patient in New Jersey, several others await the same procedure, Keith said. He is monitoring Stephens carefully, in order to learn from the case. Because it is an academic medical program, Rutgers' goal is to "teach others how to do it, study and publish," Keith said.
Gender-reassignment surgery has been covered by Medicare and Medicaid since 2016, a policy change that has opened the door for more people to have the procedure.
It is also performed at New York University Medical Center and Mount Sinai in New York City. Although the procedure is not new, it's not known how many were performed when they were not covered by insurance.
"What was once done on the fringes, and on a cash-only basis," Keith said, "has now become much more accepted and is covered by most insurance."