Am I lying to myself about bottom surgery?

[CW: suicidal ideation, transphobia in healthcare, and discussion of my genitals and sex life]

Have I told myself that I don’t want bottom surgery so if it's inaccessible it doesn’t hurt?

As I inch closer to getting top surgery, I’m both excited and terrified. It feels like if I breathe wrong then it will be snatched away, and I need it so, so badly. I’m trying to keep my expectations low about how long it will take to get from here to the actual surgery, because I need to keep actually living my life while I wait.

Something I wasn’t expecting is that I’m thinking more about bottom surgery.

I've known I wanted top surgery for years – before I even realised I’m a man. I need top surgery; I could probably survive without bottom surgery. But as top surgery looks like it might actually become a reality for me, I’ve begun to wonder if I’m lying to myself out of self-preservation.

Is the reason I've told myself I don't want bottom surgery because it feels impossible, rather than because I actually don't want it? Trans masculine bottom surgeries stopped happening completely in the UK in 2020, just as I was figuring out my gender. And according to TransActual: "whilst it has coincided with the COVID-19 pandemic, the withdrawal of access to NHS phalloplasty or metoidioplasty surgeries was unrelated to the pandemic." As of June 2025, they predict that someone referred for bottom surgery today should expect to wait more than 5 years.

I don't need bottom surgery – or any other kind of healthcare, for that matter – to be a man, for my sex to be male. But that doesn't mean I can't want it, right? The bar for accessing trans healthcare shouldn't be: 'I genuinely think I will kill myself if I can't get this’. It should be: do I want this? Would this improve my life? Would I be happier with a dick?

I already have a dick. And packers and dildos I refer to and use as dicks. Maybe what I mean is a penis. Do I want a penis?

I think I might. I haven't done much research on bottom surgery, but part of that is a coping mechanism. If I have less information about it, I’m less likely to get invested. If I don’t know what’s possible, I can’t ache for it.

When I close my eyes, I see myself with a flat chest and top surgery scars. I don’t see my genitals as clearly – maybe it’s my current dick, just a little bigger than it is right now? But because that picture is less clear, the gap between it and the reality of my body can’t hurt as much. It’s an act of self-preservation, in a society where accessing healthcare as a trans person is treated as a privilege you have to earn rather than a basic human right.¹

I won't make a decision until I've had top surgery. The overwhelming disgust I feel about my chest makes it harder to figure out how I feel about the rest of my body. I don’t feel the same feeling that my body is alien about my genitals… right?

Or have I just got used to coping with it?

With the bottom growth I’ve had, I can now jerk my dick off in a way that feels deeply hot and affirming. I can’t come that way, but even though it takes me a long time to reach an orgasm nowadays, they're more satisfying when I do get there. I feel more grounded in my body when I have sex – fucking is more pleasuable, in part because I’m more comfortable with my body, more present with my partners. More confident in who I am and what I want.

Nowadays I fondle my balls (technically my labia) as a way to stim and feel connected to my body. It’s the most comfortable I've ever been touching my junk. I have vaginismus, so while I no longer keep my underwear on during sex, I still flinch and tense up when a partner’s fingers drift a little too close to my front hole.

I've never had penetrative sex of any kind; I've never used tampons. It’s one of the reasons – along with my autism and my transness – that I spent years thinking I was broken.

I don’t think that anymore. Men typically don’t have two holes for penetrative sex, so why would I see my body as broken? To be clear, I know lots of trans men and trans masculine people enjoy vaginal sex, and I love that for them – I’m just no longer interested in viewing my body as something that needs to be 'fixed'.

But I've spent more than two decades being scared of my own body, scared of my vagina. What would it feel like not to be scared anymore?

I’m not making a choice today. I’m not planning to make a choice until I’ve had top surgery and experienced the recovery process from major surgery. I’m under no illusions that the process of getting top surgery will be easy, I just know that – for me – all the discomfort will be worth it. And phalloplasty usually takes at least three surgeries; I genuinely don’t know if I could do that.

But today I’m letting myself wonder what it would be like to have a dick between my legs that would let me use urinals. A dick that would even get hard in the way it does in my head when I picture myself jerking off. I can cope with my vagina, but what if I let myself want more than that?

Wanting a penis isn’t about my fragile masculinity or about upholding cisnormative ideas about what male bodies “should” look like. It’s about what would make me happy, what would feel good. It’s about imagining a world where trans people don’t only survive but get to thrive.

It’s a truth universally acknowledged that trans healthcare in the UK is fucked, but what if it wasn’t? What if people could actually expect our basic healthcare needs to be met? How good could it feel? I’m curious – and I’m afraid that curiosity will lead to me wanting something I can’t have.

It’s scary to let myself imagine how good it could be.