Penile prosthesis in transgender males: A narrative review

Penile prosthesis implantation plays a crucial role in gender-affirming surgery (GAS) for transgender men, helping align physical traits with their gender identity. Phalloplasty, which involves creating a neophallus, often includes penile prosthesis implantation to restore erectile function and enable sexual intercourse.This non-systematic review analyzed studies from PubMed and MEDLINE databases (2000-February 2025), focusing on original studies, excluding animal models and non-English studies. The review explores the types of penile prosthesis, surgical techniques, patient outcomes, and complications.The three main types of penile prosthesis are the two-piece inflatable, semi-rigid (malleable), and three-piece inflatable. The three-piece inflatable prosthesis is most commonly used in transgender men due to its natural erectile and flaccid states. While inflatable devices offer superior functionality, they are more prone to complications such as mechanical failure, infection, and device migration. Malleable prosthesis, though easier to implant and less prone to failure, can cause discomfort and esthetic issues due to their semi-rigid state. Functional success rates for penile prosthesis implantation in transgender men range from 70% to 85%, with high patient satisfaction despite complications. Psychologically, implantation often reduces gender dysphoria, improving self-esteem and sexual function. However, unique challenges remain, such as scarring and the absence of erectile tissue in the neophallus.Advancements in prosthetic design, surgical techniques, and tissue engineering aim to reduce complications and enhance both the physical and psychological well-being of transgender men.