Tired of Getting Shafted, This Man Is About to Get the Dick of His Dreams

Andrew Wardle is a man without a penis. He was born with a biological anomaly called bladder exstrophy, a condition in which the bladder forms on the outside of the body. In Wardle's case, the health problem prevented penile development. Now middle-aged, Wardle may undergo a phalloplasty, a procedure that will give him a more typical male body, on his new TLC show Man Without a Penis.

Wardle's case draws striking similarity to the experiences of transgender men who consider genital reconstruction. Many female-to-male transsexual patients struggle with the absence of typical male genitalia. Gender dysphoria is the medical diagnosis for transgender people, and trans people typically experience some degree of persistent mental anguish because of the discordance between their gender identity and physical body. Wardle's case shows how gender dysphoria also affects cisgender people: Wardle, who is otherwise "biologically" male, relates his gender to his body. As in transgender health care, altering Wardle's body is meant to positively impact both how he portrays his social role and his mental health.

Phalloplasty is a gender-affirming procedure regardless of whether or not it is being performed on a man who was born female or a man who was born male, like Wardle; in other words, it's typically the same whether or not you're trans. If performed adequately, the operation will provide the patient with a penis that is both cosmetically satisfactory and functional.

Dr. Harold Reed works as a specialist in genital reconstruction for transgender patients. He routinely performs vaginoplasty procedures on male-to-female transgender women, but his urology training gives him a thorough understanding of phalloplasty as well. Over the phone, he explains how the forearm is one of the most common donor graft sites for this procedure. "It's a cutaneous flap, but also a neurological and vascular flap," he says. "[Surgeons] try to connect the nerves of the forearm material—one to a femoral cutaneous nerve and the other to, hopefully, a dorsal penile nerve or a clitoral nerve. The idea is to provide erogenous sensation to the entire graft. What often happens is patients may have some sensation at the base but they don't have it distally. Patients often don't have enough erogenous sensation to induce orgasm."

Reed says it's also possible to use a flap from a patient's lower abdominal skin, swing the skin around, and tubularize it to form a penis with it. Doctors use the nerve endings in transgender men's clitorises to give the penis sensation, but in cisgender men the procedure makes use of the nerves using whatever minimal development of penile tissue the patient has. If there's absolutely no development, surgeons go for the pudendal nerves, which stimulate the perineum and anus from deep within the body.

Doctors expect certain results from the surgery. "The person should have a stand-to-void result, as opposed to urine coming out of an opening in the perineum and the penis just hanging down like skin but being incapable of conducting urine," Reed explains. "The patient would also probably want the wherewithal to penetrate, so the phallus has to have the capability of becoming erect." According to Reed, this can be accomplished with a penile implant or, if the patient has substantial penile development, their own tissue.

There was a time in history when someone like Andrew Wardle might have been raised as a girl. Most notably, controversial sexologist Dr. John Money specialized in identity and the biology of gender throughout the second half of the 20th century. He conducted experiments on children with atypical genitalia, operating from the Johns Hopkins Gender Identity Clinic he founded in 1965. Money's most famous case is that of David Reimer, a boy who endured a botched circumcision at birth. He lost his penis and was subsequently raised female. Any remnant of his genitalia was surgically removed, and a number of procedures were planned throughout the next several years to build him a vagina.

Dr. Money didn't consider remaking the child's penis—in the 1960s and 1970s, phalloplasty technology was very limited. The procedure was considered far more challenging to accomplish than vaginoplasty. Plus, Reimer provided a useful lab rat to test Money's social constructionist theory. Dr. Money theorized that gender is purely a social construct, so by raising a biologically male child as a female, and providing him with approximate female anatomy, Money thought "she" would consider herself a girl.

The tragedy came when Dr. Money's subject did not identify with his female body; during Reimer's adolescence, he discovered the truth. He made the willful decision to transition back into a boy, eventually undergoing phalloplasty. Reimer ultimately ended his own life after decades of suffering with mental illness related to his treatment by Dr. Money. The same sort of "corrective" procedures were once forcibly performed on intersex infants, with similarly devastating results. Children whose genitalia does not resemble typical male or female anatomy have long been subject to reconstructive surgery meant to normalize them.

"It's now known to be psychologically improper to try and convert someone born as a male into a female [even if someone isn't perfectly developed]," Reed says. "Later on as they develop, there's a very good possibility they will mourn or rue that day they were converted into a female because they still have the mentality of a man."

Along with the historical precedent set by Reimer's case, Reed's statements affirm the idea that gender is a mental reality, an innate understanding of oneself in relation to their body and society. Andrew Wardle, for instance, has always seen himself as a man, even though he doesn't have a penis: He is a man regardless of his genitalia. Perhaps his story will help individuals seek the medical treatment they need to live comfortably in their own skin, without obstacles from society or external factors amplifying mental anguish.