The World's First Trans Phalloplasty

Phalloplasty has come a long way since it was first performed in the 1940s. What must it have been like for that first Phalloplasty patient to undergo the surgery, without any peer support, Facebook groups or academic studies to quell fears and uncertainty? Without a doubt, he must have been a determined and courageous man. So, who was he? Take a few minutes to learn about trans trailblazer Michael Dillon and the origins of Phalloplasty.

Laurence Michael Dillon (May 1, 1915 – May 15, 1962) was a British physician who despite being born female-bodied sincerely felt that he was a man. In 1939, he sought treatment with Dr. George Foss, who provided Dillon with oral testosterone tablets. It's believed that Dillon was the first FTM individual to use testosterone therapy.

While in the hospital for a head injury, Dillon connected with a plastic surgeon, a rare specialty at the time, who performed a double mastectomy for him. It's quite likely that Dillon was also the first Top Surgery patient. This surgeon put him in touch with Dr. Harold Gillies, who performed Phalloplasty surgery for injured soldiers of WWII.

In 1946, Gillies agreed to perform Phalloplasty for Dillon, and from 1946 to 1949 Gillies performed at least 13 surgeries on Dillon. This method of Phalloplasty became known as the Gillies Technique.

Phalloplasty according to Gillies using an abdominal tube-within-a-tube bipedicled flap.
Source: Ranno, R. Phalloplasty [pdf]

Developmental History of Phalloplasty

While Gillies was the first to use the procedure for a trans patient, his method has its roots in an earlier type of Phalloplasty developed by Dr. Bogoraz (sometimes spelled "Bogoras.") Bogoraz' bipedicled abdominal tubed flap Phalloplasty was based on the use of a single abdominal tube and was a multi-stage technique requiring secondary construction of the neo-urethra. The technique was improved on by Dr. McIndoe and Dr. Maltz before Dr. Gillies popularized it.

The Gillies Technique was simply a flap of abdominal skin rolled into a tube, with urethral extension being another section of skin to create a "tube within a tube." This type of Abdominal Phalloplasty was the standard for many years before the first pedicled and free flap Phalloplasty techniques emerged in the 70s and early 80s. Abdominal Phalloplasty is still performed today by surgeons in the UK and the US. The Radial Forearm Flap Phalloplasty also has its roots in the Gillies Technique: the "tube within a tube" approach was incorporated into the Chang-design and Gottlieb-design RFF Phalloplasty methods in the 80s.

Modified Chang-design RFF Phalloplasty - Tube-Within-a-Tube

Dillon's Later Life and Death

Unwanted press attention to his aristocratic background led Dillon to flee to India where he immersed himself in Buddhist studies. He then moved on to Ladakh, where he was ordained a novice monk and took the name Lobzang Jivaka. He devoted his time to Buddhism and writing, and published four books on Buddhism, including The Life of Milarepa about the famous 11th century Tibetan yogi. In 1962, his health started to fail and he died in a hospital in India at age 47. While Dillon/Jivaka died before becoming a monk, his novice ordination was significant: It made him the first white European man to be ordained in the Tibetan Buddhist tradition.

Dillon's memoir, Out of the Ordinary: A Life of Gender and Spiritual Transitions, was published in 2018, more than 50 years after it was written. Out of the Ordinary recounts his various journeys-to Oxford, into medicine, across the world by ship-as well as his hormonal transition during World War II and his surgical transition under Sir Harold Gillies. He also chronicles his gradual shift from Christianity to esoteric spirituality to Mahayana Buddhism.

Dillon was clearly a pioneer and a man of many firsts. His courage to undergo the first trans Phalloplasty is underscored by the fact that there were literally no resources or support available to him. We owe him a debt of gratitude for opening doors for us to follow in his footsteps.

You can learn more about Michael Dillon in Pagan Kennedy's 2007 book, The First Man-Made Man, From a Girl to a Man: How Laura Became Michael by Liz Hodgkinson, and in the groundbreaking anthology, Hung Jury: Testimonies of Genital Surgery by Transsexual Men.

"Where the mind cannot be made to fit the body, the body should be made to fit, approximately at any rate, to the mind."

— Michael Dillon, Self: A Study in Endocrinology and Ethics (1946)