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1. Reconstruction of a functioning penis requires functioning erectile tissue. This tissue is stimulated by the erogonous receptors in the brain of normal males. Technology to date has not been able to replicate this nerve stimuli for born females and thus they must use a prosthesis to simulate erection.

2. Testes are not implanted as these will always carry the genetic code of the original male owner and thus is ethically prohibited worlwide. A prosthetic set is often used.

3. Laws, ethics and technology have advanced in such a way now that psychiatric assessments are now almost meaningless, and the surgery is becoming more readily available worldwide. As a result, a lot of people are bypassing crucial lifechanging help for a quick nip and tuck and some have been very disappointed with their transformation. Some even mention that there is no orgasmic sensation or a sex life anymore and become so depressed that they have committed suicide.

There are many articles on this subject. Some very horrific ones, much worse than mentioned here.

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Q: Why do more males become females rather than the other way around?
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