Ray had carried his unseen injury for years—always furtive, always anxious, always wondering how anyone who found out might react. Having lost both legs in the blast didn’t bother him that much; Ray often left the house in the summertime wearing shorts, his prosthetics shining in the sun. But his other injury? Aside from his parents, hardly anyone knew—not even the guys he went to war with.

For men like Ray who lose their genitals, the usual treatment—if there was any—was phalloplasty: a rolled tube of tissue, blood vessels, and nerves taken from the forearm or thigh and transplanted to the groin, an ersatz penis that needs an external pump to get erect. When he first met with plastic surgeon Richard Redett, an expert in genital reconstruction at Johns Hopkins Hospital in Baltimore, phalloplasty was what he was offered. But soon after, Redett decided Ray could be a candidate for one of the world’s first full penis transplants. Not a crude substitute; the real thing.