Well of course they can’t actually create a vagina, but the fake one is “better” if they have more of the skin of the penis. Basically they create a type of hole. Which is like an open wound. This then constantly tries to heal, so closing, and the boy has to insert a type of dildo into it every day to keep it from closing up. This is what they did to Jazz Jennings. Because of the hormones Jazz had to have several corrective surgeries as the first one was a disaster.
After the surgery the trans person discovers that hetro men are not interested in them because they are biologically male with a fake vagina, gay men like penis so they are missing that, lesbians don’t consider them a woman. They can’t reproduce, and quickly learn it’s not all rainbows and unicorns.