Given that in the last post I quickly glossed over the fact that I have a major surgery scheduled in less than a week, I wanted to address a few details surrounding my decision and the whole process of having a hysterectomy.
What procedure am I getting?
A total laparoscopic hysterectomy, non-robotic to avoid an extra scar. All of my organs except my ovaries will be removed, so I am not getting an oophorectomy. It’s an outpatient procedure under general anaesthesia, meaning I go into the hospital in the morning, take a quick nap, wake up and go home the same day. Expected recovery time is a week or two.
How much will it cost me?
A hysterectomy can be expensive, from surgeon’s fees to hospital fees. For that reason alone, I would not be undergoing this procedure unless it was covered by insurance. In my case I’ve been assured it is. In total I’ll play less than $1K.
What was the process for scheduling the surgery?
After doing a lot of medical research, I then started searching for trans-friendly gynecologists in my area: browsed the online listserves, asked my therapist, my primary physician, and other doctors at local trans-friendly clinics like Lyon-Martin and Dimensions. I found 2 surgeons in the Bay Area that caught my eye, though there are plenty more. My choice was primarily based on convenient location, a website that lists FTM patients, and referrals from more than one person.
During the consultation, the surgeon discussed my options very openly, addressing both my physical questions as well as my concerns surrounding insurance. The office has dealt with many FTM, genderqueer, and trans* patients before, so they know how to address you, that your insurance card will likely be under a different name (and gender), and even have inclusive forms to fill out. The experience was overall very welcoming!
Although initially my idea was to tentatively “see what’s out there” the surgeon was eager to schedule something right away, which I did, so as not to give myself a chance to over-think it, which I usually end up doing anyway.
Why am I getting a hysterectomy?
Because I want to, is the simplest answer. But if you know me well, which by now a lot of you do, you’re going to point out that for any decision I always make a detailed list of reasons.
The Short List
- No more monthly periods, forever and ever and ever
- No sense in keeping organs I’m never going to use, and that could potentially develop cancer and other diseases. I’m absolutely sure I do not want to utilize these organs in the way they were intended (ie, bearing babies)
- My hormonal composition won’t be affected, since I’m keeping my ovaries
- I can still harvest my eggs in the future (for future Littler Awesomes!)
- It’s a relatively safe and common procedure
- Minimal scarring
- Nearly free
The Long List
First getting pregnant is not something I ever imagined myself doing; this was true even before I even knew I was trans. So in that sense, it’s straightforward.
But also, in a weird sense, I do feel this is something I need to do as part of my transition. Nobody sees your internal organs, nobody knows they are there or not. Yet, as with every step so far, I do it purely for myself, because I feel it’s what I need to do, because it feels right.
The organs I still might want someday – ovaries containing my genetic material and natural hormone factory – I’m keeping. This was my primary concern when beginning to look into it, as I do not plan to continue testosterone HRT in the long term, and I’d rather avoid hitting menopause at 26.
I knew that hysterectomies were linked to hormones, in some way, but I did not quite understand how. No matter how much research I did, there was nothing clear on hormones, specifically in my situation. Moreover, nobody could tell me what would happen if I removed hormones from my body entirely – that is, remove the ovaries and not take T.
It turns out (after asking many doctors, and doing some super sleuthing) your body needs a primary sex hormone, be it E or T. Otherwise, you induce menopause. Primarily, this has serious consequences for bone health (and other stuff nobody really knows about or can specifically point out). I’ve also learned that a hysterectomy is not an “end all be all,” and you basically pick and choose which parts are taken out and which parts you keep. (Worry not, there will be more detailed medical information in an upcoming article or two.)
Lastly, gynecology is not a new field. Half of the population regularly visits a gynecologist, and a hysterectomy is nothing revolutionary. In fact, it’s the 2nd most common surgery among women in the US. My surgeon assured me her complication rate was extremely low to non-existent. Sure, it’s still major outpatient surgery, but the laparoscopic techniques cuts down on recovery time, from 6 weeks to 6 days, with only tiny scars. I’m young, I’m resilient, and I don’t have other obligations right now preventing me from taking it slow for few weeks.
What made me finally decide to do this?
Did I hesitate? Of course. You know me: doubt and I are close frenemies. In the end though, I couldn’t find a compelling reason NOT to do this.
I discussed it with my significant other, and with my therapist. This is something that had been brewing in the back of my mind for a while, something that I saw myself doing… soon-ish. The only surprising part was that soon became now quicker than I expected.
Disclaimers
I’m not a medical professional and I possess no formal medical knowledge. This summary is a layperson’s understanding of personal research. It may or may not be accurate.
Due to discussion of transgender related surgeries and insurance, I’m refraining from connecting this with any specific surgeon’s name, just to be safe. Feel free to contact me for names.
(*) Please take note that I abstained from using much abused and cliché titles, such as my Hysto-story, my Hystory, Hysteria, or Hysterectify, among others. This type of restraint deserves a little praise.
Thank you for this post! I think it is really helpful. I didn’t know it was possible to get the uterus out but keep the ovaries. And I am glad to know that now, so I can look into it if that would be available in my country as well. Because I want my uterus be gone for the same reasons as you listed, and since I am not planning to get on testosterone I don’t want to get into the menopauze either (and risk a low density in the bone minerals).
So thanks very much for posting this. And good luck with your surgery!
In countries with a different healthcare system it might be trickier. It comes down to working with a doctor that supports you. The better informed you are, the more you can push for what you want. In any case, you can complain endlessly about severe cripplingly painful cramps. I will address this a bit in a later post.
All the best; I hope it all goes well for you…!
This might be the best news I’ve gotten all month. I too was aware that hysterectomies were linked to hormones and was lead to believe that they induce menopause without hormone replacement, so I had given up on the idea of ever being able to get my uterus removed without it having severe negative effects. I was going to settle for a tubal ligation, but after this I’m so excited, I can actually get a surgery that would give me all of the things I want with none of the shitty side effects I don’t want.
It isn’t talked about much in transmale communities, and it’s usually assumed you will be on T (and few people blog about it as excitedly or document it as thoroughly as top surgery). The cis-women who have usually it do it for other reasons with other factors involved.
It was very difficult to find all the information and questions I needed, so I’m preparing a few informational articles as follow-up to summarize my research.
first off, i’m stoked for you! congrats, cat! <3
also…so.much.want. didn't know this was possible, but i officially want to get this done. first you inspire me to really, truly consider top surgery (i think i was too scared to consider it before i started reading about your experiences), and now you go and tell me i can get my inside junk ripped out without messing with my hormones. yay! seriously, thanks for this post!
and take care of yourself. <333
Congratulations! I hope you hace a speedy recovery! Ive read your blog for a long time but never commented. This is maybe a question for a gynecologist and not you, but if you have ovaries and no uterus, what happens to the eggs you would normally be ovulating? Does having extra eggs hanging around up cancer risk? (in my head i think I’m thinking of PCOS and cysts caused by not fully ovulated eggs). This isn’t to scare you as I have honestly no idea about the answers yo my question, I’m just curious as I research possible medical aspects of transition for myself.
It’s a valid question, and one I did ask because I’d consider harvesting my eggs in the future. Basically the regular ovulation cycle continues to occur, as normal. There’s just nowhere for them to go, and no tissue to build up (thus no bleeding). Additionally, the ovaries have their own artery serving as a separate blood supply apart from the uterus, so they can stay healthy and operating.
Hi there, longtime lurker here. I’ve followed a parallel path to you: top surgery first, then low dose hormones with the intent not to stay on forever. I too had a laparoscopic partial hysterectomy (keeping the cervix for structure, and ovaries as “back up” hormone producers)). My surgeon was also in the Bay Area. I’m even Jewish, and short/petite. Anyhoo, word to the wise: beware that the recovery takes longer than you think. True it is WAY less invasive than an old-school hysto; but you do need to allow time not just to recover from the anaesthetic, but for your body to adapt to its new configuration. You have to take extra care with your abdomenal area, no lifting for like 6 weeks and no exercise that would affect your abdominal region! Also: when the uterus is removed, one of two blood supplies to the ovaries is severed, so some people experience a brief “ovary shock” where their ovaries simply stop and they have menopause-like symptoms before kicking in again. That happened to me. I wasn’t on T yet at the time (my order of events was: partial hysto; top surgery; T). I got hot flashes and mood swings for a few days then everything back to normal. You should take care with your hormonal regime–I don’t know what dose of T you’ve been taking, or whether it’s enough to overpower your ovaries, but this is something to be aware of. Good luck!!
Ps something unrelated, sort of, that you might like to share with your readers: my endocrinologist warned me that T and prednisone (and certain other steroids) don’t go we’ll together and can induce mania! Since I’ve never had to use those things, it hasn’t been an issue for me and I never did ask her to explain in further detail. But I’ve never seen this discussed in any of the fora online and it sounds like something worth putting out there for people. Thanks
The pro of keeping the oeairvs when having a hysterectomy without subsequent hormone replacement therapy would be support of the bones. Basically, removal of the oeairvs will put the individual into immediate menopause. Without hormone replacement therapy (testosterone), there won’t be any hormonal support for the bone and osteoporosis could result. However, the rate of the loss of bone mineral density in this scenario would depend on the age of the individual, their genetics, their activity level and their diet (i.e. whether it’s adequate in calcium and Vitamin D). Exercise and diet can help maintain bone mineral density in the absence of hormonal support. (See my blog posts on bone health in trans men.)
That’s correct, and you’d be surprised how long it took me to find this sort of information. I’m doing a more formal article on all of this later.
Just found your blog through Neutrois.com
First, good luck and good health with your surgery.
Second, budget way more than six days for recovery. Results vary widely among patients, but for example I had my TAH with single oophorectomy four months ago and am still an achy swolly post-op gimp. My partner’s sister-in-law had a less invasive version and went to work after four weeks, and it wiped her out every day for a few weeks since it was a bit too soon. Your mileage will necessarily vary, since all bodies react a smidge differently, but be prepared for a much longer recovery time and you may be pleasantly surprised, rather than expecting to be normal again in a few weeks and being disappointed.
Take it easy, take care and let somebody take care of you for at least a few days, bringing you soft foods and lots of liquids while you lie around. Cheers!
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Very informative… thanks for this.
How did you manage to get it covered by insurance?
I’m writing a series of articles on all the ways you could go about this. In the meantime you can email me and we can explore some options.
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