Hysterectomy for FTMs, part 2

This 3-part series of articles aims to dissect all aspects of a hysterectomy, specifically covering the needs and questions of transpeople who are interested in the procedure.

In the first article, we covered What is a Hysterectomy. In this article we’ll go a bit more in-depth about the pro’s and con’s of having one versus not, and address some common misconceptions.

Why Get a Hysterectomy

First of all, your body is your body. This is a very personal choice with lots of factors to consider. Unless it is medically necessary, do it only if you want to.

Moreover, your body is your business. It’s not something you should be pressured into doing. Nobody sees your internal organs, nobody knows whether you have them or you don’t.

Reasons to Get a Hysterectomy

  • Some trans* people simply feel icky knowing certain parts are in there. This can be a very affirming surgery gender-wise. In some cases, it is considered bottom surgery, which could even be used to support a legal transition.
  • Half of the population regularly vists a gynecologist, and hysterectomies are a fairly common procedure. So it’s most definitely not something new and scary that nobody knows how to do, and skilled surgeons are not a scarce resource.
  • Having it done laparoscopically means minimal recovery time and scarring.
  • While not even cis-women jump for joy every month when they get their period, the recurring experience can be especially distressing for trans* people. Being relieved of this for the rest of your life can be a blessing.
  • Reproductive healthcare involves doctors seeing and touching areas which the very thought of might make a trans* person very uncomfortable. A hysterectomy makes (most of) these checkups unnecessary.
  • The risk for contracting cancers, cysts, fibroids, and other undesireable medical conditions is greatly reduced or entirely eliminated (this depends on what you take out and what you leave in).
  • There’s a big chance of getting it covered through insurance.

Reasons Not to Get a Hysterectomy

  • Some trans* people couldn’t care less about these parts. To reitrate, your body is your business, and nobody can tell if you have a uterus or not.
  • If you’ve been on T long enough, and plan to remain on it long term, periods are a thing of the past.
  • Surgery, regardless of technique, is invasive and does carry risks.
  • You must be absolutely sure you do not ever want to get pregnant (there are transmen, genderqueer, agender, non-binary, and otherwise transmasculine people who decide to carry children.)
  • If you opt for an oophorectomy (removal of ovaries) as well, you will be entirely sterile. Either way, this will affect your ability to reproduce.
  • It can be expensive if not covered by insurance.
  • You’re considering a hysto, but prefer to wait and combine it with another bottom surgery, such as a vaginectomy, or more commonly a metoidioplasty or phalloplasty.

Hysterectomy and Hormones

There is plenty of mis/information around hormones and hysterectomies. So let’s go over some of the myths and misconceptions and clarify them.

Testosterone and Estrogen

You can choose to keep your ovaries. This means your body will continue to produce estrogen naturally. The implications of this vary, depending on your unique gender goals.

If you do remove the ovaries (an oophorectomy), you will surgically induce menopause. Unless you’re already at or near menopause age, you will need to be on long term HRT – either testosterone or estrogen. It is not advisable for your body to be devoid of a primary sex hormone, primarily to conserve essential bone health. (Check out an article by American Trans Man for a more scientific look at this.)

If you opt to keep the ovaries, it’s not necessary to be taking Testosterone, or be on it long-term, in order to consider a hysterectomy. Which is a nice option to have for a lot of people.

The benefit of an oophorectomy is that your body will require less Testosterone afterwards, which can be a welcome change. Also, some people do not like having estrogen in their body, either physically or mentally or both.

However, some post-oopho transpeople end up supplementing their T intake with low doses of estrogen in order to maintain hormonal balance. Since this is not frequently talked about among transmen, there isn’t a lot of information. Just remember that hormones affect a myriad of bodily functions, including metabolism and mood. Plan on monitoring your hormone levels until you feel back to normal, and keep an eye out for the possibility of taking estrogen post-oopho.

PCOS

There is a possible increased risk for developing PCOS (Polycystic Ovary Syndrome) correlated with high androgen levels. In other words, taking Testosterone might increase your chances of developing PCOS, which is one reason many consider removing their ovaries.

If you already know you are at risk – say, there is a family history of PCOS – then this potentially puts you more at risk. (Of course, if you have no idea what your risk levels are to begin with, then it’s hard to say.) Also note that this only applies to prolonged exposure to androgens – that is, taking Testosterone long term. If you take T short term, this very likely doesn’t apply. Now, what is short term and long term nobody knows, and T may not be the only factor contributing to PCOS.

The only conclusion I can draw is that there is nothing conclusive yet. None of this has been proven one way or another. There’s simply not enough formal research and a large and varied enough sample size to issue a definitive statement.

This doesn’t mean it’s not true either. But you shouldn’t be scared into surgery, as many people are. Evaluate your unique individual risk factors: chances for developing PCOS, as well as uterine cancers, fibroids, or other medical conditions, in addition to everything else, as you make the overall decision of whether or not to remove your organs.

As always, do your research.

Reproduction

If you leave in your ovaries, you are also left with the option of harvesting eggs in the future, giving you the chance to genetically reproduce, should you wish to do so.

Alternatives

If you are not on Testosterone, and you’d like to get rid of your period (and in some rare cases, menses don’t stop even when on T), there are alernatives you can explore. Consider these also if you experience painful cramping or heavy bleeding.

Endometrial ablation is an outpatient operation that destroys the uterine lining. In 90% of cases it reduces flow, and only in 45% of cases does it stop it altogether. Birth control is another way to help control or reduce painful periods. However, this method involves hormones which can cause undesired side-effects. Ask your doctor about all the possibilities.

Up next…

In the next articles we’ll hit the ground running with a step-by-step list for scheduling your hysterectomy, and some notes about insurance.

Resources

Disclaimer

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.

12 responses to “Hysterectomy for FTMs, part 2

  1. Hi! I was diagnosed with PCOS last year and I’ve been considering getting a hysterectomy after being on testosterone for a few months. I’ve spent a lot of time researching but there just isn’t a lot of information for transmasculine people who had PCOS before transitioning – what would you recommend? I’m making the assumption that a hysto-oopho and testosterone therapy would relieve most of my PCOS symptoms such as painful periods, bloating, etc, but would it jump start my metabolism? I live in an area where there’s no medical professionals who specialize in treating trans people so I’m also in the position of educating my doctor. Do you have any advice?

    • There isn’t a lot of info about PCOS in general, much less for trans* people. If you’ve already been diagnosed, then I’d strongly consider a hysto + oopho. It will obviously get rid of your symptoms because, well, the parts aren’t there anymore.

      Afterwards, you will need some sort of HRT for the rest of your life. If you plan on being on T, then you’ll likely require a much lower dose than now (but keep in mind you can balance it with estrogen, should you not feel well with just testosterone). Otherwise, you can take estrogen replacement.

      As for doctors, a GP or endo can help, it doesn’t have to be a trans-specialist. From personal experience, plenty of endocrinologists don’t know how to correctly diagnose hormonal stuff, even under “normal” circumstances. Find someone who is willing to figure it out, and hear you out. Cis-people deal with all sorts of hormone imbalances, this would be one more variation of many.

      My best advice is: always listen to your body – if you’re still not feeling well, keep tweaking things until you are.

      (NOTE: this is my personal opinion, I’m not a medical professional in any way)

  2. Pingback: Hysterectomy for FTMs, part 3 | Neutrois Nonsense·

  3. A couple considerations: oopherectomies apparently increase the patient’s general mortality rate by, in my opinion, a terrifying percentage. The reasons for this aren’t understood, but this information was enough for me to do a complete 180 on my old, non-trans* related oopho plans.

    As for birth control (and I know you are ace, so you may understand where I’m coming from with this), the drastically reduced libido was, after a lot of struggling with it, an ultimately positive side effect for me, and I hope to continue taking it after I get my hysto.

    • I don’t know why oophos increase mortality rate – my guess would be not supplementing it with HRT, which you need to.

      From what I’ve read, everybody reacts differently to birth control – both physically and psychologically. I’ve never been on it so I don’t know more…

  4. FYI – sometimes even if you keep your ovaries, they stop working/stop producing sufficient hormones after a hysterectomy. [This may be due to decreased/interrupted blood supply – it seems like they don’t know for certain why it happens.] From skimming the literature, I don’t think it’s a HUGE chance, but it’s something to be aware of when weighing different options. Here is one study: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3223258/

    • Interesting info, thanks for linking to that study.

      From what my surgeon told me, the ovaries have two main blood supplies: one from the uterus, one not, so they are in theory supposed to still function normally. Of course, each body may respond differently.

  5. Pingback: MTN Transition | Neutrois Nonsense·

  6. Thanks so much for this information, it’s really helpful as I’m researching a possible hysto for myself. In your research, did you find other risk factors besides possibly increased chance of PCOS in terms of the interaction between the uterus+ovaries, or just the ovaries, and testosterone? How much medical justification is there, beyond feelings of dysphoria, for someone taking T to seek a partial or full hysto?

    • There are a lot of other reasons to get a hysto, such as heavy or painful bleeding, fibroids, or cancer, though these are unrelated to testosterone or dysphoria.

      However, I’d argue that dysphoria is “medical” justification given the mental health and physical pain it may cause (although for insurance you might need an alternate reason).

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