Hysterectomy, the surgical removal of the uterus, is a procedure that many trans men consider as part of their transition process. We want to help you understand the procedure, its implications, and considerations if you're thinking about or preparing for a hysterectomy.
What is Hysterectomy?
Hysterectomy is a surgical procedure to remove the uterus, and can include removing the cervix, ovaries and fallopian tubes. It's a common procedure in the field of gynaecology, and comes in a few forms.
Types of Hysterectomy
Total Hysterectomy: Removal of the uterus and cervix.
Partial Hysterectomy: Removal of the upper part of the uterus, leaving the cervix in place.
Radical Hysterectomy: Removal of the uterus, cervix, the top part of the vagina, and surrounding tissues. This is usually done when cancer is present.
Oophorectomy and Salpingectomy: Removal of the ovaries (oophorectomy) and/or fallopian tubes (salpingectomy), which can be performed alongside a hysterectomy.
Reasons for Choosing Hysterectomy
- Alleviating gender dysphoria by removing organs that are not aligned with their gender identity.
- Reducing the risk of certain cancers, especially if there’s a family history or personal health concerns.
- Ending menstruation, which can be a source of dysphoria for many trans men.
- As needed alongside other gender-affirming surgeries like phalloplasty or metoidioplasty.
Procedure Overview
Hysterectomy can be performed through various surgical methods, depending on your personal health factors and the surgeon's preference and expertise. These include:
Abdominal surgery: an incision made in the upper pubic area to remove the uterus.
Laparoscopic surgery: also known as keyhole surgery – a small incision is made and mirrored scope is used to see inside rather than making a larger incision.
Vaginal surgery: no incision is made, the procedure is carried out via the vagina. This requires less recovery time, time in hospital and usually has a lower cost.
Recovery and Aftercare
Recovery from a hysterectomy varies but typically involves a hospital stay followed by several weeks of rest. Individuals need to follow aftercare instructions given by their surgeon to prevent complications and ensure proper healing.
Potential Risks and Complications
There are risks involved in any surgery. These include infection, bleeding, and reactions to anaesthesia. .
Impact on Fertility
A hysterectomy ends the possibility of pregnancy. There are options for fertility preservation, which you can read about here.
Psychological Considerations
While it can alleviate gender dysphoria for many, a hysterectomy can also be a source of grief or loss for others. Support from mental health professionals, peer support groups, and the trans community can be invaluable.
Eligibility Criteria for Hysterectomy in Trans Men
Eligibility for a hysterectomy as part of gender-affirming surgery for trans men is determined based on a combination of medical guidelines, individual health factors, and psychological readiness. If you want a surgery referral letter from us, we'll help with the assessment. You'll also need to have a conversation with your surgeon before the surgery.
Medical Guidelines
Most healthcare systems and surgical centres adhere to standards set by professional bodies like the World Professional Association for Transgender Health (WPATH). Key guidelines typically include:
- Persistent, Well-Documented Gender Dysphoria: This is usually established through consistent and ongoing evaluations by mental health professionals.
- Capacity to Make Fully Informed Decisions and Consent for Treatment: Individuals must demonstrate an understanding of what the surgery entails, its risks, benefits, and the impact on their life, including fertility.
- Age of Majority in Given Country: Individuals must typically be of legal age to undergo elective surgeries. In some regions, younger individuals may access surgery with parental consent and a thorough psychological evaluation.
- Reasonable Control of Any Medical or Mental Health Concerns: While not requiring perfect health, it’s important that any existing medical or mental health conditions are reasonably well-controlled. This ensures that individuals can safely undergo surgery and handle the changes that follow.
Insurance and Funding Considerations
Some public health services and insurance providers may not fund hysterectomy for gender-affirming purposes.
The extent of coverage for gender-affirming surgeries, including hysterectomy, can vary widely between different areas. In some regions, these procedures are fully covered, while in others, they may be partially covered or not covered at all.