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<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN">
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<title>Hudson's Guide: FTM Hysterectomy and Oophorectomy</title>
<meta http-equiv="Content-Type" content="text/html; charset=iso-8859-1">
<meta name="description" content="Information about hysterectomy and oophorectomy options for FTM transsexuals and transgender people.">
<meta name="keywords" content="FTM, female-to-male transsexual, men, transgender, F2M, transexual, hysterectomy,
oophorectomy, hysto, hystorectomy, SRS, Sex Reassignment Surgery, transition">
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<h1><a href="http://www.ftmguide.org"><img src="images/hudsonsguidesmall.gif" alt="Hudson's FTM Resource Guide" width="700" height="56" border="0"></a></h1>
<h1><a name="top"></a>FTM Hysterectomy and Oophorectomy</h1>
<p><strong>DISCLAIMER</strong><br>
The information contained herein is to be used for educational purposes only.
The author is not a medical professional, and this information should not be
considered medical advice. <b>This information should NOT be used to replace
consultation with or treatment by a trained medical professional. </b>The listing
of a medication herein does not imply endorsement by the author. </p>
<p class="style1"><strong>UPDATED 7-19-2010</strong></p>
<p><a href="#intro">Introduction</a></p>
<p><a href="#why">Why have a hysterectomy/oophorectomy?</a></p>
<p><a href="#types">Types of hysterectomy and oophorectomy procedures</a></p>
<p><a href="#risks">Risks & Cost</a></p>
<p><a href="#resources">Resources</a></p>
<p><b><a name="intro"></a>Introduction</b><br>
Most (but not all) trans men will have at least one surgical procedure in his lifetime
related to gender transition, if not several of them. However, it is important
to note that many trans men do not avail themselves of the surgeries listed below
due to cost considerations, health reasons, or personal reasons. Currently,
most surgeries related to gender transition are not covered by insurance companies,
so costs can be prohibitive for many trans men of lower or fixed incomes.</p>
<p>FTM surgery is generally divided into three main groups:<br>
1. <b>Chest reconstruction surgeries</b> (also referred to as "top"
surgery or male chest contouring);<br>
2. <b>Hysterectomy</b> and <b>oophorectomy</b> (removal of the uterus and ovaries,
respectively); and<br>
3. <b>Genital reconstruction surgeries</b> (also referred to as "lower"
or "bottom" surgery or GRS).<br>
Within these three main groupings are different types of procedures and surgical
methods that will be further described herein.</p>
<p>This section describes the main types of <b>hysterectomy and oophorectomy</b>
procedures that are currently available to trans men. <a href="chest.html">Chest
surgery</a> and <a href="grs.html">genital reconstruction surgeries (GRS)</a>
are detailed in their own separate sections.</p>
<p>The descriptions of the FTM surgeries listed below are generalized. It is important
to note that there are different methods for performing a hysterectomy/oophorectomy
(sometimes referred to as "hysto" and "oopho" in FTM circles);
the procedure chosen will depend on the physical characteristics of the patient
as well as the expertise of the surgeon performing the procedure. If you are
considering any of these procedures, it is important to research your options
thoroughly and speak candidly with the surgeons you are considering.</p>
<p><a href="#top">back to the top </a></p>
<hr>
<p><a name="why"></a><b>Why have a hysterectomy/oophorectomy?<br>
</b>Some physicians recommend hysterectomy and oophorectomy within the first
5 years of starting testosterone therapy. There are two reasons for this. First,
there is some concern that long-term testosterone treatment may cause the ovaries
to develop similar symptoms as those seen in polycystic ovarian syndrome (PCOS).
PCOS has been linked to increased risk of endometrial hyperplasia (a condition
that occurs when the lining of the uterus (endometrium) grows too much) and
thus endometrial cancer, as well as ovarian cancer.</p>
<p>It should be noted that it is difficult to prove whether the risk
for such cancers is increased by testosterone therapy in trans men. Trans men are
a small population to begin with, and many undergo hysterectomy/oophorectomy
early on in their hormonal treatment, thus making the study of long-term effects of testosterone
on the uterus and ovaries difficult. Also, some trans men may have suffered from PCOS before beginning
testosterone treatment.</p>
<p>Because the relationship between long-term
androgen use and gynecological health is not yet fully understood, and because
many trans men experience embarrassment and/or access issues over obtaining
ongoing gynecological care, some may feel it is appropriate to pursue such surgeries
as a preventative measure. For more information on PCOS, endometrial cancer,
and ovarian cancer see the <a href="#resources">resources</a> section at the
end of this page.</p>
<p>The second reason why it may be considered beneficial to undergo a hysto/oopho
is that after the removal of the ovaries, testosterone doses can often be decreased
because the ovaries are no longer producing estrogen.</p>
<p>If a trans man chooses not to have a hysto/oopho procedure, he should continue to
have regular Pap smears (to screen for cervical cancer) and should seek out the
care of a doctor if he experiences any irregular vaginal bleeding (including
spotting), cramping, or pain. It is not uncommon for trans men who are pre-hysterectomy to
experience a buildup of endometrial tissue, especially during the first few
years of testosterone therapy. Endometrial tissue is normally shed during menstruation,
but since this process is usually stopped a few months into testosterone therapy,
additional tissue may continue to build up and may eventually begin to shed
in the form of spotting. Because irregular bleeding can be a sign of cancer
(though this is often not the case), trans men who experience any bleeding/spotting
should see a doctor who will perform tests to determine the cause of the spotting.
These tests may include an endometrial biopsy and/or an ultrasound. The doctor
may advise a short course of progesterone to cause the uterus to shed the excess
endometrial tissue-- this is much like inducing a period. While this may be
unpleasant, it should be understood as a preventative measure, since the unusual
buildup of endometrial tissue has been linked to endometrial cancer.</p>
<p><a href="#top">back to the top</a> </p>
<hr>
<p><a name="types"></a><b>Types of hysterectomy and Oophorectomy procedures<br>
</b>There are three main ways in which the uterus can be removed from the body:
either through an incision in the abdomen, vaginally through an incision
in the top of the vagina (sometimes assisted laparoscopically through small
incisions in the abdomen), or through a combination of tissue removal through small incisions in the abdomen as well as through the vagina. The type of surgery chosen will depend on the patient's physical
limitations as well as the surgeon's expertise.</p>
<p>Some surgeons who perform <a href="grs.html">genital reconstruction surgery
(GRS)</a> may wish to do a hysterectomy/oophorectomy at the same time as GRS.
If you are considering GRS, you may wish to fully research such options.</p>
<blockquote>
<p><b>Total abdominal hysterectomy (TAH)<br>
</b>This is the removal of the uterus and the cervix via an incision in the
abdomen. During the procedure, the surgeon will make an incision, either horizontally
or vertically, in the abdominal wall. The abdominal muscles will be spread
apart with retractors. The uterus and cervix are cut away from the surrounding
ligaments and blood vessels, and then removed by cutting them off at the top
of the vagina. The vagina is sewn closed at the top.</p>
<p>The surgical procedure lasts about 1 to 3 hours, and usually involves a hospital
stay of 3 to 5 days. Recovery is usually a 6 to 8 week period of restricted
activity. The procedure leaves a 4 to 6 inch scar on the abdomen, usually
just above the pubic hair line.</p>
<p><em>Because of the advances in laparoscopic surgical procedures, surgeons will often recommend less invasive procedures such as LAVH or TLH, listed below, if the patient is a good candidate. </em>Laparoscopic procedures generally involve smaller incisions, less scarring, shorter recovery time, and shorter hospital stays than abdominal hysterectomy.</p>
<p><b>Total Vaginal Hysterectomy (TVH)</b><br>
This is the removal of the uterus and the cervix via an incision in the vagina; all operating procedures are performed through the vagina. The uterus and cervix are cut away from the surrounding
ligaments and blood vessels, and then removed by cutting them off at the top
of the vagina. The vagina is sewn closed at the top.</p>
<p>Because there are no incisions made in the abdomen during TVH, the surgeon cannot easily access the abdominal cavity. She/he cannot examine for and remove endometriosis, she/he cannot perform the procedure if adhesions are present, and certain complications may arise if also attempting to remove the ovaries. Additionally, because TVH is performed entirely through the vagina, it is best performed on individuals who have vaginal laxity (i.e. a wide enough and flexible enough vaginal canal, as often seen after childbirth).</p>
<p>The surgical procedure lasts about 1 to 3 hours, and usually involves a hospital
stay of 1 to 3 days. Recovery is usually a 6 to 8 week period of restricted
activity. This surgery is not recommended if your vaginal canal is restricted,
as the surgeon will need space for instruments and for the removal of the
organs.<em> For a restricted vaginal canal, your surgeon may recommend TLH as an alternative option.</em></p>
<p><b>Laparoscopically Assisted Vaginal Hysterectomy (LAVH) </b><br>
This is similar to TVH above, but performed with the aid of laparoscopy. During the procedure, the surgeon makes several small cuts in the abdominal
wall to provide access for a laparoscope (a tiny telescopic camera) and other
small surgical instruments. The laparoscope is used by the surgeon to see
inside the abdomen during the procedure. The surgeon may perform some of the cutting procedures by working through the abdominal incisions, but other surgical procedures will still be performed through the vagina. The uterus and cervix
will be mainly removed through a cut at the top of the vagina, and then the vagina is
sewn closed.</p>
<p>The surgical procedure lasts about 1 to 3 hours, and usually involves a hospital
stay of 1 to 2 days. Recovery is usually a 4 to 6 week period of restricted
activity. This surgery is not recommended if your vaginal canal is very restricted,
as the surgeon will need space for instruments and for the removal of the
organs. <em>For a restricted vaginal canal, your surgeon may recommend TLH as an alternative option.</em></p>
<p><strong>Total Laparoscopic Hysterectomy (TLH)</strong><br>
Is the removal of the uterus and the cervix by operating through several small cuts in the abdominal
wall that provide access for a laparoscope (a tiny telescopic camera) and other
small surgical instruments. The uterus is removed by passing the tissue out through the vagina or through one of the small abdominal incisions. Because there is no operating performed through the vagina (though small pieces of tissue can be passed down through it), there is no requirement for a wide vaginal passage, and there are fewer problems with increased urinary incontinence at a later date. </p>
<p>The surgical procedure lasts about 1 to 3 hours, and usually involves a hospital
stay of 1 to 2 days. Recovery is usually a 2 to 4 week period of restricted
activity. Because there is no requirement for a wide vaginal passage and because this procedure involves less blood loss, lowered risk of urinary incontinence, shorter hospital stay, and shorter recovery time for most patients, TLH can be an excellent choice if it is available. Because TLH is a relatively new procedure, not all surgeons are necessarily skilled in its practice. Be sure to inquire as to your surgeon's direct experience with TLH, or with any type of surgical procedure you are considering.</p>
<p><b>Bilateral Salpingo Oophorectomy (BSO)<br>
</b> This involves the removal of both ovaries and of both fallopian tubes
(bilateral=both sides, salpingo=fallopian tubes, oophor=ovaries, ectomy=removal).
For trans men, this procedure will usually be performed at the same time as your hysterectomy.
Because the risk of ovarian cancer remains if the fallopian tubes are left
behind, both the ovaries and fallopian tubes are usually removed during this
procedure.</p>
</blockquote>
<p><a href="#top">back to the top</a></p>
<hr>
<p><b><a name="risks"></a>Risks & Cost<br>
</b> As with any surgical procedure, there are some risks that may occur. These
include bleeding, infection, problems from anesthesia, blood clots, or death
(rare). Some other problems that have been reported after hysterectomy include
irritable bowel syndrome, incontinence, damage to the urethra or bowel, prolapse
of the vagina, back pain, or loss of sexual feeling or function. Depending on the type of procedure you undergo, these risks may be more or less common-- speak directly with your surgeon about the risks of the specific procedures you are considering.</p>
<p>The cost of hysterectomy/oophorectomy will vary, but in general will run between
$7,000 and $20,000 in the United States (including surgery fees and related
hospital/staff fees). Because there is usually a hospital stay after the procedure,
and since hospitals charge by the day, this will effect the overall price depending
on the duration of the stay.</p>
<p>Hysterectomy is one of the few surgeries that trans men may be able to have covered
by insurance, if the procedure is shown to be health-related. If you are experiencing
pain or irregular bleeding, or if you have a history of abnormal Pap smears,
fibroids, or polyps, you may wish speak with your doctor about the possibility
of hysterectomy as a necessary procedure for insurance purposes.</p>
<p><strong><span class="style1">Was this page helpful to you?</span><br>
Please consider <a href="donate.html">donating</a> to ftmguide.org! </strong></p>
<hr>
<p><b><a name="resources"></a>Resources</b></p>
<p><strong>Trans Care Project of Vancouver, British Colombia</strong><br>
<a href="http://www.vch.ca/transhealth/resources/tcp.html">www.vch.ca/transhealth/resources/tcp.html<br>
</a>Completed in January of 2006, the Trans Care Project created a series of training materials and practice guidelines for clinicians treating trans patients, as well as consumer information about trans health for trans people, FTM and MTF. Their materials are downloadable in PDF, and cover numerous topics of concern to trans people and their care providers. Check the Project's Online Library to view the pamphlet "Surgery: A Guide for FTMs." </p>
<p><strong>Dr. Kate O'Hanlan's "Information For F to M Transsexuals: Removal of the uterus (hysterectomy) and the ovaries (oophorectomy)"</strong><br>
<a href="http://www.ohanlan.com/PDFs09/Surgeryfortransmen.pdf">www.ohanlan.com/PDFs09/Surgeryfortransmen.pdf</a><br>
This multi-page document provides an excellent description of the TLH procedure, as well as answers to some common questions that people have about hysterectomy and recovery.<br>
</p>
<p><em>Though the following web resources are (understandably) more focused on
hysterectomy/oophorectomy from a woman's point of view, they do contain useful
information and advice about the procedures themselves. </em></p>
<p><a href="http://www.ohanlan.com/total_laparo.htm">www.ohanlan.com/total_laparo.htm</a></p>
<p><a href="http://www.hystersisters.com">www.hystersisters.com</a></p>
<p><a href="http://www.nlm.nih.gov/medlineplus/hysterectomy.html">www.nlm.nih.gov/medlineplus/hysterectomy.html</a></p>
<p><a href="http://www.hysterectomy-association.org.uk/">www.hysterectomy-association.org.uk</a></p>
<p><a href="http://www.surgeryencyclopedia.com/Fi-La/Hysterectomy.html">www.surgeryencyclopedia.com/Fi-La/Hysterectomy.html</a></p>
<p><a href="http://www.surgeryencyclopedia.com/La-Pa/Oophorectomy.html">www.surgeryencyclopedia.com/La-Pa/Oophorectomy.html</a></p>
<p>The following site is an information group on Yahoo groups that deals specifically
with FTM surgeries. Information about hysterectomy and oophorectomy as it pertains
to trans men is included there:</p>
<p><strong>FTM Surgery Info Group on Yahoo</strong><br>
<a href="http://groups.yahoo.com/group/ftmsurgeryinfo/">groups.yahoo.com/group/ftmsurgeryinfo</a><br>
An extensive resource for information, photos, links, and research materials pertaining to surgery options for Female-to-Male transgender persons. You must apply for membership to access this group. Includes information about the following FTM-related procedures: metaoidoioplasty (metoidioplasty), phalloplasty, Centurion, hysterectomy, vaginectomy, salpingo-oophectomy, scrotoplasty, urethroplasty, testicular prostheses, and chest surgeries including double incision, liposuction, periareolar, keyhole, non-surgical enhancement alternatives such as pumping, stretching, piercing, and more. Interested persons are required to answer a short questionnaire before membership is granted.</p>
<p><em>For information on PCOS, endometrial cancer, and ovarian cancer, see the following
links:</em></p>
<p>Medline's PCOS page<br>
<a href="http://www.nlm.nih.gov/medlineplus/ovariancysts.html">www.nlm.nih.gov/medlineplus/ovariancysts.html</a></p>
<p>National Women's Health Information Center PCOS page<br>
<a href="http://www.4woman.gov/faq/pcos.htm">www.4woman.gov/faq/pcos.htm</a></p>
<p>National Cancer Institute's endometrial cancer page<br>
<a href="http://www.nci.nih.gov/cancertopics/types/endometrial">www.nci.nih.gov/cancertopics/types/endometrial</a></p>
<p>MedLine's endometrial/uterine cancer page<br>
<a href="http://www.nlm.nih.gov/medlineplus/uterinecancer.html">www.nlm.nih.gov/medlineplus/uterinecancer.html</a></p>
<p>American Cancer Society Page for information on endometrial, ovarian, and other
cancers<br>
<a href="http://www.cancer.org">www.cancer.org</a></p>
<p>CancerSource.com for information on endometrial, ovarian, and other cancers<br>
<a href="http://www.cancersource.com">www.cancersource.com</a></p>
<p>The Ovarian Cancer National Alliance<br>
<a href="http://www.ovariancancer.org/">www.ovariancancer.org</a></p>
<p>MedLine's ovarian cancer page<br>
<a href="http://www.nlm.nih.gov/medlineplus/ovariancancer.html">www.nlm.nih.gov/medlineplus/ovariancancer.html</a></p>
<p>National Cancer Institute's ovarian cancer page<br>
<a href="http://www.nci.nih.gov/cancertopics/types/ovarian">www.nci.nih.gov/cancertopics/types/ovarian</a></p>
<p><strong><span class="style1">Was this page helpful to you?</span><br>
Please consider <a href="donate.html">donating</a> to ftmguide.org! </strong></p>
<hr>
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