Why have a hysterectomy/oophorectomy during the transition phase?
There are several reasons that persuade transgender men to get a hysterectomy, ranging from preventative health care and treatment of past gynecological conditions, to obtaining correct identification and anatomy of the male gender.
In regard to health care, most physicians will recommend having a hysterectomy and oophorectomy during the first 5 years of starting testosterone therapy due to many reasons. One important reason is that there is a concern of developing symptoms in the ovaries that are similar to polycystic ovarian syndrome (PCOS) with long-term testosterone therapy. Symptoms include but are not limited to cramping, spotting, or bleeding. Furthermore, research has shown that PCOS is linked to an increased risk of endometrial hyperplasia (overgrowth of the lining of the uterus), which may become cancerous. Because of this, physicians recommend having the uterus and ovaries removed to decrease these risks.
The second important reason that may trans men chose to undergo a hysterectomy and oophorectomy is that after the ovaries are removed, there will no longer be any estrogen produced. Because of decreased estrogen, a lesser dose of testosterone therapy is usually needed.
What is a total laparoscopic hysterectomy (TLH)?
A TLH is a minimally invasive surgery, meaning the surgery is performed through small incisions in the abdomen and typically has a shorter recovery period in comparison to traditional surgery. This transgender surgery involves the removal of the uterus and the cervix by operating through small holes in the abdominal wall. These small holes provide access for a laparoscope (a tiny camera) and other small surgical instruments to be inserted in the abdomen during the procedure. The uterus is then removed by passing the tissue out through the reproductive canal, or through one of the small abdominal incisions.
This transgender surgery procedure is an outpatient procedure in which the patient is discharged home the same day. The procedure itself lasts about 1 to 2 hours, and postoperative recovery in the hospital ranges from 2 to 6 hours before the patient is discharged home. After the transgender surgery, the surgeon will inject a pain-blocker in the abdominal wall to decrease post-op pain. The patient will go home with Tylenol as needed for pain as narcotics are typically not necessary for this post-op recovery. The recovery period varies from patient to patient and typically lasts about 1-2 weeks with restricted physical activity such as running, jumping, and lifting weights.
A laparoscopy is a great route of choice when undergoing a hysterectomy due to less blood loss, shorter hospital stays, shorter recovery period, and smaller incisions in comparison to traditional surgery.
What is a bilateral salpingo oophorectomy (BSO)?
A BSO surgery involves the removal of both ovaries and both fallopian tubes. This procedure can be done by itself or is commonly performed at the same time as a total laparoscopic hysterectomy. Because of the risk of ovarian cancer occurring in the fallopian tubes, both the ovaries and fallopian tubes are removed.
Are there any risks involved in a hysterectomy/oophorectomy?
As with any surgical procedure, there are still risks that may occur. These risks are rare but include bleeding, need for blood transfusion, infection, reaction to anesthesia, blood clots, or injury to nearby organs. You should speak directly to your surgeon if you have any specific concerns regarding risks.
What is the cost of this procedure?
The cost of this surgical procedure can vary. Some insurance companies may cover this procedure. This transgender surgery may be discussed in further detail during your initial appointment.
What testosterone therapy do we offer?
Testosterone therapy is an important part of the transition period for trans men. Testosterone therapy causes changes in four main areas, including physical changes, emotional state changes, sexual changes and reproductive system changes. Testosterone therapy comes in several different forms including pill, injection, patch, gel or pellet.
In our office, we offer Bio Te Testosterone Pellets. Bio Te is a medical company that creates bioidentical hormones that are similar to the hormones naturally produced in the body. Testosterone pellets are composed of bioidentical powdered testosterone that is fused into a small pellet which looks like a grain of rice. These are manufactured through a trusting compound pharmacy which uses high-quality pellets with ingredients that are meticulously tested, giving our patients the confidence that they are receiving the best quality treatment.
The testosterone pellet is inserted into the hip. This is a quick and easy in-office procedure in which the patient’s insertion site is numbed and a small incision is made for pellet insertion. Once the pellets are inserted, the site will be covered with a small bandage. As each patient’s response to hormone therapy is different, the timing of receiving pellets will be different, too. The average time frame for one pellet is 6 months, and the patient will need to return to the clinic to receive another insertion twice yearly.