< Surgery

Hysterectomy

A hysterectomy is a gender affirming procedure that surgically removes either all or some parts of the uterus, cervix, fallopian tubes, and ovaries.

Hysterectomies are sought by trans people who were presumed female at birth (PFAB), including men and non-binary people to stop menstruation, remove any possibility of pregnancy, or for other health issues. There’s no right or wrong way to be or embody your gender, regardless of your surgical status. Not all trans people want, seek or can have surgery, and being trans doesn’t necessitate surgery either. Find out more about that here.

Information for clinicians about hysterectomies is available here.

WPATH Standards of Care

The Standards of Care - 7th Ed (SoC7) is published by the World Professional Association for Transgender Health (WPATH) and offers guidance to clinicians working with trans patients all over the world, including criteria and recommended referral pathways for those seeking particular medical and surgical interventions.

The SoC7 does not specify an order by which surgeries should occur, if sought at all, and are guidelines, not legislated requirements.

WPATH state that a hysterectomy is considered “a medically necessary component of gender affirming surgical therapy for those transgender men who choose to seek this procedure.”

Criteria for hysterectomy and salpingo-oophorectomy in FtM patients and for orchiectomy in MtF patients:

  1. Persistent, well-documented gender dysphoria;
  2. Capacity to make a fully informed decision and to consent for treatment;
  3. Age of majority in a given country;
  4. If significant medical or mental health concerns are present, they must be well controlled.
  5. 12 continuous months of hormone therapy as appropriate to the patient’s gender goals (unless hormones are not clinically indicated for the individual).

The aim of hormone therapy prior to gonadectomy is primarily to introduce a period of reversible estrogen or testosterone suppression, before the patient undergoes irreversible surgical intervention. These criteria do not apply to patients who are having these procedures for medical indications other than gender dysphoria.

WPATH Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People V7

There are several kinds of surgical options, and the procedure chosen will depend on the surgeon’s expertise and the physical capacity, and needs, of the patient.

Hysterectomy options include:

  • Full hysterectomy - removes all parts of the uterus, cervix, fallopian tubes, and ovaries

  • Partial hysterectomy - removes the uterus and fallopian tubes but not the cervix

  • Oophorectomy - removes the ovaries only

The three surgical approaches to a hysterectomy are:

  • Abdominal laparotomy, which involves an incision in the lower abdomen

  • Transvaginal, which involves removing the uterus through the vagina or front hole

  • Abdominal laparoscopy, which involves a small incision near the belly button

Recovery

A hysterectomy is conducted in a hospital, and often requires a stay of a day or two afterwards. You won’t be able to do any strenuous activity, lift heavy objects, or drive for at least a few weeks after the procedure. Following the surgery, you will also have to wait 6 weeks before having receptive sex. Time off from work is recommended if your work involves any heavy lifting or standing for long periods of time.

The specific instructions for your recovery will vary from surgeon to surgeon, and depending on where and what specific surgical techniques are used.

Costs

Cost can vary widely between surgeons and procedures, and can cost up to $12,000.

This surgery can sometimes be provided in the public health system and covered by Medicare, particularly for those people experiencing irregular cramping or breakthrough bleeding.

Locations

This procedure is done in Australia. They are also performed in various countries in Asia, in the U.S., and elsewhere around the world.

The Australian Professional Association for Trans Health hosts a provider list of their members. It includes surgeons in Australia and is available here.

Risks

All surgeries carry some risk, including complications, infection, blood clots, and rarely death. It is important to ask your surgeon about possible risks and how to avoid them.