When a Hysterectomy is Only a Hysterectomy. Notes from the Philadelphia Trans Health Conference – Part 3.

I learned something at the Philadelphia Trans Health Conference that made me sit up and take notice.  Well, it’s not that I didn’t sit up and take notice of anything else, but this particular tidbit is worth repeating.

I don’t remember who it was – one of the surgeons I listened to, or maybe one of the docs in the medical track of workshops that ran during the conference (I apologize to the person I’ve forgotten who talked about this because I cannot give them credit) – but they mentioned that they knew of trans men who’d had a hysterectomy but discovered when they went for another procedure, sometimes even years later, that they still had female reproductive organs that they had been unaware of.

Although I don’t know that this situation occurs often, I can see how it could come about relatively easily, so I thought I would provide some information on this subject in case some readers are unaware of how this scenario can arise.

Female/trans male reproductive tract

In order to discuss this topic, we first need to review the female/trans male reproductive organs.

On the left, we can see a diagram of the major reproductive structures: the uterus, ovaries, fallopian tubes (also known as oviducts), the cervix and vagina.

Okay, now let’s talk about these organs in relationship to the surgery.

The word “hysterectomy” comes from the Greek “hystera” which means “womb” (i.e. the uterus) and “ectomia” which translates as “excision.”  And so, a hysterectomy is the excision of the uterus.  A hysterectomy can be complete, where the uterus and the cervix are both removed, or it can be partial, where only the fundus (the end) and the body of the uterus are removed and the cervix is left intact.

However, you’ll notice that nowhere in this definition is there mention of removal of the ovaries or oviducts.

With that in mind, it’s probably not difficult to understand, especially in situations where the surgery is being performed for reproductive medical reasons, how a trans guy could go in for a “hysto” thinking that all of  his reproductive organs are going to be removed and end up still possessing ovaries and oviducts because the surgeon (only) performed a hysterectomy.

The key to avoiding this potential situation, then, is two-fold:  First, have a discussion with the surgeon and ask him/her exactly what is (and is not) going to be removed. Second, in addition to a hysterectomy, ensure (if this is what a person wants) that a bilateral salpingectomy will be performed, which is removal of both fallopian tubes (oviducts), along with a bilateral oophorectomy, the removal of both ovaries. When these two surgeries are combined, it’s called a bilateral salpingo-oophorectomy.

In this way, a person can ensure that a hysterectomy isn’t only a hysterectomy.

–ATM

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13 Responses to When a Hysterectomy is Only a Hysterectomy. Notes from the Philadelphia Trans Health Conference – Part 3.

  1. Evolving Gender says:

    Great post. It’s very important to weigh the pros and cons of a full hysto with the removal vs a hysto with maintaining the ovaries. Thanks for the update.

    -A

    • Good point! although, admittedly, I didn’t consider making that one of the points of my post.

    • Zander Keig says:

      What might be a pro of “maintaining the ovaries”?

      • Evolving Gender says:

        There are a few reasons. One that I understand completely is that if you decide to discontinue the use of hormone therapy you will need them to produce some form of a hormone. Without it you’ll have to continue taking something. For some trans* people this is important because they don’t want to take hormones for an extremely extended period of time.

        • Zander Keig says:

          I guess it depends on the kind of “trans” person… As a transsexual man, I will be taking T for the rest of my life, thankfully!

          I had a Hysto BSO & vaginal excision in 2008 & have not experienced any negative symptoms. Many positive though!!

          ZK

          • any reason why “trans” is in quotes here? Do you believe that the “trans” people who go off T for whatever reason aren’t (really) trans (without quotes)?

          • Hi Zander. Thanks for the comment. If a person is taking testosterone, they would have support for their bones so the question of whether the to keep the ovaries would be moot.

            Regarding using “trans” as a short version of transgender, transsexual, I have also seen the wildcard search term: trans*
            In this case, the asterix represents any ending of a word that begins with “trans.”

            • Zander Keig says:

              I frequently use trans* and find that it elicits conversation, because people want to know why I didn’t just write transgender. I enjoy the ensuing conversation.

      • The pro of keeping the ovaries when having a hysterectomy without subsequent hormone replacement therapy would be support of the bones. Basically, removal of the ovaries will put the individual into immediate menopause. Without hormone replacement therapy (testosterone), there won’t be any hormonal support for the bone and osteoporosis could result. However, the rate of the loss of bone mineral density in this scenario would depend on the age of the individual, their genetics, their activity level and their diet (i.e. whether it’s adequate in calcium and Vitamin D). Exercise and diet can help maintain bone mineral density in the absence of hormonal support. (See my blog posts on bone health in trans men.)

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