My Hysto

Given that in the last post I quickly glossed over the fact that I have a major surgery scheduled in less than a week, I wanted to address a few details surrounding my decision and the whole process of having a hysterectomy.

hysto-pin-cover

What procedure am I getting?

A total laparoscopic hysterectomy, non-robotic to avoid an extra scar. All of my organs except my ovaries will be removed, so I am not getting an oophorectomy. It’s an outpatient procedure under general anaesthesia, meaning I go into the hospital in the morning, take a quick nap, wake up and go home the same day. Expected recovery time is a week or two.

How much will it cost me?

A hysterectomy can be expensive, from surgeon’s fees to hospital fees. For that reason alone, I would not be undergoing this procedure unless it was covered by insurance. In my case I’ve been assured it is. In total I’ll play less than $1K.

What was the process for scheduling the surgery?

After doing a lot of medical research, I then started searching for trans-friendly gynecologists in my area: browsed the online listserves, asked my therapist, my primary physician, and other doctors at local trans-friendly clinics like Lyon-Martin and Dimensions. I found 2 surgeons in the Bay Area that caught my eye, though there are plenty more. My choice was primarily based on convenient location, a website that lists FTM patients, and referrals from more than one person.

During the consultation, the surgeon discussed my options very openly, addressing both my physical questions as well as my concerns surrounding insurance. The office has dealt with many FTM, genderqueer, and trans* patients before, so they know how to address you, that your insurance card will likely be under a different name (and gender), and even have inclusive forms to fill out. The experience was overall very welcoming!

Although initially my idea was to tentatively “see what’s out there” the surgeon was eager to schedule something right away, which I did, so as not to give myself a chance to over-think it, which I usually end up doing anyway.

Why am I getting a hysterectomy?

Because I want to, is the simplest answer. But if you know me well, which by now a lot of you do, you’re going to point out that for any decision I always make a detailed list of reasons.

The Short List
  • No more monthly periods, forever and ever and ever
  • No sense in keeping organs I’m never going to use, and that could potentially develop cancer and other diseases. I’m absolutely sure I do not want to utilize these organs in the way they were intended (ie, bearing babies)
  • My hormonal composition won’t be affected, since I’m keeping my ovaries
  • I can still harvest my eggs in the future (for future Littler Awesomes!)
  • It’s a relatively safe and common procedure
  • Minimal scarring
  • Nearly free
The Long List

First getting pregnant is not something I ever imagined myself doing; this was true even before I even knew I was trans. So in that sense, it’s straightforward.

But also, in a weird sense, I do feel this is something I need to do as part of my transition. Nobody sees your internal organs, nobody knows they are there or not. Yet, as with every step so far, I do it purely for myself, because I feel it’s what I need to do, because it feels right.

The organs I still might want someday – ovaries containing my genetic material and natural hormone factory – I’m keeping. This was my primary concern when beginning to look into it, as I do not plan to continue testosterone HRT in the long term, and I’d rather avoid hitting menopause at 26.

I knew that hysterectomies were linked to hormones, in some way, but I did not quite understand how. No matter how much research I did, there was nothing clear on hormones, specifically in my situation. Moreover, nobody could tell me what would happen if I removed hormones from my body entirely – that is, remove the ovaries and not take T.

It turns out (after asking many doctors, and doing some super sleuthing) your body needs a primary sex hormone, be it E or T. Otherwise, you induce menopause. Primarily, this has serious consequences for bone health (and other stuff nobody really knows about or can specifically point out). I’ve also learned that a hysterectomy is not an “end all be all,” and you basically pick and choose which parts are taken out and which parts you keep. (Worry not, there will be more detailed medical information in an upcoming article or two.)

Lastly, gynecology is not a new field. Half of the population regularly visits a gynecologist, and a hysterectomy is nothing revolutionary. In fact, it’s the 2nd most common surgery among women in the US. My surgeon assured me her complication rate was extremely low to non-existent. Sure, it’s still major outpatient surgery, but the laparoscopic techniques cuts down on recovery time, from 6 weeks to 6 days, with only tiny scars. I’m young, I’m resilient, and I don’t have other obligations right now preventing me from taking it slow for few weeks.

What made me finally decide to do this?

Did I hesitate? Of course. You know me: doubt and I are close frenemies. In the end though, I couldn’t find a compelling reason NOT to do this.

I discussed it with my significant other, and with my therapist. This is something that had been brewing in the back of my mind for a while, something that I saw myself doing… soon-ish. The only surprising part was that soon became now quicker than I expected.

Disclaimers

I’m not a medical professional and I possess no formal medical knowledge. This summary is a layperson’s understanding of personal research. It may or may not be accurate.

Due to discussion of transgender related surgeries and insurance, I’m refraining from connecting this with any specific surgeon’s name, just to be safe. Feel free to contact me for names.

(*) Please take note that I abstained from using much abused and clichΓ© titles, such as my Hysto-story, my Hystory, Hysteria, or Hysterectify, among others. This type of restraint deserves a little praise.

35 responses to “My Hysto

  1. Thank you for this post! I think it is really helpful. I didn’t know it was possible to get the uterus out but keep the ovaries. And I am glad to know that now, so I can look into it if that would be available in my country as well. Because I want my uterus be gone for the same reasons as you listed, and since I am not planning to get on testosterone I don’t want to get into the menopauze either (and risk a low density in the bone minerals).

    So thanks very much for posting this. And good luck with your surgery!

    • In countries with a different healthcare system it might be trickier. It comes down to working with a doctor that supports you. The better informed you are, the more you can push for what you want. In any case, you can complain endlessly about severe cripplingly painful cramps. I will address this a bit in a later post.

  2. This might be the best news I’ve gotten all month. I too was aware that hysterectomies were linked to hormones and was lead to believe that they induce menopause without hormone replacement, so I had given up on the idea of ever being able to get my uterus removed without it having severe negative effects. I was going to settle for a tubal ligation, but after this I’m so excited, I can actually get a surgery that would give me all of the things I want with none of the shitty side effects I don’t want.

    • It isn’t talked about much in transmale communities, and it’s usually assumed you will be on T (and few people blog about it as excitedly or document it as thoroughly as top surgery). The cis-women who have usually it do it for other reasons with other factors involved.

      It was very difficult to find all the information and questions I needed, so I’m preparing a few informational articles as follow-up to summarize my research.

  3. first off, i’m stoked for you! congrats, cat! ❀

    also…so.much.want. didn't know this was possible, but i officially want to get this done. first you inspire me to really, truly consider top surgery (i think i was too scared to consider it before i started reading about your experiences), and now you go and tell me i can get my inside junk ripped out without messing with my hormones. yay! seriously, thanks for this post!

    and take care of yourself. <333

  4. Congratulations! I hope you hace a speedy recovery! Ive read your blog for a long time but never commented. This is maybe a question for a gynecologist and not you, but if you have ovaries and no uterus, what happens to the eggs you would normally be ovulating? Does having extra eggs hanging around up cancer risk? (in my head i think I’m thinking of PCOS and cysts caused by not fully ovulated eggs). This isn’t to scare you as I have honestly no idea about the answers yo my question, I’m just curious as I research possible medical aspects of transition for myself.

    • It’s a valid question, and one I did ask because I’d consider harvesting my eggs in the future. Basically the regular ovulation cycle continues to occur, as normal. There’s just nowhere for them to go, and no tissue to build up (thus no bleeding). Additionally, the ovaries have their own artery serving as a separate blood supply apart from the uterus, so they can stay healthy and operating.

  5. Hi there, longtime lurker here. I’ve followed a parallel path to you: top surgery first, then low dose hormones with the intent not to stay on forever. I too had a laparoscopic partial hysterectomy (keeping the cervix for structure, and ovaries as “back up” hormone producers)). My surgeon was also in the Bay Area. I’m even Jewish, and short/petite. Anyhoo, word to the wise: beware that the recovery takes longer than you think. True it is WAY less invasive than an old-school hysto; but you do need to allow time not just to recover from the anaesthetic, but for your body to adapt to its new configuration. You have to take extra care with your abdomenal area, no lifting for like 6 weeks and no exercise that would affect your abdominal region! Also: when the uterus is removed, one of two blood supplies to the ovaries is severed, so some people experience a brief “ovary shock” where their ovaries simply stop and they have menopause-like symptoms before kicking in again. That happened to me. I wasn’t on T yet at the time (my order of events was: partial hysto; top surgery; T). I got hot flashes and mood swings for a few days then everything back to normal. You should take care with your hormonal regime–I don’t know what dose of T you’ve been taking, or whether it’s enough to overpower your ovaries, but this is something to be aware of. Good luck!!

  6. Ps something unrelated, sort of, that you might like to share with your readers: my endocrinologist warned me that T and prednisone (and certain other steroids) don’t go we’ll together and can induce mania! Since I’ve never had to use those things, it hasn’t been an issue for me and I never did ask her to explain in further detail. But I’ve never seen this discussed in any of the fora online and it sounds like something worth putting out there for people. Thanks

  7. The pro of keeping the oeairvs when having a hysterectomy without subsequent hormone replacement therapy would be support of the bones. Basically, removal of the oeairvs 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.)

    • That’s correct, and you’d be surprised how long it took me to find this sort of information. I’m doing a more formal article on all of this later.

  8. Just found your blog through Neutrois.com
    First, good luck and good health with your surgery.
    Second, budget way more than six days for recovery. Results vary widely among patients, but for example I had my TAH with single oophorectomy four months ago and am still an achy swolly post-op gimp. My partner’s sister-in-law had a less invasive version and went to work after four weeks, and it wiped her out every day for a few weeks since it was a bit too soon. Your mileage will necessarily vary, since all bodies react a smidge differently, but be prepared for a much longer recovery time and you may be pleasantly surprised, rather than expecting to be normal again in a few weeks and being disappointed.
    Take it easy, take care and let somebody take care of you for at least a few days, bringing you soft foods and lots of liquids while you lie around. Cheers!

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    • I’m writing a series of articles on all the ways you could go about this. In the meantime you can email me and we can explore some options.

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  17. Hey there! I found your articles very informative and useful so far, but was left with some questions:
    1) Does keeping your ovaries positively affect vaginal health, despite there no longer being a direct connection?
    The thought of ever getting pregnant or even being at a risk every time I have sex with someone able to produce sperms scares me a lot, but I don’t want to have to destroy my endocrine system just so I can do so without having to worry (which I still do even if I get an IUD or always use condoms, just because these organs are /there/ – I think that is my own form of projecting my dysphoria..).
    and
    2) Does the removal of the uterus and cervix in any way affect sex, or orgasm?
    Note that you don’t need to answer these two if you find that they’re inappropriate. I am trying to decide what type of operation to get to lessen my dysphoria, as I feel that no simple contraceptive will do the job of calming my mind about these parts and the risk of pregnancy, and so I’m looking for as many good resources as I can find. You seemed very intelligent and aware about the matter – So I wanted to give this a try and ask you.
    Finally:
    3) Does keeping your ovaries mean that you can still develop PCOS, or ovarian cancer? Do you know how high the risk for these is in xx people who got their uterus and tubes removed and are on HRT? (Pfewh, that’s one very specific and probably small group)

    Thank you very much in advance and please excuse my extensive questioning – You know, I need all the resources I can get right now.

    Props to you,
    J

    • 1) Yes and no. Estrogen helps with vaginal health, and your ovaries are your natural estrogen producers. However, being on testosterone will offset the estrogen needed for this.
      2) There is no definitive answer; anecdotally this issue is split.
      3) Yes, you can still develop PCOS because you still have ovaries.
      Note that a lot of this also depends on your individual history.
      I’m not a professional, so you should definitely consult with a doctor for more detailed answers.

  18. This is very useful Micah, thank you for posting this. What Anonymous said about keeping ovaries and STILL having side effects really is disturbing me because I am going to have everything removed but the ovaries. I would hate to put up with something more than I don’t want to. So even though I won’t have bleeding every month I would still have bloating, stomach pain like how I did during periods?…
    I don’t want to rely on external hormones (whether T or E) has side effects from them being considered medications. Besides I don’t know how much T I would need to take if I did have the ovaries out..

    Regarding cysts, my surgeon said I would have the same chances of developing ovary cysts after hysterectomy..

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  20. Was your surgery covered as part of your transition (i.e., your insurance covers gender-affirming surgeries), or was your surgery covered under your general insurance policy for “reproductive” issues?

    I have PCOS and possibly endometriosis, but my insurance doesn’t cover ANY trans-related care (hormones or surgery). I’m wondering if I can get a hysterectomy for PCOS/endo since I’m not “out” get to my doctors and am female-presenting (and therefore not trying to get SRS).

    • My insurance plan had a specific trans-exclusion clause, so I made sure nothing I did was under the pretense of transition.

      In CA you do not need a “medical reason” for coverage. Regardless, PCOS definitely qualifies as a medical necessity and any insurance plan should cover a hysterectomy if your ob-gyn recommends it. Get a surgeon who understands that’s what you want and won’t try to push other treatments instead.

  21. Hi, I’ve been a long time lurker and want to thank you so much for all the information you share with us. It has helped me so much on my journey πŸ™‚

    If I may ask, who was your surgeon? Answering either here or through my email is ok, I just really need to find a surgeon. I live in San Diego, but am open to drive to the bay area to finally be able to get a hysterectomy. I’ve had such crappy luck down here trying to get someone wiling to even consider doing it for me. Today was the last straw; I was told no one will consider it until I’m at least 30 and we have exhausted all other options (I’m 24).

    I just really am not ok with that, my dysphoria is the worst with this particular thing and it keeps getting harder and harder for me to deal with. Any help would be greatly appreciated, thank you!

    • Hey Sky – Sorry to hear you’ve been having a hard time finding a surgeon.

      My OB-GYN was <a href="http://www.sfgynsurgery.com/services-procedures/"Dr Katherine Hsiao, and I highly recommend her. She’s very trans knowledgable and respectful, even offering alternative or non-binary options. I was 26 so I don’t think age should be a factor. She did ask me for a therapist letter, mostly for consent paperwork (since it’s voluntary sterilization). She will probably remember me if you mention my name.

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