Laparoscopic hysterectomy is one of the surgical techniques used to remove the uterus. For trans men or non-binary people assigned female at birth, hysterectomy can be part of gender-affirming surgical options. However, like all steps in transition, it is not mandatory. For many, though, it represents an important step in aligning gender identity with their body.
In Spain, current legislation allows trans people to undergo a hysterectomy without requiring a psychological report or prior hormone treatment. This gives each person the freedom to decide the most appropriate moment according to their own needs and circumstances.
What does a laparoscopic hysterectomy involve?
Medically, a laparoscopic hysterectomy means removing the uterus, and in many cases, also the fallopian tubes and ovaries (salpingo-oophorectomy). Removing the ovaries has a direct impact on hormone production: since the ovaries produce estrogen and other hormones, these are no longer naturally generated once removed.
For trans men already on testosterone therapy, this hormonal change is usually well managed, but medical follow-up is essential to prevent issues such as bone loss or metabolic changes.
Hysterectomy also reduces or eliminates the risk of certain gynecological conditions such as fibroids, endometriosis, or uterine and ovarian cancer. However, it means the complete loss of fertility.
For many trans men or non-binary people assigned female at birth, hysterectomy is also performed as a preparatory step before genital-affirming surgeries.
Hysterectomy and fertility
As mentioned, one of the most important aspects to consider before hysterectomy is future reproductive plans. Even if becoming a parent is not a current priority, it is advisable to explore fertility preservation options.
Alternatives include egg or embryo freezing – the latter requiring sperm from a partner or donor – as well as ovarian tissue cryopreservation, which is less common and used in specific cases.
In Spain, legislation allows trans men to use their gametes in assisted reproduction treatments, regardless of their legal gender identity.
Laparoscopic hysterectomy and other surgical techniques
There are different approaches to laparoscopic hysterectomy in men. The choice depends on anatomy, prior surgeries, the surgical team’s expertise, and whether other procedures will be performed at the same time.
Laparoscopic hysterectomy
This is one of the most common techniques for trans men. It is performed through small abdominal incisions using a camera to guide the procedure. Benefits include less postoperative pain, a lower risk of internal adhesions, and faster recovery.
It is also indicated when removing ovaries and fallopian tubes. The procedure can be performed alone or combined with other surgeries, depending on recovery plans.
Vaginal hysterectomy
Another option is vaginal hysterectomy, which does not require external incisions and usually allows quicker return to daily activities. However, it may not always be feasible, particularly in those who have not had vaginal births or who have a narrow anatomy. In some trans men, testosterone-induced tissue changes may also complicate this approach.
Abdominal hysterectomy
For more complex cases or in patients with prior abdominal surgeries, an open abdominal hysterectomy may be necessary. This involves a larger incision in the lower abdomen (similar to a cesarean section) and generally requires longer recovery than laparoscopic or vaginal techniques.
Some centers also offer robot-assisted hysterectomy, which provides high precision but is less widely available due to higher costs.
When is laparoscopic hysterectomy usually performed?
There is no single “right time” for all trans people. The decision depends on factors such as overall health, emotional well-being, transition goals, surgical planning, and — most importantly — reproductive wishes. If there is a possibility of wanting biological children in the future, fertility preservation should be considered before surgery.
Hysterectomy in men can also be performed for medical reasons such as endometriosis, fibroids, or heavy bleeding, or as part of preparation for genital-affirming surgeries such as metoidioplasty or phalloplasty.
Many trans men or non-binary people assigned female at birth choose hysterectomy after starting testosterone therapy, although it is neither a medical nor a legal requirement. The decision is entirely individual, and it is essential to be fully informed by a specialized medical team such as IM GENDER.
Recovery and aftercare after hysterectomy in men
Recovery time depends on the surgical technique used. After laparoscopic or vaginal hysterectomy, most people can return to daily activities within three to four weeks. For open abdominal hysterectomy, recovery usually takes six to eight weeks.
During recovery, it is very important to follow medical guidance. After hospital discharge, recommendations include:
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- Avoid heavy lifting or high-impact exercise.
- Take relative rest: avoid lying down for long periods and opt for gentle walks.
- Keep surgical incisions clean.
- Attend all scheduled follow-up appointments.
Laparoscopic, vaginal, or abdominal hysterectomy are all techniques that remove the uterus. The choice will depend on individual characteristics and the medical team’s decision. Ultimately, the timing and approach should always be individualized, considering reproductive goals and the person’s transition process.
Are you considering a hysterectomy as part of your transition? Do you want to know if laparoscopic hysterectomy in trans men is the best option for you?
Book an initial consultation with our IM GENDER medical team.
