Hysterectomy is a common procedure within gender-affirming surgery. However, finding information on this topic is not always easy, as it is also a fairly common gynecological surgery in cisgender women. Although some characteristics are shared, the indications in trans men and cis women are usually very different. For this reason, discussing types of hysterectomy in trans men requires a specific approach. It is not only about explaining what the procedure involves, but also understanding when it is considered, what surgical approaches exist, what recovery is like, and which factors should be evaluated beforehand—especially if there is a desire to preserve the possibility of having biological children in the future.
What is a hysterectomy?
A hysterectomy is a surgical procedure in which the uterus is removed. In some cases, the fallopian tubes and ovaries are also removed, which is often referred to as an adnexectomy or salpingo-oophorectomy. At IM GENDER, hysterectomy with removal of the ovaries is the most common option among trans men.
When is a hysterectomy indicated?
In cis women
In cis women, hysterectomy is usually indicated to treat a medical condition or resolve a specific gynecological issue. For example, it may be considered in cases of fibroids, endometriosis, chronic pelvic pain, heavy bleeding, or certain oncological conditions.
In trans men
In trans men, although there may also be a medical reason, in most cases the surgery is part of the gender-affirmation process. It can help relieve gender dysphoria—when present—eliminate menstrual bleeding, remove internal organs that the person does not identify with, or prepare for subsequent genital surgery, such as metoidioplasty or phalloplasty.
Surgical approaches to hysterectomy
The surgical approach refers to how the surgeon accesses the internal organs. The choice of approach depends on several factors, such as anatomy, previous or planned surgeries, and whether the hysterectomy is combined with other procedures.
Laparoscopic hysterectomy
This is one of the most commonly used approaches in trans men. It is performed through small incisions in the abdomen and a camera that guides the surgery. It is usually associated with less postoperative pain, a lower risk of adhesions, and faster recovery.
Additionally, it may be a good option when the fallopian tubes and ovaries are also removed, and it can be performed either as a standalone procedure or as part of a broader surgical plan.
Abdominal hysterectomy
The open abdominal approach is mainly reserved for more complex cases or when there have been previous abdominal surgeries. It involves a larger incision in the lower abdomen, often similar to that of a cesarean section. IM GENDER notes that this incision is usually concealed by pubic hair.
It is a valid technique, although recovery is typically slower than with laparoscopy.
Vaginal hysterectomy
Another type of hysterectomy is the vaginal approach, which allows removal of the uterus without visible external incisions. In theory, it may allow for a faster return to normal activities, but it is not always the best option for trans men. According to IM GENDER, it is often ruled out in this context due to its complexity and anatomical factors, such as the absence of prior vaginal births or tissue changes associated with testosterone.
Hysterectomy and future genetic parenthoo
Fertility in trans people is an important topic to discuss carefully before surgery. A hysterectomy—especially when combined with removal of the ovaries—can eliminate the possibility of using one’s own gametes in the future if no prior measures are taken. In other words, it may result in future infertility.
Therefore, if there is any consideration of having biological children later, it is important to communicate this before surgery in order to evaluate available fertility preservation options for people with ovaries. The most common option is egg or embryo cryopreservation.
This does not mean that everyone must freeze eggs before a hysterectomy. It means that if there is uncertainty or a future desire, it is advisable to discuss it in time and explore alternatives with a specialized fertility team.
Sometimes there is no clear desire for parenthood at present, but preserving options for the future may still be worthwhile.
What should be considered before surgery?
Before undergoing a hysterectomy as a trans man, several aspects should be reviewed. The most important include:
- overall health status
- stage of the transition process
- whether to preserve the ovaries
- whether the surgery will be performed alone or combined with other procedures
- reproductive plans
It is also important to understand the hormonal impact of the surgery if the ovaries are removed. In individuals already undergoing testosterone therapy, this change may be managed, but it requires proper medical follow-up.
Postoperative period and recovery
Recovery largely depends on the surgical approach used – that is, the type of hysterectomy. For example, after a laparoscopic or vaginal hysterectomy, returning to normal activities typically occurs within three to four weeks. In contrast, with open abdominal surgery, recovery usually takes six to eight weeks.
The day after the procedure, the patient can begin to get up and resume eating, as remaining immobile for too long may delay recovery or increase the risk of complications.
During the postoperative period, it is recommended to:
- maintain relative rest
- avoid intense physical effort
- not lift heavy weights
- walk progressively
- take care of incision hygiene
- attend medical follow-up appointments
Trans hysterectomy at IM GENDER
Hysterectomy in trans men should not be approached as a standard surgery or merely a technical step. Rather, it is often part of a gender-affirmation process that requires careful planning, as it may or may not be combined with other procedures. For this reason, IM GENDER offers individualized care and a personalized approach so that each person can make informed and autonomous decisions about their path
If you would like more information about types of hysterectomy in trans men, fertility preservation, or gender-affirming surgery, you can contact our team.
