What is a hysterectomy?

Permanent surgical removal of the uterus (womb).

It's also known as Hysto.

What does a hysterectomy do?

• Lower body

  Removes womb

• Fertility

  Causes permanent infertility

• Menstruation

  Stops

Who can have a hysterectomy?

• You must have had 12 continuous months living as your gender identity

• You must have had 12 continuous months of HRT, unless you’re unable to

• You must have capacity to consent for this treatment

• If you have significant medical conditions, these need to be “reasonably well-controlled”

• Under 18s cannot have this but can be referred at 17

• You typically need a BMI of less than 30

How long does a hysterectomy last?

The effects are permanent and cannot be reversed.

What should I be aware of?

Hysterectomy for people taking testosterone is optional and you may feel the risks involved in a major operation are unnecessary. If you decide not to undergo hysterectomy it has been suggested that scans to check for thickening of the endometrium every two years could reduce any potential risks 1, p.240.

Why might I want a hysterectomy?

Hysterectomies are usually carried out because of cancer or other tumours of the uterus, cervix, fallopian tubes or ovaries. They are also sometimes carried out on people with very heavy periods.

In the past, some clinicians have recommended that people taking testosterone long-term should have a hysterectomy. They theorised that as testosterone suppresses menstruation (periods), which could lead to endometrial hyperplasia (thickening of the lining of the womb), this might increase the risk of cancer 1, p.240. However, subsequent studies have not shown any evidence of an increased risk of reproductive cancers from testosterone use, and they do not suggest any need for hysterectomy 2.

Why might I not want a hysterectomy?

Hysterectomy is irreversible and permanently destroys the uterus. If you hope to become pregnant at some point, you may not want to have a hysterectomy.

How do I get a hysterectomy?

To get a hysterectomy, you will need to be referred to a gynaecological department at a hospital, either by your GP or by a gender clinician. However, outside of Scotland, the NHS gender pathway only funds hysterectomy as part of a larger operation like phalloplasty or metoidioplasty. If you don’t wish to have one of these other operations, you can ask your gender service to write a letter to your GP asking them to refer you for a hysterectomy, or you can arrange for one privately.

To obtain hysterectomy for gender-related reasons, you will normally need to meet the following conditions:

• persistent and well-documented gender dysphoria
• capacity to make fully informed decisions and to consent to treatment
• if significant medical or mental health concerns are present, they must be reasonably well controlled
• two medical opinions, usually at least one from a gender clinic, that surgery is appropriate
• 12 months’ continuous endocrine treatment as appropriate to the patient’s goals (unless the patient has medical contraindications or is otherwise unable to take hormones) 3.

Hysterectomy for other medical reasons is not subject to these requirements.

NGICNS maintains a list of NHS surgery providers providing various gender-related surgeries. At the moment, all of these surgeons are based in England, so you will have to travel if you live in another part of the UK. If you have decided to pay for your own surgery, rather than using NHS funding, there are additional options available to you. For more information about these private surgery options read our private surgery page.

Hysterectomy is a major surgery and has a significant recovery time. You should expect to spend at least 4-6 weeks time recovering before you are ready to resume work or study. When you are discharged from hospital, your surgeon should provide you with a sick note to give to your employer.

What kinds are there?

There several types of hysterectomy, which may or may not include removing the cervix or removing the ovaries and fallopian tubes (also known as salpingo-oophorectomy). If your hysterectomy does not involve salpingo-oophorectomy, you are still at risk of ovarian cancer 1, p.240.

Hysterectomy does not usually involve removal of the vagina, which is called a vaginectomy.

How do I get ready for surgery?

Doing some preparation in advance can help make sure everything goes smoothly during your hospital stay and recovery. To help you avoid forgetting to do or buy something we have created a Getting ready for gender surgeries page.

How much will it cost?

The NHS will normally fund total hysterectomy and salpingo-oophorectomy for patients who are undergoing testosterone therapy.

If you're receiving certain benefits, or are on a low income, you may be able to get help with the cost of travel for NHS treatment. Further information about help with travel costs can be found:

• on the NHS website
• on the Welsh Government website
• on the NHS Scotland website
• on the Northern Ireland government website

Where can I learn more?

You can read more about hysterectomy on the NHS website.

References

1. 1.
   Seal, Leighton J (2017) “Hormone Treatment for Transgender Adults,” in Bouman, W. P. and Arcelus, J. (eds.), The Transgender Handbook: A Guide for Transgender People, Their Families and Professionals, Nova Science Publishers Inc, pp. 227–249. Link
2. 2.
   Toze, Michael (2018) “The risky womb and the unthinkability of the pregnant man: addressing trans masculine hysterectomy.” Feminism & Psychology, 28(2), pp. 194–211. Link
3. 3.
   Royal College of Psychiatrists (2013) “Good practice guidelines for the assessment and treatment of adults with gender dysphoria.” Link

Acknowledgements

This page is illustrated using a photograph by Павел Сорокин available at Pexels.

Errors and omissions

Is there something missing from this page? Have you spotted something that isn't correct? Please tweet us or message us on Facebook to let us know, or file an issue on GitHub.