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Hysterectomy

What is a hysterectomy?

Permanent surgical removal of the uterus (womb).

It's also known as Hysto.

What does a hysterectomy do?

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”

  • You need to be at least 16 in Scotland, but at least 17 in other parts of the UK

  • You typically need a BMI of less than 30

  • Outside of Scotland this is only commissioned as a part of phalloplasty or metoidioplasty

How long does a hysterectomy last?

The effects are permanent and cannot be reversed.

What should I be aware of?

Warning

Hysterectomy results in permanent destruction of the uterus (womb) and is irreversible. After hysterectomy you will be unable to become pregnant or give birth.

Warning

Not all types of hysterectomy remove the risk of cervical cancer. The cervix is only removed as part of an operation called a “total hysterectomy”. Ask your surgeon whether you will still need to be regularly tested for cervical cancer if you are unsure. You can read more about this on the NHS website.

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 UK, some clinicians recommend that people taking testosterone long-term should have a hysterectomy. They theorise 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 this is normally only funded by the NHS for non-gender-related reasons or as part of a larger operation like phalloplasty or metoidioplasty. If you don’t wish to have one of these other operations, you may have to seek a private referral.

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.

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?

Outside of Scotland, this is usually only funded as part of phalloplasty or metoidioplasty

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:

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

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