FTM Hysterectomy is a gender-affirming surgery in which the uterus is removed, often in conjunction with the removal of the cervix, ovaries, and fallopian tubes. This procedure is primarily sought by transgender men (female-to-male, or FTM) and some non-binary individuals as part of their medical transition. The surgery helps alleviate gender dysphoria related to having internal female reproductive organs and can also be pursued for medical reasons, such as treating conditions like endometriosis or uterine fibroids.

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Purpose and Importance

Many transgender men experience significant discomfort or dysphoria related to their reproductive organs, particularly the uterus, ovaries, and cervix. While hormone therapy (testosterone) usually stops menstruation, the presence of these organs may still cause distress, particularly if there is any residual menstrual bleeding or cramping. Removing these organs helps align the individual’s body with their gender identity, often reducing gender dysphoria and providing peace of mind.

Additionally, testosterone therapy carries the potential risk of causing ovarian and uterine health complications over time. Removing these organs can help mitigate those risks, making a hysterectomy an important step for some transgender men seeking long-term health and well-being.

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Procedure

There are several different approaches to performing an FTM hysterectomy, depending on the individual’s anatomy, goals, and any underlying medical conditions. These include:

1. Total Hysterectomy:

   • This procedure involves the removal of both the uterus and cervix. For transgender men, this is often combined with the removal of the ovaries (oophorectomy) and fallopian tubes (salpingectomy) in a procedure known as a salpingo-oophorectomy.

2. Subtotal (Partial) Hysterectomy:

   • In a partial hysterectomy, the uterus is removed, but the cervix is left intact. Some individuals choose this option to preserve the cervix, though it may still carry the risk of cervical dysphoria.

3. Laparoscopic Hysterectomy:

   • In this minimally invasive approach, the surgeon uses a laparoscope (a small camera) inserted through a tiny incision in the abdomen to guide the removal of the uterus. Laparoscopic hysterectomy typically results in less scarring and a faster recovery than open surgery.

4. Abdominal Hysterectomy:

   • In cases where laparoscopic surgery is not an option, an abdominal hysterectomy may be performed. This involves making a larger incision in the lower abdomen to remove the uterus. While more invasive, it may be necessary for individuals with larger uteri or certain medical conditions.

5. Vaginal Hysterectomy:

   • In a vaginal hysterectomy, the uterus is removed through the vagina without the need for abdominal incisions. This method is less common in transgender men due to the frequent preference for vaginectomy (removal or closure of the vaginal canal).

Additional Surgeries

Many transgender men combine a hysterectomy with other gender-affirming surgeries. For example:

• Salpingo-Oophorectomy: Removal of the ovaries and fallopian tubes, often performed alongside a hysterectomy, helps to fully remove reproductive organs and may reduce the need for long-term hormone therapy.

• Vaginectomy: Some individuals choose to have the vaginal canal closed or removed during the hysterectomy to further reduce gender dysphoria and create a more masculine anatomy.

• Phalloplasty or Metoidioplasty: Individuals undergoing genital reconstruction surgeries often have a hysterectomy as part of their overall surgical plan.

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Recovery

Recovery from an FTM hysterectomy varies depending on the surgical method used. Key aspects of recovery include:

• Hospital Stay: Individuals undergoing laparoscopic hysterectomy typically have a shorter hospital stay (1–2 days) compared to those undergoing abdominal hysterectomy (2–3 days or more).

• Pain and Discomfort: Pain and cramping are common after surgery, especially in the first few days. Pain medication is often prescribed to help manage discomfort.

• Activity Restrictions: Individuals should avoid heavy lifting, strenuous activities, and sexual activity for several weeks post-surgery to allow the body to heal. Full recovery may take 6–8 weeks, though individuals undergoing laparoscopic surgery may recover more quickly.

• Follow-Up Care: Follow-up appointments with the surgeon are important to monitor healing and address any potential complications.

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Risks and Complications

Like all surgeries, an FTM hysterectomy carries risks and potential complications, such as:

• Infection: As with any surgery, there is a risk of infection, particularly at the incision sites.

• Bleeding or Blood Clots: Excessive bleeding or the formation of blood clots are possible complications, though they are relatively rare.

• Damage to Surrounding Organs: In rare cases, the bladder, intestines, or other organs may be damaged during surgery.

• Hormonal Changes: If the ovaries are removed, the body will no longer produce estrogen, which can lead to symptoms of menopause, such as hot flashes, mood swings, and bone density loss. Testosterone therapy can help mitigate these symptoms.

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Mental Health and Emotional Impact

For many transgender men, having a hysterectomy provides significant relief from gender dysphoria, as it removes the internal reproductive organs associated with a female body. The surgery can improve mental well-being by helping individuals feel more aligned with their gender identity.

However, it is important to address the emotional aspects of losing reproductive organs. For some, the loss of fertility may cause grief or sadness, even if they do not desire to carry children. Counseling or support from a mental health professional may be beneficial before and after surgery to help individuals process these feelings.

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Conclusion

FTM hysterectomy is a gender-affirming procedure that allows transgender men and non-binary individuals to remove internal female reproductive organs, helping to alleviate gender dysphoria and promote alignment with their gender identity. While the surgery carries some risks and requires recovery time, it offers significant mental and physical benefits for those who experience distress related to their uterus, ovaries, or cervix. Combined with other gender-affirming surgeries, hysterectomy can be an essential part of a transgender man’s medical transition.