Sex reassignment surgery female-to-male

Sexual reassignment surgery from female to male includes surgical procedures which will reshape a female body into a body with a male appearance.

Hysterectomy and bilateral salpingo-oophorectomy

Hysterectomy is the removal of the uterus. Bilateral Salpingo-oophorectomy (BSO) is the removal of both ovaries and fallopian tubes. Hysterectomy without BSO in cisgendered women is sometimes referred to as a 'partial hysterectomy' and is done to treat uterine disease while maintaining the female hormonal milieu until natural menopause occurs.

Related Topics:
Hysterectomy - Uterus - Fallopian tube - Cisgender - Menopause

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Some transmen desire to have a hysterectomy/BSO because of a discomfort with having internal female reproductive organs despite the fact that menses usually cease with hormonal therapy. Some undergo this as their only gender-identity confirming 'bottom surgery'.

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For many transmen however, hysterectomy/BSO is done to decrease the risk of developing cervical, endometrial, and ovarian cancer. (Though like breast cancer, the risk does not become zero, but is drastically decreased.) It is unknown whether the risk of ovarian cancer is increased, decreased, or unchanged in transgender men compared to the general female population. Unfortunately it will probably never be known since ovarian cancer is a relatively rare disease with an overall lifetime risk in women of only 1/70, with a median age of onset of 60 years. Because ovarian cancer is uncommon, the overall population of transgender men is very small, and even within the population of transgender men on hormone therapy, many patients are at significantly decreased risk due to prior oophorectomy (removal of the ovaries), it is essentially impossible to do the appropriate epidemiological study to answer that question. While the rates of endometrial and cervical cancer are overall higher than ovarian cancer, and these malignancies occur in younger people, it is still highly unlikely that this question will ever be definitively answered.

Related Topics:
Cervical - Endometrial - Ovarian cancer - Breast cancer - Oophorectomy

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Decreasing cancer risk is however, particularly important as transmen often feel uncomfortable seeking gynecologic care, and many do not have access to adequate and culturally sensitive treatment. Though ideally, even after hysterectomy/BSO, transmen should see a gynecologist for a check-up at least every three years. This is particularly the case for transmen who:

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• retain their vagina (whether before or after further genital reconstruction,)
• have a strong family history or cancers of the breast, ovary, or uterus (endometrium,)
• have a personal history of gynecological cancer or significant dysplasia on a Pap smear.

One important consideration is that any transman who develops vaginal bleeding after successfully ceasing menses on testosterone, MUST be evaluated by a gynecologist. This is equivalent to post-menopausal bleeding in a cisgendered woman and may herald the development of a gynecologic cancer.

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