Hysterectomy Queries of Professor L. Gooren

 

Professor L. Gooren and Stephen Whittle
[Abstract] Full Text [PDF]

1. Is a hysterectomy recommended for all female-to-male transsexual people?

I assume that also removal of the ovaries is included in the term hysterectomy. Yes, I do recommend though the evidence for a yes is not super strong, but I would recommend it. Upon androgen administration ovaries become poly-cystic and simliar to those of women who suffer from a disease called poly-cystic ovarian syndrome. The latter is known to have a bigger change to become cancerous. Until recently this was rather theoretical but we have seen one case of ovarian cancer in an f-to-m after 8 years of androgen treatment and one case after 8 months of androgen treatment. In scientific terms, these findings do not constitute a scientific proof but they have made us cautious and have bolstered our already existing policy to recommend hysterectomy + ovariectomy after 18-24 months of androgen treatment.

2. How soon after commencing hormone treatment should an FTM undergo hysterectomy?

This is difficult to say, but arbitarily I would say within 4 years.

3. Should all FTMs plan to undergo a hysterectomy at some point in their life?

Not necessarily, but within a certain span of time.

4. Are there specific problems an FTM might experience eg. breakthrough bleeding, which might indicate an early hysterectomy?

No, this bleeding nearly always can be managed with progestational drugs.

5. What would be the reasons for an FTM not to undergo a hysterectomy?

A high risk for undergoing surgery, which is rare.

6. Is there any particular method that a surgeon should use, and if yes, why?

In Holland we have a gynaecologist who is able to do a vaginal hysterectomy which leaves no scar. It is a bit difficult intervention in a person whose vaginal canal has not been widened by child birth so the average gynaecologist is hesitant to do it. It would be good to find a gynaecologist who is prepared to do this. It is technically more difficult. An alternative is so-called laparoscopic removal of uterus and ovaries which leaves a minimal scar if any. Laproscopy is insertion of a tube into the abdominal cavity and operate through that peeping hole and remove tissue through it.

Citation: in Boys' Own, No 30, December 1999