For most people who identify as FTM surgery is going to take place on at least one part of the body. Some people do not need surgery to get to the point where they resemble the person they identify as in their minds, but the majority undergo some sort of surgical change. In general, FTM surgery is separated into three different classifications: chest reconstruction procedures (also known as “top” surgeries), hysterectomy and oophorectomy (removing the uterus and ovaries) and genital reconstruction procedures (also known as “bottom” surgeries). While the “top” and “bottom” surgeries affect the physical appearance of the patient, hysterectomy and oophorectomy affect the reproductive system.
For some FTM surgery patients, having a hysterectomy and/or oophorectomy is very important, because getting the female reproductive organs out of their bodies is an important part of transitioning to a male sexual identity. However, even for patients who don’t really feel an emotional need to have these surgeries but do want to start a testosterone regimen, some doctors recommend having one or both of these procedures done within five years of starting the hormone treatments. Two reasons explain this recommendation. First is that there is a degree of concern that testosterone treatment over the long haul can make the ovaries develop symptoms that are similar to polycystic ovarian syndrome, or PCOS. This has been connected to elevated danger of endometrial cancer and/or ovarian cancer. It has been hard to prove whether these cancers are more of a risk after testosterone therapy in trans men. However, doctors recommend this as a preventive measure.
Second, removing the ovaries means that, for many patients, their testosterone doses can be smaller. The ovaries continue to produce estrogen as long as they are in the body (at least up to menopause), and so if they remain in the body, patients have to take more testosterone to compensate.
Even if a trans man decides not to have a hysterectomy and/or oophorectomy as part of his FTM surgery plan, he should keep having Pap smears on a regular basis to make sure that he has not developed cervical cancer, which remains a possibility. If he develops any irregular bleeding, pain or cramping in the vagina, it’s important to seek medical attention. Some trans men who have not yet had a hysterectomy as part of their FTM surgery plan develop endometrial tissue, particularly during the early years of testosterone treatments. Menstruation generally causes the body to shed endometrial tissue, but testosterone treatments stop menstruation after several months, allowing extra tissue to aggregate. Some people shed this extra tissue through spotting, but since irregular bleeding can also be a symptom of cancer, any bleeding that is unexpected merits a trip to the doctor.
Currently, there are four different ways to go about having a hysterectomy as part of your FTM surgery protocol. The total abdominal hysterectomy (TAH) is the most invasive method. The surgeon makes an incision in the wall of the abdomen, spreads the abdominal muscles, and cuts away the cervix and uterus from the surrounding blood vessels and connective tissue. This takes up to three hours, and patients stay in the hospital from three to five days. Recovery lasts one to two months, and the surgery leaves a scar up to six inches long, just above the hair line int he pubic area. Patients who are in good health generally choose a less invasive procedure.
Total vaginal hysterectomy (TVH) all takes place through the vagina, as the surgeon removes the cervix and uterus through an incision made inside the vagina. This makes it more difficult for the surgeon to check for endometriosis, and some complications can arise if the patient also wants his ovaries removed. The time of the procedure, recovery and hospital stay are about the same as TAH.
Total laparoscopic hysterectomy (TLH) removes the uterus and cervix through small incisions int he abdominal wall that admit a laparoscope and small surgical instruments. The surgeon passes tissue out through the vagina or the small incisions. Patients only stay in the hospital for a day or two, and recovery is generally over in a month. The dangers of blood loss and loss of urinary continence are much less. This is a newer procedure, so it’s important to make sure your surgeon is experienced with TLH before requesting it.
Laparoscopically assisted vaginal hystrectomy (LAVH) is like TVH but uses laparoscopic instruments. Patients with restrited vaginal canals should consider TLH as the vagina is not needed as much for removing tissue.
To find out more about the right FTM surgery choices for you, visit sexchangeoperation.net to find a listing of different medical providers (and reviews), as well as answers to many of your questions about the various steps in the process.