Surgeries for removal of the uterus and/or ovaries are designated for people assigned female at birth, to relieve gender dysphoria and/or to stop menstruation, to avoid pregnancies, and to treat medical conditions in the female reproductive system, such as endometriosis. Studies show that it is possible to remove the uterus and ovaries separately, together¹https://pubmed.ncbi.nlm.nih.gov/20233279/, or as part of a series of gender reassignment procedures²https://transcare.ucsf.edu/guidelines/hysterectomy.

Although there have been speculations about the removal of the uterus and ovaries as a preventive operation due to reports of a relationship between taking testosterone and pain after intercourse or an increase in the incidence of ovarian cancer, as of today no extensive studies have been done to prove this correlation.³https://www.sciencedirect.com/science/article/pii/S0015028221005811⁴https://doi.org/10.1080/15532739.2010.514220

It is possible to undergo these surgeries at any medical center or hospital that performs them, but a suitable recommendation is required. Note that not all medical centers use the laparoscopic method, so it is important to evaluate the approaches offered before beginning the process.

To undergo this surgery with HMO funding, approval is required from the Committee for Gender Reassignment.

Hysterectomy (Uterus Removal)

In a hysterectomy, the uterus is removed from the body with or without the cervix. If the cervix is not removed, it is important to continue with routine checkups of the cervix such as pap smears.

There are three hysterectomy methods:

• The laparoscopic method – nowadays this is the preferred method, as it is less invasive and recovery is easier. This is a surgical operation where 3-4 small incisions with a size of 5-15mm are made, through which a camera is inserted allowing the surgery team to see what is happening on an external screen, and with the use of small tools the uterus is disconnected. With this method, the uterus can be removed through the vagina or through the incisions in parts.
• The vaginal method – in cases with uterine prolapse or if the uterus is small, it can be removed through the vagina. This operation is done under general anesthesia, during which the cervix is widened and the uterus is disconnected and removed.
• The abdominal method – in this method an incision is created along or across the lower abdomen for removing the uterus. This method is considered the most invasive, so in most cases, it is preferred to avoid it if possible. Additionally, up to a week of hospitalization can be necessary for recovery after the surgery.

Hysterectomy is considered a safe surgery, though it is important to be aware of potential side effects after the surgery, such as blood clots, damage to the ureter (a tube bringing urine from the kidneys to the bladder), infections, and vaginal issues. It is important to discuss potential complications and their prevalence with your doctor.

Ovarian Removal

There are two methods for ovarian removal:

• The laparoscopic method – the preferred method today, where several small incisions are made in the abdomen, through which the tools to perform the surgery are inserted.
• The open/abdominal method – in this method an incision is created along the abdomen, and the ovaries are removed through this incision.

You can have the ovaries and fallopian tubes fully or partially removed. Full removal will eliminate ovulation and secretion of female sex hormones, while partial removal will preserve a certain degree of fertility as well as the secretion of said hormones. Full ovarian removal can result in menopause symptoms due to the lack of ovarian hormone secretion⁵https://www.mayoclinic.org/tests-procedures/oophorectomy/about/pac-20385030. Menopause symptoms can include hot flashes and sleep disturbances, a rise in the occurrence of heart diseases, and more. Sometimes cisgender women take low doses of estrogen after surgery to limit menopause symptoms, but the situation may be different in people taking testosterone⁶https://tinyurl.com/ypp82s8z in the short or long term, so you should consult with the relevant professionals about the effects of testosterone and the lack of estrogen in the case of full ovarian removal.