Hysterectomy as Gender-Affirmation Surgery in Female-to-Male Transgender Persons [37P]

Abstract

INTRODUCTION: Persons assigned female gender at birth may seek hysterectomy as part of their gender affirmation. Little is known about the characteristics and outcomes of this population. METHODS: Retrospective chart review of 15 trans men (female-to-male transgender persons), age 16-43, who underwent hysterectomy by a single surgeon at our academically-affiliated community hospital from 2012-2016. Three patients participated in a focus group aimed at optimizing perioperative care. RESULTS: All patients were nulliparous, 93% had been on testosterone therapy and most had previously undergone bilateral mastectomy (“top surgery”). 66% underwent surgery solely for gender affirmation, the remainder had additional gynecologic indications. Most had robotic laparoscopic hysterectomy, with or without removal of the cervix, tubes and ovaries. Mean duration of surgery was 121.5 minutes (SD 18.75) and EBL was 43 cc (SD 21.9). Mean uterine weight was 91.7 g (SD 47.69). Forty percent of patients had pelvic pathology noted intra-operatively and 46% stayed overnight with mean length of stay of 15.75 hours (SD 1.75). One patient had postoperative vaginal bleeding from introital lacerations requiring two separate re-operations. Access to the vagina was frequently challenging due to absence of prior vaginal intercourse and marked vaginal atrophy due to high dose testosterone. Focus group discussion identified opportunities for creating a welcoming, trans-competent atmosphere for this population. CONCLUSION: Regardless of their future plans for genital reassignment surgery (“bottom surgery”), trans men frequently pursue hysterectomy as part of their gender affirmation. Future research is needed to characterize this population, educate providers and improve gynecologic care.