According to the 2011 Institute of Medicine Report and emphasized by the American College of Obstetricians and Gynecologists Committee Opinion, transgender individuals encounter significant healthcare barriers. The American College of Obstetricians and Gynecologists charges obstetrician-gynecologists to help eliminate these barriers to care by creating nondiscriminatory practices and assisting with transitioning. This includes supporting social, medical, and surgical aspects of the gender affirmation process. Obstetrician-gynecologists are able, without additional training, to perform hysterectomies for transgender men, and total vaginal hysterectomies are the least morbid and most cost-effective form of hysterectomy.
We present data from a retrospective chart review of all hysterectomies performed for benign indications at a single urban county hospital from 2000 to 2012. Primary area of interest is a case series of hysterectomies performed on female-to-male transgender men.
A total of 948 hysterectomies were performed for benign indications. Of those, 34 were for female-to-male transgender men. Compared with women with carcinoma in situ (CIS), female-to-male transgender men were younger, had fewer pregnancies and deliveries, had smaller uteri, had lower body mass index, were usually on testosterone before surgery, and were more likely to have concurrent oophorectomies. The primary indication for hysterectomy for female-to-male transgender men was pain (53%) compared with bleeding (46%) for women with CIS. Total vaginal hysterectomies were performed in 24% of female-to-male transgender men compared with 39% of women with CIS. There was no difference in complication or conversation rates between the two groups.
Total vaginal hysterectomy is a safe, viable, and cost-effective option to consider for female-to-male transgender men and gender affirmation surgery and encourage obstetrician-gynecologists to consider total vaginal hysterectomy as a minimally invasive option in serving female-to-male transgender men to encourage nondiscrimination and augment access to care.