TABLE 1- uploaded by Katherine Rachlin
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This study surveyed 134 female-to-male transgendered individuals (FtMs) in order to obtain information about their experience of hysterectomy and oophorectomy. The survey was designed to explore motivation for undergoing surgery, access to care, surgical complications, postoperative changes, and use of standards of care. The survey was distributed...
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... were allowed to check more than one reason for having surgery but were also asked to indicate the "number one" reason. Table 1 shows the many reasons that individ- uals had surgery and also the rank order for the reason's importance. When asked to choose the number one reason for surgery, individuals rated the following as most important: (1) done as preventative surgery due to concern about future medical problems (n = 30, 22%), (2) feelings of gender incongruence with female internal organs (n = 24, 18%), and (3) the relief of preexisting medical problems or cramping (n = 36, 27%). ...
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... In one study of 134 transgender men, 59% of hysterectomies were performed for "preventive" measures and 26% due to a pre-existing medical problem. Hysterectomy was also reported for tumors, cysts, fibroids, or endometriosis in 22% of surveyed patients and to "stop extreme bleeding and cramping" in 22% [18]. In the FtM population, hysterectomy may be therapeutic for both affirmation of gender and resolution of underlying medical conditions, such as primary or secondary dysmenorrhea, that may cause significant distress prior to and during transition. ...
Purpose of Review
The purpose of this review is to update readers on the multifactorial nature of pelvic pain with specific considerations for the female to male (FtM) transgender patient.
Recent Findings
Secondary effects of testosterone therapy include both genital and musculoskeletal changes that may contribute to the development of pelvic pain. Hysterectomy is therapeutic for gender affirmation and underlying pain conditions. Postsurgical pain from further pelvic reconstruction may be the result of the reconstruction itself, surgical scarring, or prostheses.
Summary
Pelvic pain is a common condition with many contributing factors. For the FtM patient, pelvic pain may be present at any point in the transition process. Pain conditions may be pre-existing or occur as a result of medical or surgical treatment of gender dysphoria. Research is needed on sex hormone-specific influences on the development of pelvic pain and mitigation strategies for treatment-specific development of pelvic pain in the transgender population.
... 24 Moreover, transgender men who undergo hysterectomy may also experience menstrual disorder, so it is possible that a number of transgender men in our study may have had both conditions. 25 Such considerations highlight the need for routine assessment of gender identity in health care and the incorporation of standardized reporting in health care data. 26,27 Finally, given the infrequency of surgical complications in both groups, there exists the possibility of beta error in our analyses. ...
Objective:
This study sought to assess surgical outcomes of hysterectomy performed for transgender individuals compared with hysterectomy for individuals with menstrual disorders.
Methods:
This retrospective cohort study was conducted using the American College of Surgeons National Surgical Quality Improvement Program database. Data of transgender individuals who underwent hysterectomy and individuals who underwent hysterectomy for menstrual disorders were extracted from the participant use data file (2015-2016). Transgender individuals were compared with individuals with menstrual disorders for surgical outcomes within 30 days of hysterectomy, by using appropriate statistical tests. A two-sided P value of less than 0.05 was considered statistically significant (Canadian Task Force Classification II-2).
Results:
The study identified 89 cases of hysterectomy for transgender individuals and 4439 cases of hysterectomy for menstrual disorders. Compared with patients who underwent hysterectomy for menstrual disorders, transgender patients were more likely to be younger (mean ± SD 30.79 ± 9.68 years vs. 42.6 ± 7.04 years), have a normal body mass index (25.84% vs. 17.77%), be classified as American Society of Anesthesiologists class I (34.09% vs. 10.46%), and have outpatient surgery (76.40% vs. 53.55%) (P < 0.05). Overall incidence of postoperative complications was low for both groups. No significant difference in surgical outcomes was observed for re-admission, superficial or deep/organ space infections, wound dehiscence, sepsis, blood transfusion, deep vein thrombosis, pulmonary embolism, or death. Transgender patients who underwent hysterectomy on average required decreased operative time (120.4 ± 79.2 minutes vs. 131.2 ± 64.3 minutes) and decreased lengths of stay (0.82 ± 0.82 days vs. 1.35 ± 2.73 days).
Conclusion:
This study suggests that transgender patients undergoing hysterectomy were younger and healthier than patients undergoing hysterectomy for menstrual disorders. Surgical complications were low for both groups, and significant differences in surgical outcomes were not observed.
... 5 For trans men and GNC individuals, these procedures may be desirable for a number of reasons including gender affirmation, becoming legally male on official documents, controlling abnormal uterine bleeding, or avoiding future gynecologic visits. 20 The decision whether or not to retain one's ovaries is personal and may be affected by desires for future fertility, plans for gender-affirming hormone therapy, or an individuals health history. 5 These procedures irreversibly prevent unintended pregnancy. ...
Contraception and fertility‐associated advisement is needed for any individual with a uterus who is engaging in sexual activity with reproductive potential. As greater awareness spreads regarding the health care needs of transgender, nonbinary, and gender‐nonconforming individuals, the research on evidence‐based care for these populations lags behind. Many clinicians may not be well versed in the best practices to support the sexual and reproductive well‐being of individuals who are taking gender‐affirming hormone therapy. This article reviews the use of contraception for individuals who are on testosterone gender‐affirming hormone therapy. Each contraceptive method is individually considered for the risks and benefits that are unique to this population.
... Options de traitement médical et psychologique de la dysphorie de genre Pour ceux qui sont en recherche des soins de leur dysphorie de genre, on peut envisager une variété d'options thérapeutiques. Le nombre, le type et la chronologie des interventions peuvent varier d'un individu à un autre (Bockting, Knudson, & Goldberg, 2006;Bolin, 1994;Rachlin, 1999;Rachlin, Green, & Lombardi, 2008;Rachlin, Hansbury, & Pardo, 2010 Différences entre dysphorie de genre chez les enfants et chez les adolescents Une des principales différences entre la dysphorie de genre chez les enfants et chez les adolescents est la proportion de sujets chez lesquels la dysphorie va persister à l'âge adulte 6 . La dysphorie de genre dans l'enfance ne persiste pas forcément à l'âge adulte . ...
L’étude a pour objet la fréquence des comorbidités psychiatriques chez les adolescents trans ayant un diagnostic de dysphorie de genre associé, consultant sur le dispositif Transidentité(s) du CHRU de Lille. Ainsi 43 patients ont été inclus, 72.1 % d’entre eux auraient au moins un diagnostic psychiatrique associé. Les troubles anxio-dépressifs seraient les plus représentés. Cette étude confirme la vulnérabilité psychique, voire psychiatrique, de cette population.
... Die Literaturrecherche ergab 4 relevante Publikationen aus den Jahren 2008-2011. Rachlin, Hansbury, and Pardo (2010) erheben über eine Online-Befragung bei 131 trans Männern Daten zur Operationsmotivation, zu den postoperativen Komplikationen und zur Frage, inwiefern nach Hysterektomie und Adnektomie eine vermehrte Androgenisierung des Körpers zu erwarten ist. Von den Teilnehmenden hat keiner die Operation bereut. ...
... Evidenzbasiertes Statement (Evidenzgrad III) Quellen: (Ott et al., 2010;Rachlin et al., 2010;Sehnal et al., 2008) (Neumann, 2015). Die mittlere Sprechstimmlage liegt bei Männern durchschnittlich bei 120 Hz, bei Frauen zwischen 200 und 240 Hz (Rosanowski & Eysholdt, 1999). ...
IntroductionThis paper introduces the German S3-guideline Gender Incongruence, Gender Dysphoria and Trans Health: Diagnostics, Counselling and Treatment that was finalized in October 2018.Objectives
The objective of the guideline group was to adapt the 1997 Standards for Treatment and Expert Opinion on Transsexuals to current scientific developments and research results and to make them applicable for appropriate health care in Germany.Methods
The treatment recommendations of the guideline are based on empirical evidence which was systematically researched and evaluated. In a structured consensus process, the guideline group, who is representative for the target group, and a stakeholder group of trans people in Germany agreed on 100 recommendations.ResultsThe guideline aims to individualize and deregulate the field of trans health care. Reasonable options for the treatment of gender incongruence and/or gender dysphoria are identified. Based on empirical and clinical evidence, a procedure is recommended which is tailored to the individual conditions of the treatment.Conclusion
The guideline reflects the current international state of trans health care on the basis of empirical evidence and relates it to the German health care system. Its application should be backed up by clinical and therapeutic expertise.
... Existing research into transmasculine experiences with gender-affirming surgery is disproportionately concerned with genital reconstruction surgery (i.e., phalloplasty and metoidioplasty), despite the fact that, currently, few transgender men in the United States undergo these procedures. 1,5,12,13 Relatively minimal research has evaluated how masculinizing top surgery, independent of other gender-affirming procedures, affects patient-reported mental health, quality of life, and sexual confidence. ...
Background:
Masculinizing top surgery (bilateral mastectomy with chest wall reconstruction) is an important gender-affirming procedure sought by many transmasculine and non-binary individuals. Current literature is primarily focused on details of surgical technique and complication rates, with limited data available on how top surgery affects subjective quality of life measures.
Methods:
An anonymous online survey was distributed to 81 of the senior author's former top surgery patients. Survey response rate was 72% (58 respondents). Responses were analyzed to investigate quality of life, sexual confidence, mental health, satisfaction with top surgery, and patient attitudes toward top surgery's role in gender affirmation.
Results:
Following top surgery, measures of quality of life and sexual confidence significantly improved (P < .001). Additionally, 86% reported improvement in gender dysphoria-related mental health conditions. All but 1 respondent reported that top surgery had an overall positive impact on their life.
Conclusions:
Top surgery had major positive effects on all mental health and quality of life metrics. Our findings contribute to a much-needed body of evidence that top surgery markedly improves the daily lives and functioning of transgender and non-binary individuals who choose to undergo it.
... Taking a feminist stance in this article also allows me to engage with an epistemological dilemma. Trans masculine hysterectomies are rarely discussed in academic literature (Colebunders et al., 2016;Rachlin, Hansbury, & Pardo, 2010). But I am a trans man, who has belonged to trans masculine communities for over a decade. ...
... Hysterectomy with salpingo-oopherectomy is a significant medical procedure with irreversible consequences, most notably for fertility. In addition, the surgery carries some risk of complications, although data on complications in trans masculine people are limited (Colebunders et al., 2016;Rachlin et al., 2010). The structure of gender identity services may be one factor in the emphasis on ''risks'' that are in fact minimal in younger people. ...
... However, it is not the only reason why trans masculine people decide to undergo this procedure. For some, knowing that they have a womb and ovaries is part of a sense of distress (''dysphoria'') with their anatomy, and hence removal of these organs is an important part of their transition (Rachlin et al., 2010). It has also been suggested that a hysterectomy and salpingo-oopherectomy may allow trans masculine people to reduce the amount of testosterone they need to take, although the evidence is poor (GIRES, 2008;Rachlin et al., 2010). ...
In April 2017, the European Court of Human Rights ruled that requiring trans people to undergo sterilisation in order to grant legal gender recognition was a breach of human rights. In the UK, sterilisation has never been a legal requirement for trans people. However, hysterectomy and salpingo-oopherectomy have been strongly encouraged for trans masculine people on medical grounds, although the clinical evidence for current recommendations is weak. Within this article I analyse the issue from a feminist perspective and argue that current presumptions in favour of surgical intervention are influenced by the history of medical interventions to “fix” bodies perceived as female, coupled with a strong social taboo against the pregnant man. As a consequence, medical and legal frameworks are not necessarily facilitating optimal outcomes for the individual. I suggest that practices in this regard should be critically examined, with a view to developing more tailored, person-centred practices and facilitating informed choice.
... Research on hysterectomy in cisgender women, although extensive, does not answer the questions trans men have regarding the outcomes of this surgery [81]. Rachlin et al. [50] reported the reasons for undergoing hysterectomy and oophorectomy in 134 trans men, with the most common reasons being the concern about future medical problems (22%), relief of preexisting medical problems or cramping (27%), and feelings of gender incongruence toward female internal organs (18%), whereas the most common reason for performing hysterectomy in cisgender women is the presence of leiomyomas [81]. Although vaginal hysterectomy in trans men is associated with certain difficulties, including nulliparity, the lack of uterine descensus and small, noncompliant, and atrophic vaginal walls due to previous testosterone use, vaginal hysterectomy is feasible in trans men, as in cisgender women [81]. ...
... Although vaginal hysterectomy in trans men is associated with certain difficulties, including nulliparity, the lack of uterine descensus and small, noncompliant, and atrophic vaginal walls due to previous testosterone use, vaginal hysterectomy is feasible in trans men, as in cisgender women [81]. In the study by Rachlin et al. [50], 89% of the respondents reported post-operative complications, of which 25% included postsurgical bladder/urinary problems (most commonly increased urinary frequency and pain during urination). Other postsurgical complications included keloid scarring (10%), infections (8%), adhesions (6%), and postsurgical bleeding (3%). ...
... Whether hystero-oophorectomy has a masculinizing effect on trans men, is difficult to determine, as many trans men take testosterone before and after hystero-oophorectomy. Rachlin et al. [50] describe 86 trans men who continued the testosterone that was started before surgery. They reported increased facial (50%) and body hair (56%), hair loss (34%), increased muscle mass (28%), lower voice (27%), microphallus growth (26%), decrease in vaginal lubrication (15%) and increased vaginal discomfort (5.6%), changes in body fat (12% increased, 17% decreased), changes in the occurrence of bloating (16% increased, 10% decreased), and changes in the occurrence of acne (12% increased, 8% decreased). ...
INTRODUCTION: Options for gender affirming therapy in trans men include social transitioning, mental coaching, hormonal therapy and gender affirming surgery. Research has concluded that gender affirming therapy is safe and feasible and generally leads to high satisfaction rates. However, research regarding the cost-effectiveness is scarce.
AREAS COVERED: A literature research was conducted on PubMed, Google scholar and Scopus, searching for relevant articles on the subject of the effects of gender affirming hormone therapy, gender affirming surgery and fertility in trans persons. Out of the 77 full text articles, 29 on the topic of quality of life and sexual desire following the initiation of gender affirming hormonal therapy and gender affirming surgery were selected for this review.
EXPERT COMMENTARY: Multiple studies have shown the positive effect of gender affirming hormonal therapy and gender affirming surgery on quality of life of trans persons and several studies describe an increase in their psychological wellbeing. In addition, satisfaction rates after gender affirming surgery are high and surgery is rarely regretted. However, as only one study has addressed cost-effectiveness of gender affirming treatment in trans men, further research is necessary.
... 3,4 Although not all transgender men use surgical treatments (eg, hysterectomy, vaginectomy, mastectomy, phalloplasty 2,5 ) as part of the gender affirmation process, many do with associated improvements in quality of life. [5][6][7][8][9] Twenty-one percent of transgender men undergo hysterectomy, and an additional 58% desire it but experience limited health care access, care avoidance secondary to discrimination, and lack of insurance coverage. 10 However, little is known about hysterectomy outcomes among transgender men. ...
... 10 However, little is known about hysterectomy outcomes among transgender men. 2,[5][6][7] Hysterectomies are the most common hospitalbased nonobstetric procedure performed in the United States. 11,12 As a result of decreased morbidity and cost, vaginal hysterectomy is the route of choice in cisgender women (those whose identify as women and were assigned female sex at birth). ...
Objective:
To describe the hysterectomy data among a cohort of transgender men and nontransgender (ie, cisgender) women with a particular goal to evaluate the feasibility of vaginal hysterectomy among transgender men.
Methods:
This cohort study includes all hysterectomies performed for benign indications on transgender men and cisgender women at a single academic county hospital from 2000 to 2012. Hysterectomy cases and patient gender were identified by billing records and confirmed by review of medical records. Primary study outcome was the hysterectomy route among transgender men compared with cisgender women. We also examined risk factors and operative outcomes. Student two-sided t tests, χ analysis, and descriptive statistics are presented; sensitivity analyses using regression techniques were performed.
Results:
Hysterectomies for benign gynecologic procedures were performed in 883 people: 33 on transgender men and 850 on cisgender women. Transgender men were younger, had fewer pregnancies and deliveries, and smaller uteri. The leading indication for hysterectomy differed significantly: pain (85%) was most common among transgender men (compared with 22% in cisgender women; P<.001), whereas leiomyomas (64%) was most common for cisgender women (compared with 21% in transgender men; P<.001). Vaginal hysterectomies were performed in 24% transgender men and 42% of cisgender women. Estimated blood loss was less among transgender men (P=.002), but when uterine size and route of hysterectomy were considered, the difference between gender groups was no longer significant. There was no difference in patients experiencing complications between the groups.
Conclusion:
Transgender men and cisgender women have different preoperative characteristics and surgical indications. Vaginal hysterectomies have been successfully completed among transgender men. Because vaginal hysterectomy is a viable procedure for this population, it should be considered in surgical planning for transgender men.
... The number and type of interventions applied and the order in which they take place, however, may differ from person to person. [4][5][6][7][8] Transgender people with gender dysphoria may undergo treatment with cross-sex hormones and/or genderaffirming surgeries as part of a medical transition. Transgender individuals may be treated in any combination of medical or surgical interventions to alleviate gender dysphoria to the fullest extent possible. ...
Background:
The transgender community is one of the most marginalized sections of our society. The literature is scarce regarding the pathology and laboratory medicine challenges associated with caring for transgender patients.
Objective:
To summarize the available gender-transitioning options and to discuss healthcare challenges, from a pathology/laboratory medicine perspective, in the care of transgender patients.
Method:
We reviewed the current terminology and epidemiology relevant to the transgender population in preparing our analysis.
Conclusions:
The main transgender healthcare challenges in pathology/laboratory medicine practice include the inflexibility of electronic medical records in documenting affirmed gender, unfamiliarity among medical and laboratory professional with the needs of and terminology related to the transgender population, lack of reference ranges for laboratory tests, unclear guidelines regarding gender classification for blood donation eligibility criteria, and paucity of experience in handling and interpreting surgical and cytologic specimens from gender-transitioning individuals. Directed efforts to overcome these shortcomings, coupled with a more welcoming posture, are essential to achieving the highest standards of care for the transgender population.
