My Hysto

Given that in the last post I quickly glossed over the fact that I have a major surgery scheduled in less than a week, I wanted to address a few details surrounding my decision and the whole process of having a hysterectomy.

What procedure am I getting?

A total laparoscopic hysterectomy, non-robotic to avoid an extra scar. All of my organs except my ovaries will be removed, so I am not getting an oophorectomy. It’s an outpatient procedure under general anaesthesia, meaning I go into the hospital in the morning, take a quick nap, wake up and go home the same day. Expected recovery time is a week or two.

How much will it cost me?

A hysterectomy can be expensive, from surgeon’s fees to hospital fees. For that reason alone, I would not be undergoing this procedure unless it was covered by insurance. In my case I’ve been assured it is. In total I’ll play less than $1K.

What was the process for scheduling the surgery?

After doing a lot of medical research, I then started searching for trans-friendly gynecologists in my area: browsed the online listserves, asked my therapist, my primary physician, and other doctors at local trans-friendly clinics like Lyon-Martin and Dimensions. I found 2 surgeons in the Bay Area that caught my eye, though there are plenty more. My choice was primarily based on convenient location, a website that lists FTM patients, and referrals from more than one person.

During the consultation, the surgeon discussed my options very openly, addressing both my physical questions as well as my concerns surrounding insurance. The office has dealt with many FTM, genderqueer, and trans* patients before, so they know how to address you, that your insurance card will likely be under a different name (and gender), and even have inclusive forms to fill out. The experience was overall very welcoming!

Although initially my idea was to tentatively “see what’s out there” the surgeon was eager to schedule something right away, which I did, so as not to give myself a chance to over-think it, which I usually end up doing anyway.

Why am I getting a hysterectomy?

Because I want to, is the simplest answer. But if you know me well, which by now a lot of you do, you’re going to point out that for any decision I always make a detailed list of reasons.

The Short List

• No more monthly periods, forever and ever and ever
• No sense in keeping organs I’m never going to use, and that could potentially develop cancer and other diseases. I’m absolutely sure I do not want to utilize these organs in the way they were intended (ie, bearing babies)
• My hormonal composition won’t be affected, since I’m keeping my ovaries
• I can still harvest my eggs in the future (for future Littler Awesomes!)
• It’s a relatively safe and common procedure
• Minimal scarring
• Nearly free

The Long List

First getting pregnant is not something I ever imagined myself doing; this was true even before I even knew I was trans. So in that sense, it’s straightforward.

But also, in a weird sense, I do feel this is something I need to do as part of my transition. Nobody sees your internal organs, nobody knows they are there or not. Yet, as with every step so far, I do it purely for myself, because I feel it’s what I need to do, because it feels right.

The organs I still might want someday – ovaries containing my genetic material and natural hormone factory – I’m keeping. This was my primary concern when beginning to look into it, as I do not plan to continue testosterone HRT in the long term, and I’d rather avoid hitting menopause at 26.

I knew that hysterectomies were linked to hormones, in some way, but I did not quite understand how. No matter how much research I did, there was nothing clear on hormones, specifically in my situation. Moreover, nobody could tell me what would happen if I removed hormones from my body entirely – that is, remove the ovaries and not take T.

It turns out (after asking many doctors, and doing some super sleuthing) your body needs a primary sex hormone, be it E or T. Otherwise, you induce menopause. Primarily, this has serious consequences for bone health (and other stuff nobody really knows about or can specifically point out). I’ve also learned that a hysterectomy is not an “end all be all,” and you basically pick and choose which parts are taken out and which parts you keep. (Worry not, there will be more detailed medical information in an upcoming article or two.)

Lastly, gynecology is not a new field. Half of the population regularly visits a gynecologist, and a hysterectomy is nothing revolutionary. In fact, it’s the 2nd most common surgery among women in the US. My surgeon assured me her complication rate was extremely low to non-existent. Sure, it’s still major outpatient surgery, but the laparoscopic techniques cuts down on recovery time, from 6 weeks to 6 days, with only tiny scars. I’m young, I’m resilient, and I don’t have other obligations right now preventing me from taking it slow for few weeks.

What made me finally decide to do this?

Did I hesitate? Of course. You know me: doubt and I are close frenemies. In the end though, I couldn’t find a compelling reason NOT to do this.

I discussed it with my significant other, and with my therapist. This is something that had been brewing in the back of my mind for a while, something that I saw myself doing… soon-ish. The only surprising part was that soon became now quicker than I expected.

Disclaimers

I’m not a medical professional and I possess no formal medical knowledge. This summary is a layperson’s understanding of personal research. It may or may not be accurate.

Due to discussion of transgender related surgeries and insurance, I’m refraining from connecting this with any specific surgeon’s name, just to be safe. Feel free to contact me for names.

(*) Please take note that I abstained from using much abused and cliché titles, such as my Hysto-story, my Hystory, Hysteria, or Hysterectify, among others. This type of restraint deserves a little praise.