A hysterectomy for trans men removes the uterus, usually with the fallopian tubes and ovaries (bilateral salpingo-oophorectomy, or BSO). It permanently ends menstruation and stops the ovaries from producing estrogen, which many trans men find relieves gender dysphoria.
The World Professional Association for Transgender Health (WPATH) recognizes hysterectomy, with or without removal of the tubes and ovaries, as a medically necessary part of gender-affirming care for trans men who choose it. It can be combined with other gender-affirming procedures in the same operation, such as vaginectomy, top surgery, metoidioplasty or phalloplasty
At Kamol, the surgery is performed by a gynecologist. It takes about 1–2 hours, with a hospital stay of about 2–3 nights.
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Who Is a Good Candidate?
- Trans men and transmasculine people who want to stop menstruation and estrogen production
- Assessed by a psychiatrist and confident in their decision
- In good general health and fit for general anesthesia
- BMI under 30
- Non-smokers, or willing to stop
4 Hysterectomy Techniques at Kamol Hospital
1. Laparoscopic Hysterectomy
Instead of one large incision, the surgeon makes three small incisions: one at the navel and two on the lower abdomen. A camera and thin instruments are passed through these to remove the uterus, tubes and ovaries. Compared with open surgery, there’s less scarring, pain and blood loss, a shorter hospital stay and faster healing.
2. Abdominal Hysterectomy with Bilateral Salpingo-Oophorectomy (BSO) or Open Technique
A transverse incision is an abdominal wall, usually above the pubic bone, as close to the upper hairline of the individual’s lower pelvis as possible, similar to the incision made for a cesarean section approximately 4-5cm long. This technique allows the surgeon the most exceptional access to the reproductive structures and performs the removal of the entire reproductive complex. Abdominal hysterectomy is the most common method. The recovery time for an open hysterectomy is 4–6 weeks.
3. Subsequently, the Vaginal or V technique
Vaginal hysterectomy is performed entirely through the vaginal canal and has clear advantages over abdominal surgery, such as fewer complications, shorter hospital stays, and quicker healing time. If this technique is complicated, surgical exploration will be required.
4. vNOTES Hysterectomy (Scarless Hysterectomy)
A new technique removes the uterus and ovaries. They were developed from total laparoscopic hysterectomy and transvaginal hysterectomy procedures, which provide more safety. The surgeon inserts a vaginal speculum into the vagina and inserts the shield into the vagina to protect the cervix. Then the surgical instrument is inserted into the vagina. After dissection, both uterus and ovaries are removed from the vagina opening.
Advantages of vNOTES:
- No visible scars on the abdomen
- Less pain after surgery than laparoscopic surgery
- A shorter hospital stay, as bowel function returns faster
- A faster return to daily activities
- Fewer complications. Removing the uterus and ovaries through the vagina without a camera can be difficult because they sit high in the pelvis, with a risk of injury to the ureters, bowel or blood vessels. The camera lets the surgeon see these clearly, reducing that risk.
Preparation
Gather information. Learn as much as you can about having a hysterectomy. Make sure you understand how the procedure will go and what is involved in the recovery process.
Stop smoking. Stopping or cutting down on smoking as much as possible can help with general anesthesia and recovery from surgery; smokers may have problems breathing during surgery, and they tend to heal more slowly afterward.
Discuss your medication with your doctor. Talk to your doctor about whether you need to change your usual medication routine before having a hysterectomy. It would be best to inform your doctor about any over-the-counter medications, such as aspirin or dietary supplements. Some supplements can help prepare you for a hysterectomy. For example, taking a daily multivitamin can help improve general health, and vitamin C can help promote healing. Talk to your doctor about recommended supplements you might take before your hysterectomy surgery.
Make sure other medical conditions are well-controlled. If you have diabetes, high blood pressure, sleep apnea, or other medical conditions, check with your doctor to make sure they’re under control before you have a hysterectomy. When other pre-existing conditions are managed,
Eat light. Limiting heavy foods and avoiding big meals can help you feel better before and after the procedure. “Eating healthy is always important, but even more so when you plan to have surgery.
Post-operative Care
- After having a hysterectomy, you will feel tired and in some pain. This is normal after this type of surgery. You will get a painkiller
- You may have a drainage tube in your abdomen (if you have had an abdominal hysterectomy) to take away any blood from beneath your wound – these tubes usually stay in place for 1 to 2 days
- You may have a gauze pack inserted into your vagina (if you have had a vaginal hysterectomy) to minimize the risk of bleeding – this usually stays in place for 24 hours
- you’ll be encouraged to take a short walk the day after your operation. This helps your blood to flow normally, reducing the risk of complications developing, such as blood clots in your leg
- After removing the catheter, you should be able to pass urine normally.
- Any stitches that need to be removed will be taken out 5 to 7 days after the operation.
Recovery
Risks and Side Effects
Surgical risks
- Pain, which may need strong pain relief at first
- Bleeding inside the abdomen in the first 2–3 days, which is why you stay in hospital for monitoring. In rare cases, another operation may be needed to stop bleeding.
- Wound separation or delayed healing
- Infection
- Injury to the bladder, ureters or bowel, which is uncommon
- Blood clots in the legs
- Scarring (after open surgery)
- Side effects of anesthesia, such as nausea, vomiting or dizziness
Temporary side effects
- Bowel and bladder changes: drink plenty of fluids and eat more fruit and fiber. You may need a mild laxative to avoid straining at first.
- Bloating: from slow bowel function in the first few days.
- Vaginal spotting or discharge: light bleeding for 2–3 weeks and discharge for up to 6 weeks is normal. See a doctor if you have heavy bleeding, pass clots, or notice a foul-smelling discharge.
- Hormonal symptoms: if your ovaries are removed, you may have hot flushes, sweating or mood changes. These are usually mild if you continue testosterone. Talk to your doctor about your hormone therapy after surgery.
- Emotional changes: many trans men feel relief after hysterectomy, but mood can also be affected by hormonal changes and recovery. Support is available from our mental healthcare team.
Before and After for Hysterectomy with BSO
Why Choose Kamol Hospital in Bangkok for FTM Hysterectomy
- Gynecologists within a gender-affirming team: Surgery is performed by gynecologists who work alongside Kamol’s plastic surgeons, psychiatrists and hormone specialists.
- Four techniques, including scarless vNOTES: Laparoscopic, open, vaginal and vNOTES hysterectomy, so the technique is matched to your anatomy and goals.
- Combined female-to-male planning: Hysterectomy can be coordinated with top surgery, metoidioplasty, phalloplasty and facial masculinization.
- Assessment and aftercare in one place: Psychiatric assessment, surgery, hormone follow-up and mental health support.
- Hospital-level safety: Inpatient monitoring after surgery, in a JCI-accredited hospital.
- Support for international patients: Multilingual coordinators and Kamol Trip help you plan your stay in Bangkok.
What Questions Do Patients Commonly Ask?
What is an FTM Hysterectomy?
An FTM hysterectomy is a surgical procedure that removes the uterus and sometimes the ovaries and fallopian tubes in female-to-male transgender individuals. It’s a significant step in gender affirmation for many, as it eliminates menstruation and reduces the production of female hormones. This can help alleviate gender dysphoria and create a physical experience that aligns more closely with a male identity.
Why might someone choose to have an FTM Hysterectomy?
People choose to have the procedure for various reasons. Primarily, it helps align their body with their gender identity. Removing the uterus stops menstruation, which can be a source of dysphoria for transgender men. Additionally, removing the ovaries reduces estrogen production, which can further aid in masculinization.
Some individuals may also choose this surgery to reduce the risk of certain gynecological cancers.
Will I still need testosterone after a hysterectomy?
Yes, if your ovaries are removed. Without ovaries, your body no longer produces enough sex hormones, and testosterone therapy is needed to protect your bones, heart and overall health. Many trans men find their testosterone dose can be adjusted after surgery. See Gender-Affirming Hormone Therapy.
Can hysterectomy be combined with top surgery?
Often, yes. Combining the two means one anesthetic, one hospital stay and one recovery period, which many international patients prefer. Your surgical team will assess whether combining is safe for you.
Do I need a hysterectomy before metoidioplasty or phalloplasty?
If you plan to have the vagina closed (vaginectomy) as part of genital surgery, a hysterectomy is usually needed first or at the same time. Your surgeons will plan the safest order. See Metoidioplasty and Phalloplasty.
Can I preserve my fertility before surgery?
Removing the uterus means you won’t be able to carry a pregnancy, and removing the ovaries ends egg production. If you might want biological children in the future, ask about egg or embryo freezing before surgery. If you keep your ovaries, egg retrieval may still be possible later.
