(137) Trends in oophorectomy at the time of gender affirming hysterectomy

Background: An estimated 25-35% of transgender individuals undergo some form of gender affirming surgery. Hysterectomy is the most common bottom surgery. Approximately 8-14% of transgender males undergo a hysterectomy, though many more report desiring a hysterectomy. Depending on patient goals and preferences, patients may elect to undergo a concurrent oophorectomy. The decision to retain or remove ovaries has implications for reproductive health (e.g., fertility, cancer screening) and potential implications for patients’ hormonal profile and cardiovascular and bone health. The aim of this study is to assess rates of oophorectomy at time of hysterectomy for young adult transgender males and decision-making rationale.

Methods: A retrospective chart review was performed as part of a larger multi-method, IRB-approved study (#23-1299). Data derive from patients, ages 18-25, who underwent a hysterectomy indicated for gender dysphoria from 1 Jan. 2018 to 31 May 2023 at Children’s Hospital Colorado. We report descriptive statistics as means and standard deviations for continuous variables and as frequency and percent for categorical variables.

Results: Twenty-three patients met inclusion criteria. Table 1 reports demographic information. All patients were assigned female at birth and most currently identified as male or trans(male/masculine) (22, 95.7%). Fourteen underwent top surgeries (60.9%) prior to or concurrent with hysterectomy. Patient’s mean age at hysterectomy was 19.7 (range: 18-24) and nearly all were performed laparoscopically (22, 95.6%). Concurrent bilateral oophorectomies were performed in 15 patients (65.2%) and unilateral oophorectomy was performed in 2 (8.7%) patients. Six patients (26.1%) retained both ovaries. Among patients who retained ovaries, 5 (62.5%) stated a desire for future fertility, 2 (25.0%) indicated concerns about access to cross-sex hormones in the future, and 1 expressed concern about bone and cardiovascular health (12.5%). One patient who opted for bilateral oophorectomy underwent fertility preservation.

Conclusions: Prior to undergoing hysterectomy, many young adult transgender patients do not indicate a desire for future fertility and many elect for concurrent bilateral oophorectomies (though, some may still be interested in future fertility). Patients who retain ovaries may be interested in fertility preservation or have concerns about future healthcare access or general health. In-depth interviews are underway to understand the factors influencing the decision to retain or remove ovaries at the time of gender affirming hysterectomy.