Keep or Remove Ovaries?

[JamesRoe73]

I'm getting a hysterectomy in May and I can't decide whether I should keep or remove the ovaries. The main reason I'm getting the hysterectomy is that I feel really uncomfortable with the idea that I could get pregnant and that I would need any gynecological check-ups (I just don't want it in there). I don't think I care about having biological kids, I'm totally fine with adoption and the process of harvesting eggs sounds pretty awful to me, but I'm still young so maybe I'll change my mind. I've heard there are some good medical reasons to keep the ovaries related to long-term heart and bone health, but I'm also afraid of any possible things that could go wrong with them (PCOS, cancer, etc) and the fact that I would need to think about the ovaries makes me a little bit uncomfortable.

Basically, how do I know if the benefits of keeping the ovaries (heart and bone health as well as possible reproductive uses) are worth my mild discomfort (like, maybe needing to see a doctor in the future, but I'm mostly uncomfortable with the uterus) and possible (but unlikely) health problems (like PCOS and cancer)? I don't want to be 80 years old and have heart and bone problems because I was a little bit uncomfortable with my ovaries (I don't want them, but I don't want to jeopardize my health).

(My surgeon wants me to be very sure of my choice, and she seems to be biased towards keeping them)

Thanks!

Edit: I'm also pretty sure I want Metoidioplasty sometime, does having or not having the ovaries matter for that?

[mm]

JamesRoe73, you are asking a valid question.  When I have mine done in few years, they are going along all my internal parts.  I don't want to be getting internal exams to check my ovaries, having a dr putting his/her fingers in me and feeling my tummy to check them is something I don't want done.  When I have bottom surgery the extra will be removed at well.  This is my think; I know there are a couple of positives for keeping them but I am willing to take my changes with them gone.

[FTMax]

Hey James,

I am getting everything taken out for a few reasons.

(1) I'm having meta with a vaginectomy. That'll remove the most easy means of access to those internal parts. If I kept them and there was an issue down the road, I would have very few options available as to having a doctor get in there to sort it out. That is generally what you will be told when you start looking into bottom surgery. It all kind of hinges on the vaginectomy. I'm happy to explain further if you'd like.

(2) I plan on taking testosterone the rest of my life. The issues that come from removing internal hormone producers are typically a greater concern for people who are not taking hormones externally, in my understanding. That is why you'll often see cis women taking estrogen after a hysterectomy. If you have some kind of hormones going into your body, you will be fine not having anything internally producing them.

(3) I don't want to have kids, or the option to do so. Self explanatory.

(4) I don't want to have to see any kind of female-specific doctor ever again, or have to explain to a doctor that I have ovaries. I have an appointment with the surgeon who's doing my hysto next week and I'm 100% not excited about sitting in a gynecology office, even if it is for a good cause.

[Kylo]

Far as I know you will have to take estrogen supplements for life if you have them out since the body can't do without E and you can't really produce it from anywhere else? That's the only reason I personally would keep them.

If you take T long term though, I hear it does cause potential problems with the ovaries long term and those might make the decision for you, and end with you having to have them out anyway. That's what my doc said.   

[FTMax]

Far as I know you will have to take estrogen supplements for life if you have them out since the body can't do without E and you can't really produce it from anywhere else? That's the only reason I personally would keep them.

I've never heard of a transguy taking estrogen post-hysto w/ oophorectomy.

[Tysilio]

If you have the ovaries out, there's no reason to take E as long as you're on testosterone. You may find, though, that you can get by with a lower dose of T -- I'm sure your doctor will want to check your levels at some point post-surgery, but as someone who's post-menopausal, with more or less non-functioning ovaries, I find my T levels run on the high side with a dose that's about half the standard one.

[Bimmer Guy]

The only reason I removed my ovaries was because I am getting a vaginectomy (closure of the vagina).  I am 45 years old.

If you DO remove your ovaries you should plan to:

1) Be on either testosterone or estrogen for most of your life.  My surgeon told me that if I went off T, he would suggest I take E until age 53, which is the average age of menopause. 

Again, if you remove your ovaries, you should plan to be on T until age 53 or take estrogen (shots, pills, etc).

2) Never have your own children.


If you do NOT remove your ovaries:

1) You have the option to stop T whenever you want and do nothing else (your E will kick back in).

2) You have the option of harvesting your eggs and have your own biological child.


Please know that if you leave your ovaries, your chances of ovarian cancer is very low, especially since your fallopian tubes are removed (they connect the urterus to the ovaries).  The fallopian tubes are the key to ovarian cancer.

Did your doctor tell you you would still need to get some form of exams if you left just the ovaries?  I just googled it and seems as if this is not the case after a couple of years.

I never tell people what they should do, but I do implore you to strongly consider what you are giving up by removing your ovaries.  I would skip it for now and if you figure out later that they cause you dysphoria, go back in and get them removed. 

[Arch]

If you are planning meta, you might post your question to a few meta surgeons (preferably those you are considering for the procedure).

As far as other aspects are concerned, I have no advice. I assume that my ovaries were shut down completely and would have been utterly useless for any health benefits. I got everything taken out, and I was bloody glad to get rid of it all. I will never stop taking T, I do not like children, I hate going to the GYN, and the very idea of having those things (and the other parts) inside me has been tearing me apart for the last couple of years. I'm glad I had such strong feelings about it all; the decision to have the whole mess taken out was easy to make.

If you are not on T and do not have dysphoria about having those organs in your body, then you may have a very difficult choice ahead of you. I wish you luck.

[Dex]

I also had everything removed when I had my hysterectomy. Bimmer sums it up pretty well.  You don't necessarily need to worry about the potential "low e" problems *if you plan to be on T for life*.  That was the one thing my surgeon asked me as they would want me to be on some sort of sex hormone without having my ovaries. For me, it was a no brainier because I don't ever want to be fueled on E again, whether synthetic or naturally produced. But Bimmers decision list is a good start for you. No matter what you decide, it's not wrong. Do what is the best decision for you.

[spro]

I am getting everything taken out for a few reasons.

(1) I'm having meta with a vaginectomy. That'll remove the most easy means of access to those internal parts. If I kept them and there was an issue down the road, I would have very few options available as to having a doctor get in there to sort it out. That is generally what you will be told when you start looking into bottom surgery. It all kind of hinges on the vaginectomy. I'm happy to explain further if you'd like.

Hey there, would you mind going into more detail on this for me? I'm looking to get hysto and meta with vaginectomy and been trying to figure out the ovary question. Why is it impossible to get meta and leave the ovaries in, and where did you get that information?

Thanks for your help! This is my first comment here, sorry if I did anything wrong. 

[Dena]

Welcome to Susan's Place spro. You haven't done anything wrong and your post is fine. Many people do introductions but I didn't as I made my first post in the voice section. You will find the guys make most of there post in the FTM section but you may post anywhere on the site you feel comfortable. We are pretty lose about posts as long as they conform to the TOS that you will find in the following links. If you need something, just let us know.

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[spro]

Thanks for the info and welcome Dena! 

[FTMax]

Hey there, would you mind going into more detail on this for me? I'm looking to get hysto and meta with vaginectomy and been trying to figure out the ovary question. Why is it impossible to get meta and leave the ovaries in, and where did you get that information?

Thanks for your help! This is my first comment here, sorry if I did anything wrong. 

No problem And it's not impossible, it's just generally not recommended by the surgeons who perform vaginectomies as a part of their bottom surgery packages.

The analogy I used to explain it to my mom was to think of the ovaries as tonsils, and the V as a mouth. Sometimes people have issues with their tonsils, sometimes they don't. Some people have them removed, some people don't. But if the patient has had their jaw wired shut and can't open their mouth, and is also having significant throat pain and other symptoms of tonsillitis, what can a doctor do? Not much until they open the patient up in some way and take a look inside.

The vaginectomy removes the front door to the reproductive system. So when you leave pieces of the reproductive system behind, you run the risk of not being able to easily get to them in the event that there is an issue. In order to take a look, they would have to make an incision and go in through the abdomen. Most surgeons performing meta and phallo do not want to put you in the position to potentially need that unless you fully understand the ramifications of that choice, and the choice makes sense for what your goals are regarding offspring, HRT, etc.

[spro]

Oh I see. I guess that pretty much settles the question for me. Vaginectomy is way more important than having ovaries. I do want kids in the future, so I worry that I'll regret having the ovaries taken out, even though I plan on adopting or using sperm donation. It seems like this is hardest decision I'll have to make in regards to transition though and it's the first time I've had to worry "What if I regret this?"

I've heard people say that there may be health problems related to lack of ovaries. But logically, those health problems must have more to do with the lack of estrogen than the lack of ovaries right? Which is something doctors can take into account in my hormone regimen if need be. There seems to be some controversy and not enough medical information at the moment, so one doctor will say it's better to leave them in, and another will say there's no reason to.

Anyway thank you for your reply and the info, it's been very helpful.

[FTMax]

Oh I see. I guess that pretty much settles the question for me. Vaginectomy is way more important than having ovaries. I do want kids in the future, so I worry that I'll regret having the ovaries taken out, even though I plan on adopting or using sperm donation. It seems like this is hardest decision I'll have to make in regards to transition though and it's the first time I've had to worry "What if I regret this?"

I've heard people say that there may be health problems related to lack of ovaries. But logically, those health problems must have more to do with the lack of estrogen than the lack of ovaries right? Which is something doctors can take into account in my hormone regimen if need be. There seems to be some controversy and not enough medical information at the moment, so one doctor will say it's better to leave them in, and another will say there's no reason to.

Anyway thank you for your reply and the info, it's been very helpful.

If you worry about having kids, you could always have your eggs harvested now. I don't know anything about that process, but I know people have done it.

And yes - the issues are related to not having any hormones in your body. That's why most women who have a hysterectomy prior to menopause take an estrogen supplement. It is not a huge issue for us because we are typically on testosterone.