What it is

Hysterectomy is surgical removal of the uterus. In gender medicine it is performed on trans-identified females ("trans men") to stop menstruation, eliminate pregnancy risk, and relieve dysphoria about the reproductive organs. It is one of the most commonly requested surgeries in transmasculine care — in the 2015 US Transgender Survey, 14% of transmasculine respondents reported having had one, representing under 1% of all hysterectomies performed in the United States.

The word covers several different operations, and the differences matter enormously for what happens to your hormones, your fertility, and your health for the rest of your life. The key variable is what else gets removed alongside the uterus.

Types of hysterectomy

Surgical approach is usually laparoscopic (small abdominal incisions, sometimes robot-assisted) or vaginal. The vaginal route is often preferred when the cervix is removed, because the tissue can be extracted through the canal without an abdominal scar.

Why trans-identified people get it

The stated reasons cluster into four groups, and they are not equally strong:

• Dysphoria about the organs themselves — wanting the uterus/ovaries gone as such.
• Menstruation distress — periods as a source of dysphoria or plain physical suffering.
• Pregnancy fear — eliminating the possibility of ever becoming pregnant.
• Practical/medical reasons — family history of reproductive cancer, endometriosis, chronic pelvic pain, or as a required precursor to vaginoplasty or phalloplasty with vaginectomy.

Notice that three of these four are not actually about gender identity. A person can hate periods, fear pregnancy, or have a family history of ovarian cancer without any belief that they are male. This distinction matters when you are trying to figure out whether surgery will solve the problem you actually have.

What the research shows

Complications

Large studies generally find that postoperative complication rates after hysterectomy in transmasculine patients are similar to those in non-trans women having the same surgery for benign reasons. Two large studies found no increased rate of postoperative complications in transgender cohorts compared with cisgender women undergoing hysterectomy.

But testosterone before surgery creates specific technical problems. A 2026 case series of four laparoscopic hysterectomies in trans men on long-term testosterone documented, in every case, intraoperative injuries: posterior cul-de-sac perforation (a tear in the pouch behind the uterus), cervical avulsion (the cervix tearing away) requiring conversion to open surgery, bladder dome injury, and deep vaginal lacerations. The cause was testosterone-induced cervical stenosis (narrowing), vaginal atrophy, and tissue fragility — the tissue behaves like that of a severely hypoestrogenic (estrogen-deprived) postmenopausal woman. A larger retrospective cohort of 333 patients found significantly more vaginal lacerations requiring intraoperative repair in the transgender cohort, though no difference in readmission, reoperation, or infection.

Regret and satisfaction

Published regret figures for hysterectomy in this population are low — but read them carefully.

The Johnson 2023 finding deserves attention because it isolates something the satisfaction surveys miss. When you ask "are you glad you had the surgery," most people say yes. When you ask "were you adequately counselled about fertility before the surgery, and do you regret how that was handled," 38.6% say they have regret — and the regret is concentrated among those who reported inadequate preoperative counselling. In that study, 79% had their ovaries removed, and not a single respondent who accepted a fertility-preservation referral actually underwent fertility preservation treatment.

There is also a timing problem. Regret about fertility decisions after hysterectomy in the general literature has been observed anywhere from 1 to 3 years after surgery, and after cancer-related fertility treatment anywhere from 1 to 10 years. Most surgical satisfaction surveys close the window long before that.

Detrans perspectives

Hysterectomy is one of the surgeries detransitioners on /r/detrans discuss most often, and the accounts are strikingly consistent about where the regret sits: not with the surgical recovery, but with fertility and with hormonal dependence.

I had my hysterectomy at 20 because I "didn't want to deal with periods" and "knew I never wanted to have kids." Which now at 24, I regret deeply.

—totallyacrow, detrans female

I was really happy with my decision for years, but after about a year into detransitioning, I took some biology classes and learned more about pregnancy than I had ever learned before... I'm still dealing with the grief of knowing that I can never become pregnant or enter parenthood how I would like to. Writing and talking to a therapist has helped a little, but I think I'll always be at least a little upset with myself for having a hysto.

—MangoProud3126, detrans female

ya, big time. worst mistake. i regret it more than my mastectomy. (both are awful tho). being on these pills for the rest of my life, exhausted and feeling like trash all the time, not having a period anymore, unable to have kids and start a family of my own. pretty wack!

—starberrles, detrans female

I completely regret the hysterectomy. It was an elective surgery that I didn't need, and I have now to buy and use synthetic hormones for the rest of my life as my ovaries were also removed in the process. I was like 20, nowadays I look back and definitely wasn't mature enough to make such a big decision.

—riprovevole, detrans female

Sometimes. Not sure I really want kids but I sometimes get jealous when I see a pregnant woman. I also have reoccurring dreams where I have a baby and I wake up very sad each time. I got a hysterectomy at 16 years old. I don't think anyone should get a hysterectomy that young even if they're 100% certain they don't want kids and/or are trans.

—notaplant999, questioning

A recurring theme is that the regret often arrives after a period of satisfaction — sometimes years later, when life circumstances or understanding change:

Hello! I had a total hysterectomy last year as my first (and only) surgery. My own experience with it was pretty brutal - I had to be operated on twice in one day and then got hospitalised two more times in the following weeks. Realised it hadn't been worth it, then started questioning my whole transition and things kind of spiralled from there... Personally, I also wish I'd reflected more on what exactly I had to gain by getting a hysterectomy before going through with it, and challenged myself to think in more specific terms than just "alleviating dysphoria"... What exactly does the dysphoria constitute? What situations make you dysphoric, and which ones would be made better by surgery? In what way?

—Nevrotiker, detrans female

Others point to health consequences they were not warned about:

I had a hysterectomy in 2018 and kept my ovaries... The hysterectomy itself also comes with risks. It puts you at risk of early onset dementia. It also puts you at risk of prolapse occurring. The uterus is a major organ, and it holds the rest of the internal body parts in place. No one told me this before my hysterectomy. I personally regret my hysterectomy and wish I never had it... It's my biggest regret out of every transition step that I made.

—somenuanceplease, detrans female

I had an ovary-sparing hysterectomy as well, and noticed the same. I had read it is mainly the removal of the cervix that causes a reduction in sensation because that is the area capable of spasming.

—ViscountVixen, socially trans — regrets entire transition

Not all detransitioners regret it. Some distinguish sharply between hysterectomy done for genuine medical necessity and hysterectomy done for identity reasons:

Obviously the hysterectomy can't have been a mistake for someone in your position, you were very sick... The big worry for people is when HEALTHY organs are removed without reason. For women, it will obviously take away our ability to have children. And even though many women in their twenties swear they will never want to have children... There really are women who change their minds, and removing the option for them can be cruel.

—TheDorkyDane, desisted female

Trans perspectives

Trans-identified people who are satisfied with hysterectomy describe real benefits, and their reasoning is often practical rather than purely about identity:

I got hysto with oophorectomy because I hated those fucking things, and because I had no intention of subjecting myself to "exams" to make sure the life destroying pieces of shit were "healthy"... The biggest advantage and potential disadvantage of keeping one or both ovaries is that they produce estrogen. If you ever stop T for extended periods of time, that estrogen provides a backup hormone that can protect you from the effects of not having any sex hormones at all. One of the most medically significant effects of not having any sex hormones is bone mineral density loss, which can lead to osteoporosis.

—tgjer, ftm

I did hysto with cervix removal but left ovaries intact. They don't make me dysphoric and my adhd makes my T use irregular at times. I ended up being grateful because I moved to a new country and getting into the care system and getting referrals for T is taking a long time. If I didn't have ovaries it could create lots of issues because adult bodies need a sex hormone to work well.

—enigmaticsurrender, ftm

I had a hysterectomy at 18 for medical reasons, with both ovaries removed. The trouble with having the ovaries removed is that you will need to be on some form of HRT for the rest of your life, either testosterone or oestrogen. Otherwise you end up with pain, fatigue, menopause symptoms. If you can't access that HRT for whatever reason, it's gonna suck.

—tomgrouch, ftm

That last comment comes from someone who supports the surgery and is warning about its terms. Even within the trans community, the consensus is that removing the ovaries creates a lifelong dependency that must be planned for.

What to think about before deciding

If you are considering this surgery, the following questions are the ones the regret literature suggests actually predict whether you will be at peace with it later:

• Are you keeping or removing the ovaries? This is the single biggest decision. Keeping them preserves a natural hormonal backup and the possibility of some future fertility technology. Removing them means you will need prescription hormones for life — through insurance gaps, moves, cost increases, or a change of mind.
• Have you explored what specifically about your situation is making you want this? "Alleviating dysphoria" is too vague to test. Is it periods? Pregnancy fear? The organs themselves? Pap smears? Each has different solutions, some reversible.
• How old are you, and how certain are you about future parenthood? The general-population data shows dramatically higher regret under 30. At 18–20, "I never want kids" is a common position that many people hold sincerely and still change.
• Have you had a real fertility conversation? In Johnson 2023, 56% reported receiving no fertility counselling at all before surgery, and those with moderate-to-severe regret were far more likely to say counselling was inadequate.
• What happens if you stop testosterone? If you keep ovaries, your body can make its own hormones again. If you don't, you go into surgical menopause unless you take hormones indefinitely.
• Is there a medical indication independent of gender? Endometriosis, cancer risk, chronic pain — these are legitimate reasons that exist whether or not you are trans, and they carry a different risk-benefit calculation than elective organ removal.

Related pages

• Orchiectomy: Methods, Outcomes, and Detrans Perspectives — the male counterpart procedure
• Vaginoplasty (Male Bottom Surgery)
• Phalloplasty — hysterectomy is often a precursor step
• Detransition: Meaning, Reasons, and Life Afterward
• Study archive · Support directory

References

• Rokhgireh et al. (2026). Intraoperative complications during gender-affirming laparoscopic hysterectomy in transgender men receiving testosterone: a case series. BMC Surgery. source.
• Pando et al. (2024). Operative complications, vaginal bleeding, and practice considerations for patients on testosterone undergoing gender-affirming hysterectomy. J Minim Invasive Gynecol 31(10):836–42. (cited in Rokhgireh et al. 2026)
• Alder et al. (2025). Surgical outcomes after gender-affirming hysterectomies: a consecutive case series of 72 patients. J Obstet Gynaecol 45(1). (cited in Rokhgireh et al. 2026)
• Adverse events and practice considerations for transgender patients undergoing hysterectomy. American Journal of Obstetrics & Gynecology (2024). source.
• Retrospective review of changes in testosterone dosing and physiologic parameters in transgender and gender-diverse individuals following hysterectomy with and without oophorectomy (2023). PubMed 36987750.
• Uterine and Ovarian Histopathology After Testosterone for Gender Affirmation: A Systematic Review (2024). PMC11456762.
• Barriers to Care and Reproductive Considerations for Transmasculine Gender Affirming Surgery (2022). PMC8903873.
• Johnson et al. (2023). Fertility preservation choices and decisional regret after gender-affirming surgery in transgender men or gender nonbinary persons. F&S Reports 5(1):87–94. PubMed 38524213.
• Bustos et al. (2021). Regret after Gender-affirmation Surgery: A Systematic Review and Meta-analysis of Prevalence. Plastic and Reconstructive Surgery. PMC8099405.
• Cohn, J. (2023). The Detransition Rate Is Unknown. Archives of Sexual Behavior. study page, source.
• Nathan et al. Younger Patients Have More Regrets About Hysterectomy. Obstetrics & Gynecology. MedPage Today coverage.
• Gribble, Bewley & Dahlen (2023). Breastfeeding grief after chest masculinisation mastectomy and detransition: A case report. Frontiers in Global Women's Health. study page.
• Littman, L. (2021). Individuals Treated for Gender Dysphoria with Medical and/or Surgical Transition Who Subsequently Detransitioned: A Survey of 100 Detransitioners. Archives of Sexual Behavior. study page.