File this under my ongoing campaign against the patient-autonomy framework…
Any benefit in not having an oophorectomy?
I'm meeting my gyno tomorrow to book a tubal and I'm curious if there is any benefit for us to keep ovaries? I kind of want to push to have them removed too
My gyno was unsure because I have a "female phenotype" and we spent months waiting on my endo (who I already really really dislike and don't massively trust) whose argument was to keep for it for osteo or "incase I want to stop hormones" Which I am BEYOND pissed about
Is there any actually real reason to keep them? Is the risk of osteo actually significantly higher or just higher as it tends to be for cis men? I don't want to cave on this because some 'what if' that will never eventuate
According to her fellow Redditors, the main reason to keep your ovaries is “in case this rampant transphobia thing gets worse and they make taking t illegal here” or a “freaking apocalyptic event that makes HRT [hormone replacement therapy, which is, by the way, not the same as taking cross-sex hormones] impossible to obtain.”
But the original poster says, in effect, damn your apocalypses: “I don't ever want to stop T, even if I had to I couldn't cope mentally anyway so the lack of sex hormone is the least dangerous part.” The clear implication here is that this woman would kill herself if she couldn’t access testosterone. Patients who cannot imagine a future that doesn’t involve tampering with their endocrine system are not in a position to provide informed consent, if you ask me. She doesn’t want to think about worst-case scenarios (and reveals a concerning piece of personal history in the process):
In reality there is no reason I wouldn't have access to hormones even if I were to find myself unhoused again and there hasn't been a shortage of hormones in the past - I'm aware the past isn't always future proof but I don't believe there is reason for concern there either, not enough to convince me to justify that in my decision making
My question was more health associated risks and their relevancy in trans men since a lot of information is under the assumption someone has an estrogen run body which is not the case for myself. I am trying to be as informed as possible before just "having them removed" and "going on with my life" which came across with a very aggressive tone considering I am asking for support to make said decision.
Someone else reassures her that, “[f]rom what I understand cardiovascular and bone health-wise, your risk factors are no different than a cis male’s.” There is, as far as I know, no reason to think this is the case. These are women removing organs that are integral to the healthy functioning of their bodies while taking massive doses of testosterone. There’s no universe where this set of risk factors can possibly add up to “no different than a cis male’s.”
Why remove everything? Because “my factory settings and I never got along.” (But you are not a device.) Another woman describes “hat[ing] the idea of using [her ovaries] again.” There’s just no recognition here that ovarian function is part of a woman’s overall health and wellbeing, not just slot machine that spits out eggs.
“I got rid of everything.
There is no reason for them to be there if you are gona be on T for life.”
Some women kept their ovaries—not for health reasons but because their ovaries were not a specific source of ‘dysphoria’ or because they could “always get them removed later.”
Here’s another woman, whose surgeon recommended keeping at least one ovary for some very good reasons (and not even mentioning other very good reasons, like elevated risk of dementia) but she just “didn’t want to have to worry about them anymore,” so she got both removed:
My surgeon recommended I keep at least one to prevent osteoarthritis, some cancers that can sometimes be associated with removal, and the protections that estrogen offers for the heart and other soft tissues. She also said that, due to obvious political issues in the US, it would be a safer option if HRT is ever banned for the trans community.
But she didn't push it, and I ultimately decided to have both removed. While I didn't have any massive dysphoria surrounding organs, I didn't want to have to worry about them anymore.
Others extend the promise of realizing previously unattainable transition goals by shutting down your body’s “estrogen production potential”:
My ovaries did not stop producing, even on T, and when I got a hysto/ooph it's like I got a part 2 to my transition. My beard finally filled out, I finally masculinized to cis proportions. Maybe you wouldn't have that issue. A lot of guys don't. I didn't realize the extent of the issue until I got them out, and suddenly I actually made my transition goals in like 6 months after being years and years on T. The difference was unmistakeable.
Some folks do keep them for just in case, because you need to stay on hormones for the rest of you life, but I figure I am going to be taking T until they take it from my cold dead hands, so that wasn't much of a concern for me. I am much older, and so far so good. No bone density issues so far. And while being safe is great but we are such a small population I don't think there is a lot of studies on aging transgender men and that issue.
I'm also a little distrustful of safety borne out of speculation. I watched my wife get told to stop her estrogen before every trans surgery, and not for any non-trans surgery (and we asked explicitly) and now it comes out that you don't need to stop it before surgery like that.
While it came from a nice place out of an abundance of caution from doctors that cared, it was not needed, and put my wife through a lot of dysphoria and pain for 4-6 weeks depending on the doc before each of her MTF related surgeries. So color me skeptical when we don't know if we even have to worry about osteoarthritis or bone density when we are on a steady dose of testosterone. I'd like to see some good longitudinal studies on this. We may have higher risks, or we may not. I don't know.
Sorry, I've had a lot of thoughts on this due to my own situation. I don't think there is a right answer, and it's really up to you, your docs, and how you feel, and your body's estrogen production potential.
For some women, it seems, “dysphoria outweighs the risk”—any risk—“and that's okay.”
When I read posts like this, I feel a terrifying sense of gravitylessness. This cannot be about patient autonomy. This has to be about medical responsibility. Doctors cannot responsibly put patients who hate and misunderstand their bodies this much in charge of deciding which healthy organs to cut out.
The answer has to be: We don't remove healthy organs. Let us help you deal with the underlying issues that make you think you need to do this.
"Is the risk of osteo actually significantly higher or just higher as it tends to be for cis men?"
But men don't have a higher risk for osteoporosis. Women do. It's a much, much higher risk. And one of the reasons they are at higher risk is they naturally have smaller, less dense bones than men.
There's no informed consent or "trying to be informed as possible" (as she states in the later comment you quoted) when she's already starting from wrong information that she doesn't want challenged.
This is just insane. I’m a 55 year old woman who has just gone through menopause (a totally natural event) and I can tell you that there are DEFINITELY a lot of consequences of your body not making estrogen any more. Declining bone density is just one of the many, many things that are affected by low estrogen levels. That is why HRT is frequently prescribed for menopausal women; osteoporosis is very common, in addition to a dramatically increased risk of heart disease, vaginal atrophy/pain, constant joint pain, brain fog…
In fact, surgical menopause induced by hysterectomy and removal of the ovaries is often more intense and much worst than the natural sort of menopause - to the point where most women who undergo surgical menopause are usually put on HRT immediately because the sudden, massive drop in hormones is physically and mentally debilitating.
This is just incredibly unethical for providers to do this to mentally unstable young women.