Bilateral oophorectomy common for adults undergoing gender-affirming hysterectomy

Key takeaways:

• Most adults seeking gender-affirming hysterectomy also opted for a bilateral oophorectomy.
• All patients who underwent bilateral oophorectomy used testosterone preoperatively.

DENVER — Bilateral oophorectomy was common during gender-affirming hysterectomy and associated with younger age, prior testosterone use and male identity, according to study results presented at the ASRM Scientific Congress & Expo.

“About 1.6 million adults and 300,000 youth in the United States identify as transgender. Many of these patients will ultimately decide to have a gender-affirming surgery, and sometimes the surgeries may include hysterectomy, with or without oophorectomy,” Jourdin Batchelor, MD, first-year fellow in pediatric gynecology at Boston Children’s Hospital, said during the presentation. “Unfortunately, there are minimal data regarding ovarian conservation vs. removal, especially in gender-diverse young adults who choose hysterectomy.”

Batchelor and colleagues conducted a retrospective cohort study with 91 young adults (76% white; 74% privately insured) aged 18 to 30 years assigned female at birth who underwent total hysterectomy with gender affirmation as the primary or secondary indication at the Hospital of the University of Pennsylvania from 2016 to 2024. Researchers collected data on patient demographics, gynecologic comorbidities, mental health diagnoses, preoperative factors, surgical characteristics and pathology.

Overall, 66% of patients underwent bilateral oophorectomy during gender-affirming hysterectomy.

Researchers observed no differences in race/ethnicity, insurance type, gynecologic comorbidities, mental health diagnoses or desired fertility between the bilateral oophorectomy or ovarian retention groups. Bilateral oophorectomy was more common among patients aged 22 years and younger vs. patients aged 23 to 30 years (53% vs. 47%; P = .012). Patients who identified as male were more likely to undergo bilateral oophorectomy vs. those identifying as nonbinary or gender-fluid (97% vs. 3%; P < .001).

All those who underwent bilateral oophorectomy were prescribed testosterone before surgery compared with 77% of patients in the ovarian retention group.

Endometriosis, adenomyosis and ovarian cysts were not associated with higher bilateral oophorectomy frequency.

“Many factors we may traditionally see as reasons for oophorectomy in a cisgender population — for example, debilitating endometriosis or concerning ovarian masses — are not relevant to this population at all, and so it will be important to conduct future qualitative research to explore patient motivations, the education that patients receive and the current counseling regarding this topic in order to help us develop best practices,” Batchelor said. “Advocacy is inherent to this field, but it is imperative for all of us to continue to advocate for the protection of this vulnerable population.”