Zak: There are a lot of reasons why a trans man would want to have a hysterectomy, here are some of them:
1. Because their doctors recommend it/preventative medical reasons. My doctor pretty much told me when she put me on testosterone that she prefers her patients on T to get hystos within 5-7 years. Part of this is because of cancer risks and other health problems. Regarding this health risk, Hudson’s FtM guide states: “…some physicians recommend hysterectomy (surgical removal of the uterus) and oophorectomy (surgical removal of the ovaries) within the first 5 years of starting testosterone therapy. There is some concern that long-term testosterone treatment may cause the ovaries to develop similar symptoms as those seen in polycystic ovarian syndrome (PCOS). PCOS has been linked to increased risk of endometrial hyperplasia…endometrial cancer, as well as ovarian cancer. It should be noted that it is difficult to know whether the risk for such cancers is increased by testosterone therapy in trans men.” So basically, testosterone might be bad for those parts so a lot of people (including doctors) think that if you aren’t planning on using them (which some trans guys do, others don’t), it’s probably better to just get rid of them.
2. Because if you don’t have those parts removed, you still need regular pap smears. Many trans men are deeply uncomfortable with pap exams, or have difficulty accessing that kind of medical care. Getting everything removed (uterus, ovaries, fallopian tubes, cervix) means no more exams, which for many guys is a huge incentive.
3. As a form of birth control. Some trans men have sex with cisgender men and worry about pregnancy. Hormonal birth control is not really an option on testosterone, and really a hysto is the only surefire way (other than abstinence) to prevent pregnancy anyway.
4. To get rid of competing hormones. Testosterone shuts down your ovaries and therefore most of your estrogen production, but many trans guys are able to lower their doses of T after getting their ovaries removed.
5. In order to get documentation changed. In some states in the US, some form of irreversible surgery is required in order to change one’s birth certificate. Some states consider top surgery to be irreversible, but other states, such as Nebraska, do not top surgery but do count a hysterectomy.
6. In order to get bottom surgery. Many surgeons require a hysto before bottom surgery or in conjunction with bottom surgery. Not too well-informed about this, I just know this is a reason that some trans guys get hystos.
There are several other reasons, for instance experiencing cramps or spotting after a few years on T. Other people simply do it because they view it as the next step in their transition.