BILATERAL oophorectomy is commonly chosen during gender-affirming hysterectomy, especially among younger patients, those identifying as male, and those using testosterone preoperatively. In recent years, gender-affirming care has become more accessible, leading to a rise in patients pursuing gender-affirming surgeries, such as hysterectomy, with or without oophorectomy. Yet, little is known about the rates of oophorectomy among young gender-diverse adults. As political factors impact access to these procedures, the choice to undergo bilateral oophorectomy carries significant implications for long-term health, making it crucial to understand the factors that influence this decision. This study aimed to identify the factors associated with opting for bilateral oophorectomy versus ovarian conservation in young adults undergoing gender-affirming hysterectomy.
In total, the retrospective cohort study included 91 patients aged 18-30 assigned female at birth, who underwent gender-affirming hysterectomy at the University of Pennsylvania between January 2016 and January 2024. Patient demographics, mental health diagnoses, gynecological comorbidities, and surgical details were gathered from electronic medical records and stored in a REDCap database. Statistical analyses, including t-tests, Wilcoxon rank-sum, and Chi-square tests, were used to compare characteristics between those who underwent bilateral oophorectomy and those who did not.
Results showed that 60 (66%) of the patients opted for bilateral oophorectomy, while 31 (34%) retained one or both ovaries. Patients who underwent oophorectomy were younger (80% of patients aged ≤22 years vs. 55% of those aged 23-30 years; p=0.012) and more likely to identify as male (81% vs. 11% among nonbinary/genderfluid patients; p<0.001). Preoperative testosterone use was also higher among those who chose bilateral oophorectomy (100% vs. 77% among those with ovarian conservation; p<0.001). No differences were found in race, insurance, or gynaecologic conditions.
These findings highlight the prevalence of bilateral oophorectomy among young adults undergoing gender-affirming hysterectomy, particularly for younger patients, males, and testosterone users. This choice may have significant effects on reproductive and general health, with ethical and financial considerations, as many will require lifelong hormone replacement therapy. Future research is needed to explore additional factors influencing these decisions and to guide clinical practice in supporting informed choices for gender-diverse patients considering gender-affirming surgeries.
Reference
Batchelor J et al. Oophorectomy at time of gender affirming hysterectomy in young adults. Abstract Number: O-210. The ASRM Scientific Congress & Expo. 19-23 October 2024.
