The transgender population is a small yet vulnerable portion of the gynecology patient population. These patients require primary care as well as specialty gynecologic services. The female to male (FTM) patient may undergo any number of therapies in the course of their transition including (1) lifetime testosterone therapy, bilateral mastectomy, hysterectomy, and/or phalloplasty.
Hysterectomies in the transgender population may be done for medical or personal reasons, or a combination of both. While many patients suffer from irregular bleeding and pelvic pain following the initiation of testosterone therapy, many desire the removal of their internal biologically female organs as a part of their transition to the male gender.
World Professional Association for Transgender Health (WPATH) has provided general guidelines for the care and treatment of the transgender population. Before receiving hormonal therapy, most providers require a thorough assessment by a mental health provider specializing in gender dysphoria as well as have the subject living as a male for at least three months (in the case of FTM). Prior to surgical transition, at least one mental health referral is required as well as 12 months of continuous hormonal therapy. Recently, a referral to Reproductive Endocrinology and Infertility (REI) to discuss fertility options prior to hysterectomy has been recommended.