Oophorectomy (or ovariectomy) is the surgical removal of an ovary or ovaries. In the case of animals, it is also called spaying and is a form of (surgical procedure) sterilisation. Removal of the ovaries in female-bodied people is the biological equivalent of castration in male-bodied people, and the term castration is occasionally used in medical literature instead of oophorectomy.
In the case of humans, oophorectomies are most often performed due to diseases such as ovarian cysts or cancer; prophylactically (as a preventative measure) to reduce the chances of developing ovarian cancer or breast cancer; or in conjunction with removal of the uterus.
An FTM may elect to have an oopherectomy rather than a ‘full hysto’, as is the colloquial term for the removal of the ovaries, Fallopian tubes, and uterus, for a number of reasons. An oopherectomy is considerably cheaper than a full hysto, for those who would be paying out of pocket. If you’ve consulted with a surgeon and been told that a full hysto would require an abdominal incision, which is considerably traumatic and requires weeks of recovery time, you may opt to just have an oopherectomy as it can generally be done lapariscopically, which is minimally invasive and often has a recovery time of just a few days.
Some folks also don’t have any particular problem with having a uterus, but want to get rid of the ovaries as they want to eliminate any sort of ‘hormonal battle’ in their system. The ovaries produce oestrogen, and taking testosterone makes them go dormant and produce little to no oestrogen; if you stop taking T, the ovaries will wake up and start producing oestrogen again, even if you’ve been on T for years. (There is no long-term data as yet to determine whether the ovaries ever do completely stop producing oestrogen forever as a result of testosterone use.) The ovaries comply as long as there’s enough testosterone to overpower them, as testosterone is more potent than oestrogen, but they’re not particularly happy about doing it; depending on your dose of T and your general endocrine health, your hormone levels may go up and down a bit more than is comfortable or healthy for you. Removing the ovaries eliminates this issue for many people who find it a problem. (Please note that taking T does not automatically mean you will have any such problem; plenty of FTMs take T for many years without ever having ‘hormone war’ issues.)
The removal of an ovary together with a Fallopian tube is called salpingo-oophorectomy, or bilateral salpingo-oophorectomy if both ovaries and tubes are removed. Oophorectomy and salpingo-oophorectomy are not common forms of birth control in humans; more usual is tubal ligation, in which the Fallopian tubes are blocked but the ovaries remain intact. In many cases, surgical removal of the ovaries is performed concurrently with a hysterectomy. The surgery is then called “ovariohysterectomy” casually or “total abdominal hysterectomy with bilateral salpingo-oophorectomy” (sometimes abbreviated TAH-BSO), the more correct medical term. However, the term “hysterectomy” is often used colloquially yet incorrectly to refer to removal of any parts of the female reproductive system, including just the ovaries.
Benefits
Please remember that this information is based on studies of non-Trans women who were not taking testosterone. Because testosterone shuts down the ovaries so that they sit dormant and produce little or no oestrogen, some of the benefits – and risks – associated with oopherectomy may also be achieved simply by being on T. Talk to your doctor if you want to know more about the specifics of this. If your doctor doesn’t know, have hir read Medical Therapy and Health Maintenance for Transgender Men: A Guide For Health Care Providers and then get back to you.
Reduced breast cancer risk
People with a risk of breast cancer, especially those with mutated BRCA1 and/or BRCA2 genes, have been shown to have a significantly reduced risk of developing breast cancer after prophylactic oophorectomy. In addition, removal of the uterus in conjunction with prophylactic oophorectomy allows estrogen-based HRT to be prescribed to aid the woman through her transition into surgical menopause, instead of mixed hormone HRT, which has a significant contribution to breast cancer as well.
Reduced ovarian cancer risk
People with a risk of ovarian cancer, especially those women with mutated BRCA1 and/or BRCA2 genes, have been shown to have a significantly reduced risk of developing ovarian cancer after prophylactic oophorectomy. Risk is not reduced to zero, however, because the possibility of developing primary peritoneal cancer (ovarian cancer that begins outside the ovaries) does persist.
Reduced problems of endometriosis
In rare cases, oophorectomy can be used to treat endometriosis. This is done to remove a source of hormones that fuel uterine lining growth, thus reducing the overgrowth responsible for endometriosis. Oophorectomy for endometriosis is usually a last-resort surgery, since hormonal agonists such as Lupron are usually prescribed first to alter the hormonal cycle. Oophorectomy for endometriosis is often done in conjunction with a hysterectomy as a final shot at removing all traces of endometriosis in cases where non-surgical treatments such as hormonal agonists have failed to stop the uterine overgrowth.
Ovarian cyst removal not involving total oophorectomy is often used to treat milder cases of endometriosis when non-surgical hormonal treatments fail to stop cyst formation. Removal of ovarian cysts through partial oophorectomy is also used to treat extreme pelvic pain from chronic hormonal-related pelvic problems.
Risks
Longevity Risk
Removal of ovaries causes hormonal changes and symptoms similar to, but generally more severe than, menopause. People who have had an oophorectomy are usually encouraged to take hormone to prevent other conditions often associated with menopause. People younger than 45 who have had their ovaries removed face a mortality risk 170% higher than those who have retained their ovaries. Retaining the ovaries when a hysterectomy is performed is associated with greater longevity. However, hormone therapy is commonly believed by many doctors to mitigate the mortality risks of oophorectomy.
People who have had bilateral oophorectomy surgeries lose most of their ability to produce the hormones estrogen and progesterone, and lose about half of their ability to produce testosterone, and subsequently enter what is known as “surgical menopause” (as opposed to normal menopause, which occurs naturally in women as part of the ageing process). “Surgical menopause” differs from naturally occurring menopause in several respects: Surgical menopause is the result of surgery, while menopause is a natural event. A menopausal woman has intact functional female organs, a woman with surgical menopause does not. In natural menopause the ovaries generally continue to produce low levels of hormones, while in surgical menopause the ovaries and their hormones are absent, which can explain why surgical menopause is generally accompanied by a more sudden and severe onset of symptoms than natural menopause, symptoms which may continue until natural age of menopause arrives. These symptoms are commonly addressed through hormone therapy, utilising various forms of oestrogen, testosterone, progesterone or a combination of them.
Cardiovascular Risk
When the ovaries are removed a woman is at a seven times greater risk of cardiovascular disease, but the mechanisms are not precisely known. The hormones produced by the ovaries cannot be truly replaced. The ovaries produce hormones a woman needs throughout her entire life, in the quantity they are needed, at the time they are needed, and released directly into the blood stream in a continuous fashion, in response to and as part of the complex endocrine system.
Bone Density Risk
In people under the age of 50 who have undergone oophorectomy, hormone supplements (usually oestrogen) are often prescribed as part of hormone replacement therapy (HRT) to offset the negative effects of sudden hormonal loss (most notably an increased risk for early-onset osteoporosis) as well as menopausal problems like flush hot flushes (also called “hot flashes”) that are usually more severe than those experienced by women undergoing natural menopause.
Some studies have found that increased bone loss or fracture risk is associated with oophorectomy.
Technique
When performed alone (without hysterectomy), an oophorectomy is generally performed by abdominal laparotomy.
External links
- Useful list of currently available hormone replacements in the US
- Useful list of currently available hormone replacements in the UK
- A.D.A.M Medical Encyclopedia Article on Oophorectomy
- A Survivor’s Guide to Surgical Menopause: Collected information on managing post-surgical menopause conditions
- Information for F to M Transsexuals: Removal of the Uterus and the Ovaries (PDF) by Kate O’Hanlan, MD
- Encyclopedia of Surgery Article on Hysterectomy
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