A survey of reproductive anatomy and gender affirming hysterectomy knowledge among transgender men who started testosterone at or before 18 years old.

BackgroundFor many transgender young adults considering gender affirming hysterectomy, discussions may begin prior to the age of 18. However, the extent of their relevant understanding is unclear.ObjectivesDetermining whether transgender men who started testosterone during adolescence correctly understand their reproductive anatomy and the nature and implications of hysterectomy with or without oophorectomy as well as the extent of their recalled counseling and related beliefs.DesignCross-sectional survey.MethodsAn anonymous REDCap survey, sent both through community message boards and the Prolific survey platform, assessing knowledge of and experiences with reproductive and sexual health care in the context of gender affirming care. Analyses were descriptive.ResultsOf 125 respondents, most had initiated testosterone between age 17 and 18 (n=85,67%). Roughly two-thirds (n=80, 64%) wanted or had had a hysterectomy, but only 48% (n=60) wanted or had had an oophorectomy. The majority correctly identified the purpose of the uterus (n=116, 93%) and ovaries (n=88, 70%) ovaries, as well as their physical relationship to each other (n=103, 82%). Fewer correctly defined a hysterectomy (n=78, 64%). Only a third of our respondents reported ever being counseled about the uterus (n=42, 35%) and the ovaries (n=43, 36%). Roughly one-third recalled counseling about testosterone's effects on the uterus and ovaries, primarily by their testosterone prescriber. Most people were uncertain of their knowledge of surgical requirements, but those who felt confident enough to state beliefs tended to be correct.ConclusionMost respondents who started testosterone prior to 18 had basic knowledge of the function and location of the uterus and ovaries, with less knowledge about gender-affirming surgeries. There is a need for clear guidelines to inform clinical counseling in adolescence, as transgender patients may start thinking about hysterectomy for gender affirmation during adolescence, even if the procedure is not accessible until they reach majority.