Oophorectomy
An oophorectomy removes the ovaries, nearly always both, and nearly always as part of a hysterectomy rather than on its own. The tubes come out with them, which is why the formal name is bilateral salpingo-oophorectomy, usually shortened to BSO. It adds a few minutes to the operation, no scars of its own, and nothing to the recovery.
What it adds is a decision. The ovaries are the last source of your own oestrogen and the only source of your own eggs. Taking them ends periods for good even if you ever stop testosterone, removes a small ovarian cancer risk, and for some people removes a specific dysphoria. It also means you rely on prescribed hormones for the rest of your life, for bone as much as anything else.
The reason this gets its own page is that it is the one part of a hysterectomy you cannot undo. Keep them now and you can take them out later, at the cost of a second, small operation. Take them now and there is no going back. That asymmetry is the whole decision.
At a glance
- Also known as
- Bilateral salpingo-oophorectomy (BSO), ovary removal, oophorectomy with hysterectomy
- Surgery time
- Adds 15–30 minutes to a hysterectomy; about 1 hour standalone
- Anaesthesia
- General
- Hospital stay
- Same as the hysterectomy; outpatient standalone
- Back to work
- Adds nothing to a hysterectomy; about 1 week standalone
- Full recovery
- 4–6 weeks standalone
- Scar
- None of its own; uses the hysterectomy ports
- Sensation
- No change to sensation
- Typical cost
- $0–$1,000 with a hysterectomy; $5,000–$10,000 standalone (United States, self-pay)
Figures reviewed .
On this page
Who it’s for
The people for whom the choice is easy are those with a clear reason. Ovarian pain or cysts on testosterone, which a minority of trans men get. Dysphoria about the ovaries specifically, or about any oestrogen being made inside you. A family history of ovarian or breast cancer, where a gynaecologist may recommend removal anyway. Or a firm decision that you will never want your own eggs and never want to stop testosterone.
The people who should think harder are younger, unsure about fertility, or unsure about staying on testosterone for life. Without ovaries and without testosterone you would have no sex hormones at all, and bone density falls fast in that state.
Keeping the ovaries keeps a fallback. If eggs might matter, fertility preservation has to happen before the operation. It usually means pausing testosterone for a few months, then a round of stimulation and retrieval. That is a bigger ask than most people expect.
The eligibility side is the hysterectomy's. If you qualify for that, you qualify for this. See eligibility.
Before you book
Write down your answer to two questions: will I ever want my own eggs, and could I ever see myself off testosterone. If either answer is "maybe", the ovaries can stay for now and you've lost nothing. If both are a clear no, you can let them go without a second thought.
How it’s done
There is nothing extra to see from the outside. During a laparoscopic (keyhole) hysterectomy the surgeon already has a camera and instruments in the pelvis through three or four small cuts, called ports. To remove the ovaries they seal and divide the vessels running to each one and free the ovary and tube from their ligaments. Everything comes out with the uterus through the vagina, or in a small bag through a port.
As a standalone operation, for someone who had a hysterectomy earlier and kept the ovaries, it is the same laparoscopy on a smaller scale. Two or three ports, under an hour, home the same day. Surgeons will sometimes leave one ovary if asked. For trans men it is rare, because one ovary makes almost as much oestrogen as two, and the fertility and hormone questions are unchanged.
Whatever is removed goes to the lab to be checked, as routine. Tell the surgeon before the day if you want any tissue kept for fertility purposes, because ovarian tissue freezing is a specialist arrangement that has to be planned.
At the pre-op appointment
Ask the surgeon to say back to you exactly what is coming out, organ by organ. Uterus, cervix, tubes, ovaries. Consent forms use the abbreviations, and I have seen people discover in the recovery bay that "hysterectomy with BSO" meant more than they thought.
Oophorectomy recovery
Done with a hysterectomy, you will not be able to tell which part of the soreness is which. The recovery is the hysterectomy's, gas pain and fatigue and six weeks of nothing internal, and the ovaries add nothing you would notice physically.
What they can add is hormonal. If you are on a steady testosterone dose, oestrogen was already suppressed and most people feel no change at all. If your dose is low, you have recently started, or you are not on testosterone, oestrogen drops to nothing within days.
Hot flushes, night sweats and a flat or irritable mood follow. That is surgical menopause and it is real. Tell your prescriber in advance so the dose is right going in, and get levels checked a few months on.
Standalone, it is one of the lighter keyhole operations. Sore and bloated for a few days, back to a desk within a week or so, nothing strenuous for a month.
| Day 0 | Home the same day or after one night, alongside the hysterectomy. Bloated and tired. |
|---|---|
| Days 1–3 | Gas pain, including the shoulders. If oestrogen was not already suppressed, hot flushes can start now. |
| Week 1 | Moving normally around the house. Standalone, desk work is realistic by the end of the week. |
| Weeks 2–4 | Energy returning. Mood and sleep should be settling if there was a hormonal dip. |
| Weeks 4–6 | Full activity. Post-op check with the surgeon. |
| Months 3–6 | Testosterone levels checked and dose adjusted if needed. Nothing else to wait for. |
In the first two weeks
Keep a short note of hot flushes, sleep and mood, even one word a day. If oestrogen drops harder than expected, that note is what turns a vague "I feel off" into a dose conversation your prescriber can act on.
Oophorectomy scars
None that belong to this operation. With a hysterectomy the ovaries come out through the same ports, so the scars are the hysterectomy's three or four small marks on the abdomen. Standalone, it is two or three of the same, one usually hidden in the navel, fading to faint lines within a year.
Risks and complications
Surgically, very little beyond the hysterectomy it rides on. The ovarian vessels are a known bleeding point and the ureters run close by, which is why surgeons take their time here, but injury is uncommon. Standalone, the risks are those of any short laparoscopy, bleeding, infection and a small chance of clots.
The risks that matter are long term and hormonal. Without ovaries there is no fallback oestrogen. If you stay on testosterone, bone density is generally maintained, and most endocrinologists are comfortable with that. If you stop, or run under-dosed for years, bone loss can be significant and early osteoporosis, bones thin enough to break easily, is a real possibility.
Some prescribers recommend a bone density scan at some point after surgery, and I would ask about it if nobody offers. There is also an open question about heart and brain health after early oophorectomy. The evidence comes mostly from cisgender women not taking hormones, and nobody knows how far it applies to trans men on testosterone.
The risk on the other side is smaller than people expect. The lifetime chance of ovarian cancer in the general population is roughly one in eighty, and nobody is sure whether long-term testosterone raises or lowers it. It is a reason, not a mandate.
Oophorectomy results
The physical result is invisible. Any ovarian pain or cysts stop. Periods cannot come back under any circumstances, which matters to people who worry about what would happen if they ever had to pause testosterone. Some people find their testosterone runs steadier without the ovaries pushing back, and the dose comes down a little.
What it does not do is change how you look, feel or function day to day, provided the hormones are right. The people I have seen unhappy afterwards were not unhappy with the operation. They were unhappy because a fertility or fallback question was skipped rather than answered.
Alternatives to oophorectomy
The alternative is keeping them, and it is a good one for a lot of people. Ovaries on testosterone are quiet, make little oestrogen, and sit there as insurance. They can be removed later if a reason turns up, for a second small operation. What you carry is a small ovarian cancer risk that cannot be screened for well, and for some people a nagging awareness that they are still there.
If you are borderline, keep them. The choice stays open in one direction only, and that direction is the one you are in now.
Combining oophorectomy with other surgery
Almost always combined, and that is the point. Done with a hysterectomy it costs a few minutes and nothing extra in recovery. Done later on its own it is a second anaesthetic, a second set of ports and a second bill, which is the reason to decide now rather than defer by default.
If genital surgery is planned, the ovaries are usually removed in the same session as the hysterectomy and vaginectomy, so the pelvis is dealt with in one go before metoidioplasty or phalloplasty. See surgery order.
Oophorectomy cost
With a hysterectomy, the ovaries are normally included in the price. Some surgeons add a small line for it and most do not. Where you will see a real number is as a standalone operation, because you are paying for a whole laparoscopy again. The other real number is fertility preservation. It is not part of the surgery quote at all and often costs more than the hysterectomy itself once storage is counted.
Insurance follows the hysterectomy. If that is covered, removing the ovaries at the same time almost always is. Egg freezing is a separate claim and coverage is patchy.
| Country | Self-pay | Public / insurance |
|---|---|---|
| United States Standalone figures are a full laparoscopy; egg freezing separate | $0–$1,000 with a hysterectomy; $5,000–$10,000 standalone | Covered whenever the hysterectomy is covered |
| Thailand Bundled into hysterectomy or genital surgery packages | Included with a hysterectomy; $2,500–$5,000 standalone | Self-pay only for international patients |
Choosing a oophorectomy surgeon
The surgeon is the gynaecologist doing your hysterectomy, and the technical skill needed is the same. What differs is the conversation. A good one treats the ovaries as your decision, gives you the fallback and fertility arguments without pushing either, and is comfortable with "keep them for now".
The questions I would ask are what they recommend for someone your age and why, and how they would handle it if you came back in ten years wanting them out. Every gynaecologist I have put the first question to has an opinion. The ones worth listening to also tell you what the other side of the argument is.
At the consultation
Ask "if I keep my ovaries now, how easy is it to take them out later?" A surgeon who gives you a straight answer about a second small operation is telling you the choice is genuinely yours. One who pushes hard either way is telling you something too.
Frequently asked questions
If I keep my ovaries, will they still make oestrogen on testosterone?
Very little. Testosterone suppresses them, and most trans men on a standard dose have oestrogen in the male range. They can wake up if you stop, which is the argument for keeping them. See who it's for.
Will I need a lower testosterone dose afterwards?
Sometimes. Without ovarian oestrogen some people run steadier on less. Levels are checked a few months after surgery and adjusted with your prescriber. See recovery.
Can I have my ovaries removed without a hysterectomy?
Yes, but it is unusual. Removing the ovaries and leaving the uterus keeps the cancer and screening burden of the uterus with none of the hormone fallback. Most people who want either have both done together.
Does removing the ovaries put me into menopause?
Technically yes, instantly. On a steady testosterone dose most people notice nothing, because oestrogen was already suppressed. See risks for the long-term side.