Resources

A great place to look for Ontario-based trans-friendly healthcare providers, and trans health resources.

Rainbow Health Home Page

Rainbow Health resource library

2SLGBTQAA+ Health Programs

This clinic has a surgical self-care program which is well-suited to people pursuing top or bottom surgery in the next year or so. The top surgery program is 3 weeks, and the bottom surgery program is 6. The registration form for both programs can be found here.

A good place to go to get referrals for gender affirming care.

Website

Elements Toronto

195 Avenue Rd., Toronto

416.929.1618

Dr. Ali Adbifar

Kawartha Collaborative Surgical Care

272 Charlotte Street, Suite 302, Collins Barrow Place, Peterborough

705-874-5222

Dr. Jennifer Klok

McLean Clinic

50 Burnhamthorpe Road West, Suite 343, Mississauga

866-731-0431

http://www.mcleanclinic.com/surgical-procedures/breast/ftm-top-surgery/

Dr. Hugh McLean

Dr McEvenue - Contact facilitators about this doctor

Dr. Kathleen Armstrong

Rouge Valley Centenary Hospital

2863 Ellesmere Road, Suite 413, Toronto

416-283-5871

annabella@zorncosmeticsurgery.com (Annabella is the secretary)

Dr. Marietta Zorn

St.Mike’s Hospital

www.uoftplasticsurgery.ca/people/faculty/melinda-musgrave/

30 Bond St., 3rd Floor Donnelly wing, Toronto

416-864-6040

Dr. Melinda Musgrave

The Ottawa Hospital

501 Smyth Road, Module S, Room S6, Ottawa

Dr. Mario Jarmusk

Visage Clinic

Fashion District, 179 John Street, #209, Toronto

416-929-9800

Dr. Marc DuPere

Windsor Regional Hospital

1995 Lens Ave, Windsor

519-254-5577

Dr. Hana Farhang Khoee

Women's College Hospital

76 Grenville St, Toronto

416-323-6400

Dr. Mitch Brown & Dr. John Semple

Dr. Brett Beber

40 Holly St, Suite 203, Toronto ON

416-466-5023

This is a private surgeon who will take OHIP to cover about half of the surgery cost, but the rest the patient pays.

In Canada

GRS Clinic Montreal

• GRS Post-Op Info Packages

  • Metoidioplasty

  • Phalloplasty

In the US

Crane Centre (Austin, TX)

Chen, Mang (San Francisco, CA)

Meltzer, Toby (Scottsdale, AZ)

Rumer, Kathy (Ardmore, PA)

Safa, Bauback (San Francisco, CA)

Schechter, Loren (Chicago, IL)

Questions you can ask your surgeon to prepare for surgery and recover:

• What technique do you recommend for me? Why that technique?

  • How many surgical visits will I need?

  • Will a graft be needed? From where?

• What testicular implants will you use? What erectile implant is used? Why did you choose those implants of over others?

• Where will my scrotum be?

• What are the complications with the surgery? What are the rates of those complications?

  • Urethral complications?

  • Implant failure/replacement?

• How can we minimize complications?

• How do I care for the graft site?

• Given the long distance between us, what is the follow-up plan for complications of:

  • Urethral stricture or stenosis?

  • Delayed healing or infection?

  • Implant problems

• What are the long-term satisfaction ratings for your clients?

• What are my options if I am dissatisfied with the outcome?

• Do you have before-and-after photos I can look at for this procedure and what results are reasonable for me?

Oliver Clinic

920 King Street, Suite 7, Kitchener

519-744-0800

Dr. Gillian Oliver

St. Michael’s Gynecological Services (Recommended)

61 Queen St. East, 5th floor, Toronto

416-867-7478

Dr. Rajiv Shah

Mount Sinai

700 University Ave, Room 8-713, Toronto

416-586-3162

Dr. Lisa Allen

What is a hysterectomy?

• Hysterectomy is surgery to remove the uterus.

What are the different hysto’s?

• There are different types of hysterectomy:

  • Total hysterectomy—The entire uterus, including the cervix, is removed.

  • Supracervical (also called subtotal or partial) hysterectomy—The upper part of the uterus is removed, but the cervix is left in place. This type of hysterectomy can only be performed laparoscopically or abdominally.

  • Radical hysterectomy—This is a total hysterectomy that also includes removal of structures around the uterus. the uterus and the ligaments (tissue fibers) that hold it in place. The cervix and an inch or 2 of the vagina around the cervix are also removed.

  • Salpingo-Oophorectomy— One or both of your ovaries and fallopian tubes are removed. This procedure is called salpingo-oophorectomy if both tubes and ovaries are removed; salpingectomy if just the fallopian tubes are removed; and oophorectomy if just the ovaries are removed.

Why have a hysterectomy/oophorectomy?

• First, there is some concern that long-term testosterone treatment may cause the ovaries to develop similar symptoms as those seen in polycystic ovarian syndrome (PCOS). PCOS has been linked to increased risk of endometrial hyperplasia (a condition that occurs when the lining of the uterus (endometrium) grows too much) and thus endometrial cancer, as well as ovarian cancer.

• Second, testosterone doses can often be decreased because the ovaries are no longer producing estrogen or are removed. If you choose not to have a hysto you must go for regular Pap smears (to screen for cervical cancer) and should seek out the care of a doctor if he experiences any irregular vaginal bleeding (including spotting), cramping, or pain. It is not uncommon for trans men who are pre-hysterectomy to experience a buildup of endometrial tissue, especially during the first few years of testosterone therapy. Endometrial tissue is normally shed during menstruation, but since this process is usually stopped a few months into testosterone therapy, additional tissue may continue to build up and may eventually begin to shed in the form of spotting. Because irregular bleeding can be a sign of cancer (though this is often not the case), trans men who experience any bleeding/spotting should see a doctor who will perform tests to determine the cause of the spotting. These tests may include an endometrial biopsy and/or an ultrasound. The doctor may advise a short course of progesterone to cause the uterus to shed the excess endometrial tissue-- this is much like inducing a period. While this may be unpleasant, it should be understood as a preventative measure, since the unusual buildup of endometrial tissue has been linked to endometrial cancer.

What are the different ways hysterectomy can be performed?

• Vaginal hysterectomy: the uterus is removed through the vagina. There is no abdominal incision.

• Abdominal hysterectomy: the uterus is removed through an incision in your lower abdomen. The opening in your abdomen gives the surgeon a clear view of your pelvic organs.

• Laparoscopic surgery: requires only a few small (about one-half inch long) incisions in your abdomen. A laparoscope inserted through one of these incisions allows the surgeon to see the pelvic organs. Other surgical instruments are used to perform the surgery through separate small incisions. Your uterus can be removed in small pieces through the incisions

How do Hysterectomies (hysto’s) effect your hormones?

• You can choose to keep your ovaries. This means your body will continue to produce estrogen naturally. The implications of this vary, depending on your unique gender goals.

• If you do remove the ovaries (an oophorectomy), you will surgically induce menopause. Unless you’re already at or near menopause age, you will need to be on long term HRT – either testosterone or estrogen. It is not advisable for your body to be devoid of a primary sex hormone, primarily to conserve essential bone health.

• The benefit of an oophorectomy is that your body will require less Testosterone afterwards, which can be a welcome change. Also, some people do not like having estrogen in their body, either physically or mentally or both.

Will Hysto’s Make Your Period Stop?

• “Everyone who has a hysterectomy will stop getting their period. Whether you will have other symptoms of menopause after a hysterectomy depends on whether your doctor removes your ovaries during the surgery.”

• “If you keep your ovaries during the hysterectomy, you should not have other menopausal symptoms right away. But you may have symptoms a few years younger than the average age for menopause (52 years).”

• “If both ovaries are removed during the hysterectomy, you will no longer have periods and you may have other menopausal symptoms right away. Because your hormone levels drop quickly without ovaries, your symptoms may be stronger than with natural menopause. Ask your doctor about ways to manage your symptoms.”

I've had a hysterectomy. Do I still need to have Pap tests?

• You only need to screen for cervical cancer with pap tested if you did not have your cervix removed.

What changes can I expect after a hysterectomy?

• Other changes that you may experience after a hysterectomy include:

  • Menopause. You will no longer have periods.

  • Change in sexual feelings. Some folks experience dryness or less interest in sex after a hysterectomy.

  • Increased risk for other health problems. If both ovaries are removed, this may put you at higher risk for certain conditions such as: bone loss, heart disease, and urinary incontinence (leaking of urine). Talk to your doctor about how to prevent these problems. (This is why doctors want you to take hormones; Testosterone or Estrogen after a full-hysto.)

  • Sense of loss. Some may feel grief or depression over the loss of fertility or the change in their bodies.

What about Egg Harvesting? Will I have to take Estrogen?

• When harvesting eggs, hormones are used to induce the development of the follicles of the ovaries. The following are the hormones typically used during this process:

  • Human chorionic gonadotropin (hCG)

  • Clomiphene Citrate

  • Gonadotropin-releasing hormone (GnRH)

• These hormones mature the eggs, which are then harvested from the ovaries. The maturity of the eggs can affect its survival rate. Immature eggs are able to withstand the cryopreservation storage. In contrast, mature eggs may have a lower rate of survival in comparison to younger eggs. You must pay out of pocket for this.

Which hysto’s are required for bottom surgery?

• Hysterectomy including removal of the cervix (at least 6 months before the procedure), according to the Montreal Clinic.

• Note: All bottom surgeons have different policies on this, there is no one overall rule.

What are the Potential Risks?

• Injury to nearby organs.

• Anesthesia problems, such as breathing or heart problems.

• Blood clots in the legs or lungs.

• Infection.

• Heavy bleeding.

• Early menopause, if the ovaries are removed.

• Pain during sexual intercourse

Next Steps

• Talk with your doctor, request a referral, meet surgeon for pre-surgery meeting, book the appointment, get the required tests done (ex: bloodwork), go for surgery

Costs

• All hysterectomies are covered by OHIP

• Prepare to pay for medications & transportation

• Budget for 6 weeks off work incase of any complications or emergencies: Rent, utilities, phone bill, internet bill, credit card bill, student loans & food.

Recovery

• 3-6 weeks, back on your feet quickly, could work a desk job after 2 weeks off. You must be off for 4 weeks if you work physical labour.

• You may need to stay in the hospital for a night after surgery. The length of your hospital stay will depend on the type of hysterectomy you had and how it was done. You will be urged to walk around as soon as possible after your surgery. Walking will help prevent blood clots in your legs.

• You also may receive medicine or other care to help prevent blood clots.

• You can expect to have some pain for the first few days after the surgery. You will be given medication to relieve pain. You will have bleeding and discharge for several weeks. Sanitary pads can be used after the surgery. Constipation is common after most hysterectomies.

• Other effects may be emotional. It is not uncommon to have an emotional response to hysterectomy. You may feel depressed that you are no longer able to bear children, or you may be relieved that your former symptoms are gone.

• Take short walks and gradually increase the distance you walk every day. You should not lift heavy objects until your doctor says you can. Do not penetrate the front hole for 6 weeks. That includes douching, having sex, and using tampons.