Trans Men After Oophorectomy: Do You Still Need Hormones?

A trans man came to see me about two years after having his uterus and ovaries removed. He told me, "After the surgery I thought I was done, so I stopped injecting for almost a year." During that time he was extremely tired, had hot flushes, low mood and joint pain, and began to feel that his body wasn't his own again. Tests showed his hormone levels were almost zero and his bone density had started to fall. I'd like this story to be a lesson: surgery isn't the end of hormone care; it's the start of long-term care.

Why are hormones still needed after surgery?

Before surgery, even while using testosterone, the ovaries can still produce some hormones, so if you stop medication your body still has some of its own. Once the ovaries are removed, the body no longer has its main source of sex hormones. This is called surgical hypogonadism.

Sex hormones don't just create sexual characteristics; they also look after bones, muscles, blood vessels, the brain and mood. Having no hormones at all before the age of natural menopause therefore affects long-term health. That's why the Endocrine Society and WPATH SOC-8 guidelines recommend continuing hormone replacement after removal of hormone-producing organs.

What happens if you lack sex hormones?

Thinning bones and osteoporosis

Sex hormones help maintain bone mass. Without them, bone breaks down faster, just as in women whose ovaries are removed before menopause, raising the risk of osteoporosis and fractures with age. This usually causes no symptoms until a bone breaks.

Muscle loss, reduced strength, fatigue

The muscle you've built gradually decreases, fat increases, you tire easily and exercise doesn't seem to work as well.

Mood and sleep

You may feel irritable, depressed or anxious, sleep poorly, have reduced sex drive, and experience hot flushes and night sweats, similar to menopause symptoms.

Metabolism and heart

Chronic sex-hormone deficiency is associated with increased abdominal fat, insulin resistance and a higher long-term risk of cardiovascular disease.

Return of gender incongruence distress

Some features, such as a deeper voice, usually remain, but changes in muscle, fat distribution and energy can bring back distress about your body.

Lacking sex hormones

Bone

• Thin bones, osteoporosis
• Often no symptoms until a fracture

Muscle and strength

• Less muscle, more fat
• Fatigue, tires easily

Mood and sleep

• Low mood, irritable, insomnia
• Hot flushes, night sweats

Metabolism and heart

• Belly fat, insulin resistance
• Long-term heart disease risk

Body-related distress

• Muscle and fat change back
• Gender incongruence returns

Endocrine Society and WPATH SOC-8 advise continuing hormone replacement after removal of hormone-producing organs.

How hormones are used after surgery

• Most people continue testosterone in the same form, as injections or gel (see masculinising hormone therapy (FTM)).
• The dose may need readjusting after surgery based on blood results and symptoms; don't keep the old dose without testing.
• If testosterone can't be used for medical reasons, your doctor may consider another form of hormone replacement to protect your bones.
• If you need to pause temporarily, for example around major surgery or because of a supply problem, talk to your doctor to plan ahead rather than going without for long.

Long-term monitoring

Read about side effects to watch in testosterone side effects in trans men.

Look after your bones yourself, too

1. Get enough calcium from food, such as milk, firm tofu, small fish eaten with bones and green leafy vegetables.
2. Get enough vitamin D from sunlight and food, or as your doctor advises (see calcium, zinc and vitamin D).
3. Do weight-bearing and resistance exercise.
4. Don't smoke, and cut down on alcohol.

What if you've already stopped hormones for a long time?

There's no need to feel guilty. Many people stop because of cost, inconvenience or because nobody told them. What you should do is come for blood tests and a health assessment, then restart hormones appropriately. Your doctor may also recommend a bone density scan. If cost is a problem and you are a Thai citizen, ask about the National Health Security Office (NHSO) gender-affirming hormone benefit on the NHSO hotline 1330 (Thai language).

If you have severe low mood or thoughts of harming yourself, call 1323, Thailand's free 24-hour mental-health hotline (Thai language; ask for English support).

1. 1No need for guiltMany stop due to cost, inconvenience, or because nobody told them
2. 2Blood tests, assessmentHormone levels and overall health; maybe a bone density scan
3. 3Restart hormonesDose as assessed by your doctor from results and symptoms
4. 4Protect bones tooCalcium, vitamin D, weight-bearing exercise, no smoking

If cost is a problem, ask about NHSO coverage on 1330 (national health insurance hotline, Thai language).

Ongoing care at Dr. Kris Clinic

At Dr. Kris Clinic, I care for trans men before and after surgery, with blood tests, hormone dose adjustments and long-term bone and heart health care, using a family-medicine approach that looks at the whole person, at the clinic in Surat Thani and online, with English-speaking consultations available. If you're planning surgery, read about preparation in assessment and letters before gender-affirming surgery, and the overview in GAHT.