Transgender men experience a disharmony between their birth sex and their intimate sense of gender belonging. Gender-affirming hormone therapy and gender-affirming surgery (GAS) are often inherently part of the gender-affirming process. In this context, we should ask whether it is better to keep or remove the uterus. Keeping the uterus and ovaries avoids a surgical procedure and a pubic scar. Furthermore, it preserves fertility and the possibility of carrying a baby. On the other hand, keeping the uterus is often psychologically unbearable for transgender men and the long-term effects of androgens on the uterus and ovaries remain uncertain. Conversely, hysterectomy and oophorectomy are part of the GAS process. New mini-invasive surgery procedures for hysterectomies decrease the risks and limit the likelihood of scars to a minimum. In practice, the data suggest that very few transgender men carry a pregnancy and/or use their oocytes after gender-reaffirming treatment. Clinicians should counsel their transgender men patients about the definitive infertility consequences of hysterectomy and oophorectomy and discuss all fertility preservation options before undertaking GAS. Individualized approaches must be preferred to systematic procedures regarding the personal decision to keep or not keep the uterus and ovaries.

跨性别男性在他们的出生性别和他们亲密的性别归属感之间经历了不和谐。性别肯定激素疗法和性别肯定手术 (GAS) 通常是性别肯定过程的固有部分。在这种情况下，我们应该问，是保留子宫还是切除子宫更好。保留子宫和卵巢可避免外科手术和耻骨疤痕。此外，它保留了生育能力和生育婴儿的可能性。另一方面，对于跨性别男性来说，保留子宫在心理上通常是无法忍受的，雄激素对子宫和卵巢的长期影响仍然不确定。相反，子宫切除术和卵巢切除术是 GAS 过程的一部分。用于子宫切除术的新微创手术程序降低了风险并将疤痕的可能性降至最低。在实践中，数据表明，很少有跨性别男性在接受性别确认治疗后怀孕和/或使用他们的卵母细胞。临床医生应向他们的跨性别男性患者咨询子宫切除术和卵巢切除术的明确不孕症后果，并在进行 GAS 之前讨论所有保留生育能力的选择。关于保留或不保留子宫和卵巢的个人决定，个体化方法必须优先于系统程序。