Gender-affirming healthcare is about much more than hormones or surgery: it’s about helping each person feel comfortable, respected, and at home in their body. For many trans men (and gender-diverse people assigned female at birth), gynaecologists play a key part in that journey.

From menstrual suppression to fertility preservation, and from preventive care to gender-affirming surgery, gynaecologists (and particularly gynaecological surgeons) have a unique and important role to play.

Understanding transition

Transition is deeply individual. Some trans people may seek social transition only (changing name, pronouns, or clothing), while others may pursue hormonal or surgical care. There’s no “right way”: each path is shaped by personal goals, access to care, and health considerations.

In Australia, gender-affirming healthcare is guided by international guidelines written by the World Professional Association for Transgender Health (WPATH) and the Endocrine Society. These guidelines support a multidisciplinary approach, involving endocrinologists, GPs, mental health professionals, gynaecologists, surgeons, and fertility specialists all working together.

Unfortunately, many gynaecologists receive little training in transgender health: thankfully, this is changing fast. All Maven Centre gynaecologists offer inclusive, evidence-based care that meets both medical and emotional needs.

Menstrual Suppression and Hormone Therapy

For many gender diverse people, one of the first steps is menstrual suppression, as periods can be distressing and incongruent with gender identity. Options for suppressing vaginal bleeding include:

• Combined oral contraceptive pill or progesterone-only pill, used continuously to skip bleeding
• Depo-Provera injections (progesterone)
• Mirena intra-uterine device (IUD), which may be able to reduce or stop bleeding for several years
• GnRH analogues, used short-term to suppress ovarian function

Once testosterone therapy begins, most people stop having periods within three to six months. Gynaecologists often work alongside endocrinologists to manage this transition, monitor bone health, and ensure the uterus and ovaries remain healthy while on long-term testosterone.

Contraception and Fertility

A common misconception is that testosterone acts as contraception: it doesn’t. Even if periods have stopped, ovulation can still occur, and pregnancy is possible.

Gynaecologists can discuss contraceptive options that suit each person’s body and transition stage: from IUDs to implants or barrier methods. These discussions should be sensitive and gender-affirming, avoiding assumptions about sexual partners or practices.

Before any surgical or hormonal treatment that may affect fertility, we also talk about fertility preservation, such as egg freezing, embryo freezing, or ovarian tissue storage. The opportunity to preserve fertility before surgery gives you more control over your future family-building choices, and helps to keep your options open.

Surgical Options: the gynaecologist’s role

Gynaecological surgeons play a key role in the surgical phase of gender affirmation. For trans men, the most common gynaecological procedures are:

Hysterectomy and bilateral salpingectomy +/- oophorectomy

This involves removing the uterus, cervix (‘hysterectomy’), fallopian tubes (‘salpingectomy’) +/- the ovaries (‘oophorectomy’). Many trans men choose this procedure to eliminate the need for cervical screening, prevent periods, and align their anatomy with their gender identity.

Discussions around whether to retain or remove your ovaries are quite nuanced, and often require the expert guidance of experienced gynaecological surgeons, such as Maven Centre’s Dr Melissa Cameron.

More often than not, a laparoscopic (keyhole) approach is possible for your hysterectomy, meaning smaller scars, less pain, and faster recovery. Surgeons experienced in trans care also pay attention to details that affirm gender identity: for example, positioning incisions discreetly and providing privacy during recovery.

Collaboration with Gender-Affirming Surgeons

Gynaecological surgeons frequently may work in partnership with plastic or urological surgeons performing phalloplasty or metoidioplasty (masculinising genital surgeries). Our role often includes the hysterectomy and oophorectomy components of a staged operation.

Successful surgical outcomes depend on careful planning, multidisciplinary communication, and shared decision-making.

What to Expect Before Surgery

Before surgery, your gynaecologist is likely to:

• Review your overall health and any ongoing hormone therapy
• Prescribe vaginal estrogen, which helps maintain the integrity of the vaginal lining, and aides with healing post-operatively)
• Discuss both future fertility options and current contraception
• Outline the risks, benefits, and recovery process
• Ensure you’ve had appropriate mental health and endocrinology support
• Provide a safe space to ask any and all questions: no judgement, just information

For some, surgery marks a milestone in gender affirmation; for others, it’s simply one step in a longer process. Either way, informed choice and collaborative planning are essential.

Recovery and Aftercare

Most laparoscopic hysterectomies allow patients to go home the next day. Pain is usually mild to moderate, and well-controlled with oral medication.

Testosterone is usually paused briefly around the time of surgery to minimise risk of clotting, then restarted under medical supervision. Follow-up visits monitor healing, hormone balance, and emotional wellbeing.

Ongoing Care and Screening

Even after hysterectomy, some preventive health checks remain important. For example:

• Breast / chest screening: if breast tissue remains, mammography or ultrasound may still be needed based on age and risk. After top surgery, your doctor may recommend occasional chest wall examination instead.
• Cervical screening: required only if the cervix is still present. HPV self-collection is now an option and can be done privately and comfortably.
• Pelvic or abdominal symptoms: new pain, bleeding, or swelling should always be assessed. Trans men can still experience gynaecological conditions such as ovarian cysts (if their ovaries were retained at hysterectomy), or disorders of the pelvic floor muscles.

Gynaecologists also provide support for sexual function, lubrication, and pelvic health, since long-term testosterone can cause vaginal dryness or atrophy. Local estrogen treatments can help manage discomfort without reversing masculinising effects.

Creating Inclusive, Affirming Care

For trans and gender-diverse patients, attending a gynaecology appointment can feel daunting. A welcoming environment makes all the difference. Simple steps (such as using correct names and pronouns, gender-neutral signage, and staff training) go a long way in building trust.

Maven Centre prides itself on being a welcoming environment for all trans and gender diverse patients. We promote an inclusive environment, and do all we can to ensure that your needs will be respected and supported.

Inclusive practice also means:

• Asking open, respectful questions about anatomy and preferred terminology
• Avoiding gendered language like ‘ladies’ clinic’
• Offering privacy during examinations and recovery
• Recognising that not every trans man wants ‘bottom surgery’

At Maven Centre, we approach every patient as an individual, focusing on what you need to feel safe, informed, and respected.

Mental Health and Support

Transition is as much an emotional process as a physical one. Anxiety, dysphoria, or social stress can all affect wellbeing. Gynaecologists often work alongside psychologists or psychiatrists to ensure holistic care. Peer support networks such as TransHub, Twenty10, and A Gender Agenda can provide community connection and lived-experience guidance.

The Bigger Picture

Transgender and gender diverse healthcare in Australia has made enormous progress, but access and awareness are still improving. Many trans men continue to face barriers to respectful, evidence-based care, especially outside major cities.

Gynaecologists and surgeons have an important advocacy role: helping normalise trans-inclusive healthcare, training future doctors, and pushing for better access to fertility preservation, surgery, and postoperative support. Knowledge regarding evidence-based care of transgender patients is (too) slowly spreading amongst gynaecologists, and is becoming an important part of comprehensive gynaecological practice.

Final Word

Transitioning from female to male is a deeply personal journey. Whether it involves hormones, surgery, both, or neither, a supportive and experienced gynaecologist can make all the difference.
From menstrual suppression to fertility planning, from laparoscopic surgery to long-term preventive care, our role is to ensure your body and identity are respected – and your health optimised – every step of the way.

At Maven Centre, we’re committed to providing compassionate, inclusive, and expert care for all patients – because everyone deserves to feel comfortable in their own skin.