A week ago I had a laparoscopic bilateral salpingectomy. In case you don’t already know these medical terms, salpingectomy is the surgical removal of one (unilateral) or both (bilateral) fallopian tubes. And laparoscopy is an operation performed in the abdomen or pelvis using small incisions (usually 0.5–1.5 cm) with the aid of a camera. There are a number of advantages to the patient with laparoscopic surgery versus the more common, open procedure. These include reduced pain due to smaller incisions, reduced hemorrhaging, and shorter recovery time. The obvious drawback—laparoscopic surgeries require extra medical equipment and are a bit longer, which means a more expensive medical bill. In the transphobic and backwards country where I live neither the state nor insurance companies pay for the procedures that are necessary for people who are either trans or don’t want children. Thus I had to pay from my own pocket. Lucky me.

In my native language there is a saying, “labāk zīle rokā nekā mednis kokā,” which translates as “an acorn in your hand is better than a capercaillie in tree branches.” The capercaillie, being a traditional gamebird in this part of the world, was a highly desirable food, while edible acorns were much less desirable. The point of the proverb is that it is better to settle for something you can reach instead of dreaming about something you won’t be able to get anyway.

I have known that I don’t want children for ages. Latvian laws state that any person who is at least 25 years old can obtain voluntary sterilization, the only requirement being their written confirmation that they do, indeed, want this procedure. Soon after my 25th birthday, I scheduled an appointment with a doctor, who immediately kicked me out of her office proclaiming that she won’t allow me to sterilize myself. Among other insults, she also proclaimed that trans people or AFAB people who don’t want children are lunatics. Since I was both, I was a double lunatic who needed urgent psychiatric help. How nice.

A transphobic doctor kicks me out of their office. I pick another doctor at random, schedule an appointment, pay for the doctor’s visit, only to get immediately kicked out of their office yet again. Rinse and repeat. After all, there is no visible “*transphobe” written next to the names of some doctors, thus I had to just try new doctors at random and hope for better luck next time. I wrote more about those experiences here.

At first I asked for a hysterectomy (removal of the uterus). On top of eliminating the risk of unwanted pregnancies, it would also have the added benefit of getting rid of menstruation and eliminating the future risk of uterine cancer. I do not have a female gender identity, I don’t live as a woman, I do not want female reproductive organs inside my body.

Here’s the problem—the European Court of Human Rights has ruled that trans people have a right to change their gender and obtain appropriate surgeries. Thus Latvian hospitals do have a duty to provide me the treatments I want. Simultaneously, Latvian laws do not regulate how exactly this is supposed to happen. Fearing that they might end up getting sued for failing to follow a nonexistent protocol, even the non-transphobic doctors still tried to get rid of me. “Go somewhere else,” they all told me. Doctors seem to not want difficult patients.

When I started writing complaint letters to government institutions, a hospital told me that they won’t provide me the surgery I requested until I subject myself to a humiliating medical evaluation during which a panel of at least seven doctors will decide whether I really am transsexual enough to need a hysterectomy. (As a matter of fact, the word “agender” characterizes me better than “transsexual” anyway.) I wrote more about that here. After two years of this depressing grind, I decided that I might as well settle for a tubal litigation. That wasn’t my first choice, but it was an acceptable alternative.

After a few more doctors’ appointments, I finally found a surgeon who agreed to sterilize me. She offered me a choice between a tubal litigation or a salpingectomy. Obviously, I chose the latter. I do not want to have female reproductive organs, and fallopian tubes are among the organs I don’t need. Besides, there seems to be some evidence that a salpingectomy can reduce the risk of ovarian cancer. On top of that, this was a procedure I could actually get without having to subject myself to a humiliating psychiatric evaluation that robs me of my bodily autonomy and allows doctors to decide in my place what will happen with my body.

The day before the surgery I could only have a light breakfast and I also had to take medication that caused diarrhea. Thus, on the day of the surgery, I woke up hungry and a bit dehydrated. I arrived at the hospital in the morning, signed all the paperwork, paid my oversized medical bill, and spent a few hours waiting in a hospital room. My surgery was scheduled for the afternoon, at 14:30.

Oddly enough, the most painful part of the whole experience was the insertion of a peripheral venous catheter. That was before I was knocked out by the anesthesia.

Next thing I remember was waking up when doctors placed me in the hospital bed. I was pleasantly surprised by how little it hurt. Also, my hand in which I had a catheter actually hurt more than my abdomen. Granted, considering that I had gotten a painkiller injection, it only meant sense to feel fine. I stopped being sleepy rather quickly, which meant spending the evening reading a book. In the evening I got an IV drip and a sleeping pill, and that was it or the day.

The next morning I got another painkiller injection, a nurse removed the catheter, changed plasters on my abdomen where I had three 1.5 cm long scars, and I could go home.

At the age of 27, I still live with my mother. Welcome to 21st century life, an age when young people stay with their parents for a long time just because real estate is too expensive to buy or rent! Anyway, my mother is homophobic, transphobic, and wants me to have babies. She still has no clue that I am something other than a heterosexual woman. It’s amazing how willfully blind some people can be, my mother is amazing at failing to notice or excusing all my non-feminine behavior.

Anyway, my mother wasn’t supposed to find out that I had a surgery. Thus I rented an apartment for a week. I told my mother that I am going to Germany for a vacation. My boyfriend, the only person to whom I had told in advance about my medical plans, picked me up at the hospital, called a taxi, and took me to the apartment I had rented. He also brought me a bag of groceries, cooked a lunch for us, kept me company for a while, and then I was on my own. (My boyfriend also lives with his parents, thus I couldn’t just stay at his home.)

Doctors told me to use over the counter painkillers in case I’m in pain, but that wasn’t necessary. While I stayed still, it didn’t hurt. I could sleep, sit, stand, and walk without any pain. Getting up, sitting down, bending in any way, laughing, coughing, and pooping did hurt. Thus I just spent the last week being a total couch potato. I spent all the time reading books. I don’t own a laptop, thus I couldn’t type anything. Hence I have been mostly offline for the last week. I could browse some websites on my phone, but I absolutely dislike typing on a mobile phone.

By now, it’s been a week since the surgery. I am back home. For another three weeks I cannot have any physical exercises, I cannot lift or carry heavy stuff, I cannot take a bath, and I cannot have sex. The latter is the most annoying limitation. Not being able to carry stuff is also a problem. Today, I returned home only to find out that my mother is sick. This means grocery shopping is on me. The obvious solution is to buy less stuff and to go grocery shopping more often so as to avoid having to carry heavy bags.

At least I have gotten better compared to the first few days after the surgery. Walking isn’t a problem, now it only barely hurts whenever I do anything that requires moving my abdomen. And I can now also put on my shoes on my own. On the first day after the surgery, I asked my boyfriend to tie my shoelaces for me (try reaching your shoes without bending). Oh, and I still have a large bruise on my arm where a catheter was inserted.

Overall, I feel tremendous relief that now I am no longer at the mercy of politicians who make decisions about abortion access. Nor do I have to hope that I get lucky with contraceptives. Male condoms are only 85% to 95% effective depending on how careful you are while using them. Even with perfect use, you still have an about 5% probability of getting pregnant within the next twelve months. Such probabilities cause plenty of stress and fear. With female sterilization, the chance of pregnancy within the first year of use is rated as 0.5%. Since I got a salpingectomy instead of the more common tubal litigation, the statistics for me look even better. Unless my surgeon totally fucked up the surgery and failed to inform me about it (I rate such a possibility as highly unlikely), my risk of an unwanted pregnancy actually is zero.

When it comes to my future plans, I still want to get rid of periods. Firstly, this shit is unpleasant. Secondly, menstruation doesn’t help if you are an AFAB person with a gender dysphoria. The simplest way how to get rid of periods would be a continuous usage of hormonal birth control pills. I cannot use those, because more estrogen is something I absolutely do not need in my body. I have a polycystic ovary syndrome, which results in a naturally elevated testosterone level. Gratis testosterone is something I love having. I enjoy perks like extra body hair. And, yes, I have known for a long time that progestin-only pills also exist, but I didn’t want those either.

Besides a hysterectomy, the other two options how to get rid of periods are either getting regular testosterone injections (trans men stop having periods while regularly taking testosterone) or getting an endometrial ablation, which is a surgical procedure that is used to remove (ablate) or destroy the endometrial lining of the uterus. Normally this procedure is performed on women who have heavy menstrual bleeding.

Oh well, at least I have options, and now I am safe from parasites (aka unwanted fetuses).


  1. John Morales says

    I’m aware this has been a goal of yours for a long time, so congratulations.
    Seems that your convalescence is untroubled, so no worries there.

  2. says

    Seems that your convalescence is untroubled, so no worries there.

    Yes, I haven’t had any post surgery complications for a week already, which indicates that probably nothing will go wrong at this point.

  3. billseymour says

    I’m glad you’re back and that your recovery is going well. I confess to having a selfish reason, too:  I missed your posts. (I hope that’s taken as a compliment.)

  4. anat says

    Congratulations on getting one step closer to the body you want to have! According to doctors I heard, unless you have one of the mutations in the BRCA genes that are associated with ovarian cancer, your risk of ovarian cancer is now very close to zero. Great thing because ovarian cancer is hard to detect early.

  5. Jazzlet says

    Congratulations Andreas! Sorry you weren’t able to have the lot out.

    As someone who has also had laproscopic surgery I have one piece of advice – when sales staff at the supermarket ask “would your like help with your packing?” say “yes please!” because every little helps, oh and plan out routes to minimie the time you spend carrying anything. I hope you heal well and smoothly.

  6. says

    billseymour @#3

    I missed your posts.

    And here I was thinking that maybe nobody will notice me being offline for a while.

    anat @#4

    Everybody is my family dies of some kind of cancer, thus reducing the risk of at least some cancers is always a nice bonus for me.


    when sales staff at the supermarket ask “would your like help with your packing?” say “yes please!” because every little helps

    They don’t do this here. Shoppers are expected to pack their stuff on their own.
    At least public transportation does exist here. Normally I walk everywhere, but I’ll probably use public transportation for the next week.

  7. kestrel says

    Congratulations on being able to achieve what you should have been able to achieve with government sanctions… that so often are not what they say, it just sounds good I guess. As long as one does not look too closely.

    I hope this will help to relieve stress in your life. Life is already stressful enough, without all the unwanted drama of pregnancy.

  8. Allison says

    I am glad you were able to achieve your goal.

    While I personally love children (and wish I could have had more than the two I have, much as I love them), I also believe that forcing a child to be born to parents who do not want them (or are not in a position to care for them) amounts to child abuse. Some years after I was grown up, my mother (a mother of 5!) started casually mentioning, “I never liked babies. I only like them when they’re old enough to have intellectual discussions.” IMHO, it explains a lot about why I’m as messed up as I am. (And my siblings aren’t in such great shape, either.)

    FWIW, there’s a theory here in the USA that the reason crime (esp. street crime) rates dropped was that abortion became legal, because it meant that fewer children were born to parents who did not want them or knew they were in no position to care for them. In other words, it removed a (maybe the) major source of the sort of desperate and messed-up people who are largely responsible for street crime and violence.

  9. avalus says

    Congratulations Andreas, I am glad to hear you are ok and the treatment went well. Here is to a good recovery!

  10. says

    Allison @#8

    Some years after I was grown up, my mother (a mother of 5!) started casually mentioning, “I never liked babies. I only like them when they’re old enough to have intellectual discussions.”

    “I only like children when they’re old enough to have intellectual discussions” is a statement that is true also for me. I simply have the wrong personality for taking care of a baby.

    Each child deserves loving parents who can provide emotional support and a happy childhood for their offspring. Thus it is better for some people not to have children.

    I find it immensely frustrating that some people cannot comprehend this fact and label me as coldhearted for not wanting to inflict emotional suffering upon an innocent child.

  11. dangerousbeans says

    Woo! I hope the recovery goes well

    I would be ok with babies except they are just too much work. and then they turn into children, then teenagers. then if you’re lucky they turn into good adults, but a lot just turn into arseholes.
    I’ll stick to rabbits, at least they are cute arseholes you can put in a pen

  12. captrench says

    Hi Andreas, I’ve been a long time lurker of PZ, Marcus Ranum and yourself, amongst many others here. I don’t have anything insightful to say here, I just wanted to add my voice to those who are happy that you have managed to achieve some of the autonomy you deserve.

    I’m cis/heterosexual, but I have a had a few battles establishing my own autonomy (but nothing to equate with here). Given my orientation, society is conveniently disposed to relate to my earlier struggles and not have a problem helping mitigate them. But the challenges of the transgender/agender(?) community are especially horrifying to me precisely because large numbers of fellow humans, both our neighbours and people in authority, seem predisposed to an attitude that denies reality or just the humanity and autonomy that the trans community deserves. And that’s before dealing with whether the science itself is at a level within our lifetimes to comfortably enable someone to have/not have certain gender attributes.

    Anyway… I just wanted to say that when i read your post here, I felt happy, both for myself (weirdly or not, there it is) and for you. Life is short, and getting these wins is important. I hope you get more of them.

  13. says

    captrench @#14



    then if you’re lucky they turn into good adults, but a lot just turn into arseholes.
    I’ll stick to rabbits, at least they are cute arseholes you can put in a pen

    We have dogs in my family. Dogs are cute, and compared to human children puppies are easier to raise with more predictable results—even with little training they still don’t turn into assholes.

  14. secmilchap says

    I am greatly relieved on your behalf that you’ve been able to make it partway along the path you hope to follow. It was so sad to read your posts about recalcitrant clinicians (despite law and regulation) and (maybe a year ago?) of a Swedish archaeologist who was trying for the same legal procedure, although she didn’t have transition in mind. My own experience was better, but I’m AMAB, and (probably) 98% cis. Still, some Mediterranean-appearing HouseDoc tried to stop the procedure for me, despite the ObGyn Docs in our HMO citing greater and greater risk of death for the mother of my children if she suffered any more miscarriages. In those days (1967) the surgery was major for her and minor for me, and she was succeeding in a very difficult PhD program. I’m delighted with my kids (in their 50s), and was very relieved when I knew there were no more likely. I wish you well in future stages, as they may occur.

  15. says

    secmilchap @#16

    Still, some Mediterranean-appearing HouseDoc tried to stop the procedure for me, despite the ObGyn Docs in our HMO citing greater and greater risk of death for the mother of my children if she suffered any more miscarriages. In those days (1967) the surgery was major for her and minor for me

    This is terrible. Doctors forcing their patients to literally risk dying in the name of maintaining fertility is crazy.

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