Hysterectomy for Transgender Men and Gender Diverse People

Transgender men and gender diverse folks have a variety of options when it comes to hysterectomy.

A hysterectomy is a surgical procedure to remove the uterus.

You may choose to have all other reproductive organs — fallopian tubes, ovaries, and cervix — removed at the same time. This is known as a total hysterectomy with bilateral salpingo-oophorectomy.

If only the uterus and cervix are removed, it’s known as a total hysterectomy. And if only the uterus is removed, it’s known as a subtotal hysterectomy or partial hysterectomy.

“The most common reason an individual gets a hysterectomy is to eliminate their menstrual cycle and some or all of the symptoms that accompany it,” says Natalia P. Zhikhareva, PhD, a clinical psychologist who works exclusively with transgender and nonbinary adults.

A person who has endometriosis and experiences the most pain during menstruation, for example, may choose to have a hysterectomy in hopes that they will experience pain relief.

Major health insurance companies have faced legal trouble over their claim denial practices. In February 2018, the insurance commissioner of California announced plans to investigate Aetna’s coverage denial practices after a former medical director of the insurance company admitted that he never once looked at a patient’s medical records when deciding whether to deny claims over the three years he worked in the position, according to CNN.

“Someone might also have their uterus removed if they have uterine fibroids that are painful, uterine cancer, pelvic inflammatory disease, or a uterus that’s prolapsing through the vaginal canal,” says Michelle Forcier, MD, a gender affirming clinician with virtual healthcare service FOLX.

Transgender men, nonbinary folks, and other gender diverse people assigned female at birth may also pursue a hysterectomy to better align their physical body with their sense of self.

“Some trans persons who identify as more masculine might have a hysterectomy because they feel like their uterus doesn’t belong in their body,” Forcier says. “These folks might have it removed because it makes more sense given their gender identity or because it relieves their gender dysphoria.”

“Some might want it removed to never ever have to have a period again or to not ever worry about becoming pregnant,” they add.

And with a total hysterectomy, folks no longer need Pap smears, which can be an invasive and dysphoric experience.

For some people, “menstruating is a consistent reminder that their body does not align with who they are, which can lead to self-hate, self-harm, and suicide,” says Kryss Shane, LSW, LMSW, author of “The Educator’s Guide to LGBT+ Inclusion: A Practical Resource for K-12 Teachers, Administrators, and School Support Staff.”

As such, having the option to have a hysterectomy can be life changing and even lifesaving, she says.

Technically, anyone assigned female at birth who is of legal age can consent to a hysterectomy.

But it usually has to be deemed medically necessary by a healthcare professional, especially if you’re under age 35.

You may be eligible for a hysterectomy if you have a history of:

• gender dysphoria
• heavy, painful menstruation
• endometriosis
• adenomyosis
• uterine fibroids
• uterine prolapse
• pelvic inflammatory disease
• uterine cancer

The cost of a hysterectomy can vary widely. The nationwide average is $2,000 to $5,000 out of pocket.

The exact cost depends on:

• the type of hysterectomy
• the healthcare professionals performing the procedure
• the hospital or medical facility facilitating the procedure
• your geographic location
• whether you have insurance and, if so, what your insurance covers

Generally speaking, insurance will cover any procedure that’s deemed medically necessary.

Medicare, for instance, covers the cost of all “medically necessary services” and “preventative services.”

If you are underinsured or uninsured, patient assistance programs are available. Some of them are specifically for trans and gender diverse folks.

These programs include:

• Patient Assist
• The Jim Collins Foundation
• Genderbands Transition Grants
• TransMission
• Black Transmen Inc. Surgery Scholarship
• Point of Pride
• Trans United with Family and Friends
• LOFT Community Center

First things first: Talk with your clinician and get all of your questions answered.

• “What organs do I need to have removed to achieve my desired result?”
• “Which type of hysterectomy makes the most sense for me?”
• “How will this procedure impact my hormone levels? Will it put me into menopause?”
• “Are there any nonsurgical alternatives that could achieve the same desired outcome?”
• “Will I need to change my over-the-counter or prescription medication routine leading up to or after surgery?”
• “What symptom relief can I expect after recovery?”
• “How long do you recommend I take off work?”

Next, make sure you arrange your work, family, romantic, and extracurricular life so that you can take adequate time off to rest and recover. This might involve:

• talking with your boss or human resources
• organizing child and pet care
• creating a schedule for your loved ones to stop by with meals
• arranging for someone to take over your volunteer or extracurricular responsibilities

Finally, prepare your place of recovery to make your life as easy and low stress as possible. It may be beneficial to:

• prepare and freeze a week’s worth of meals or order prepared meals from a meal delivery service
• use your downstairs couch as a bed so you don’t have to walk upstairs to sleep
• tidy your floors so there’s nothing for you to trip over

You may also want to think about future family planning. Some people choose to have their eggs frozen before getting a hysterectomy, explains Forcier.

Preserving your eggs allows you to conceive via IVF or surrogacy down the line.

A hysterectomy can be performed laparoscopically, vaginally, or abdominally.

You will receive general anesthesia for a laparoscopic or abdominal hysterectomy, so you will not be awake during the procedure.

With a vaginal hysterectomy, you have the option to forego general anesthesia and remain awake. A local or spinal anesthetic will be used to numb the area so you do not feel pain during the procedure.

During a laparoscopic procedure — also known as keyhole surgery — your surgeon will make a small incision on your abdomen and insert a small tube containing a telescope and a tiny video camera. This allows them to see your internal organs and remove what needs to be removed.

During an abdominal hysterectomy, your surgeon will make an incision horizontally along your underwear line or vertically from your belly button to your pubic bone. This approach is typically used if your uterus is enlarged with fibroids or tumors, as well as to remove the ovaries.

A vaginal hysterectomy is considered the least invasive approach. Your surgeon will make an incision along the top of your vaginal canal and remove the uterus and, if applicable, the cervix.

“Typically, and especially for healthy persons, a hysterectomy is a common and safe procedure,” says Forcier.

In fact, it’s the second most common procedure performed on people assigned female at birth. (The first is cesarean delivery.)

That said, a hysterectomy has the same potential complications as other surgeries. These include:

• accidental damage to surrounding organs
• heavy bleeding (hemorrhage)
• blood clots (thrombosis)
• infection
• problems with anesthesia

“There is also a risk of long-term side effects such as menopause and loss of sexual function that patients should be aware of and discuss with their doctor before undergoing the procedure,” adds Gregory Quayle, MD, a Mississippi-based urologist.

“The recovery from abdominal incision hysterectomy takes longer than through the vagina, which takes longer than laparoscopic removal,” says Forcier. That’s because the incisions to remove are larger and involve cutting through more muscle or tissue, they explain.

That said, you can expect full recovery to take anywhere from 6 to 8 weeks.

While you heal, you will not be able to drive, exercise, or have certain kinds of sex. Depending on how physically demanding your job is, you also won’t be able to work in some instances.

“You can’t drive immediately after a hysterectomy,” says Forcier. “Driving or having to push hard on the brakes before the 2- or 4-week mark could tear through the stitches holding the incision together.”

You also need to avoid exercise for the first 4 to 6 weeks, she says. Your abdominal muscles and surrounding tissues are trying to heal — exercising too early can interfere with their ability to do so by agitating your stitches, causing muscle inflammation, and otherwise injuring the area.

Talk with a healthcare professional if you’re getting a hysterectomy, are healing from a hysterectomy and have questions, or think you could be a good candidate for a hysterectomy down the line.

If you can, take some time to make sure the clinician you’re consulting with is queer- and trans-inclusive. You may be able to find an affirming healthcare professional by Googling “hysterectomy provider near me + LGBTQIA.”

You can also check out:

• your local Planned Parenthood
• the Tegan and Sara Foundation’s LGBTQ+ healthcare directory
• the World Professional Association for Transgender Health provider directory

Gabrielle Kassel (she/her) is a queer sex educator and wellness journalist who is committed to helping people feel the best they can in their bodies. In addition to Austra Health, her work has appeared in publications such as Shape, Cosmopolitan, Well+Good, Health, Self, Women’s Health, Greatist, and more! In her free time, Gabrielle can be found coaching CrossFit, reviewing pleasure products, hiking with her border collie, or recording episodes of the podcast she co-hosts called Bad In Bed. Follow her on Instagram @Gabriellekassel.

Last medically reviewed on March 27, 2023