• Back to "Masculinizing" Techniques

Hysterectomy for Transgender and Non-Binary Patients

Medically reviewed by Jennifer Richman on August 28, 2025.

What is a Hysterectomy for Gender-Affirmation?

Hysterectomy is the surgical removal of the uterus. This procedure is performed by a board-certified gynecological surgeon and can be performed in conjunction with an oophorectomy (the removal of one or both ovaries) and/or a salpingectomy (the removal of the fallopian tubes.

The World Professional Association for Transgender Health (WPATH) recognizes that hysterectomy is a medically necessary procedure to alleviate gender dysphoria in some transgender men and non-binary patients. Hysterectomy can also help address other medical concerns such as pelvic pain, abnormal uterine bleeding, excessive cramping or precancerous cervical conditions. If you are planning on having a gender-affirming bottom surgery procedure that involves a vaginectomy (removal of the vaginal canal), you should undergo a hysterectomy at least 8-12 weeks prior.

Hysterectomy Referrals for Bottom Surgery

Many patients choose to undergo hysterectomy and/or oophorectomy as a part of their gender-affirming surgical journeys. Besides treating medical pathologies, a hysterectomy is a necessary requirement before undergoing a vaginectomy. Generally speaking, if a patient would like to undergo a urethral lengthening––to facilitate urinating while standing––as a part of their metoidioplasty or phalloplasty, Dr. Zara Ley (she/her/they) requires that patients undergo a simultaneous vaginectomy to prevent urinary complications.

Before the removal of your vaginal canal, a patient must have their uterus removed, preferably 8-12 weeks before your vaginectomy procedure. At this time, the Gender Confirmation Center (GCC) does not offer hysterectomies. However, you can find a gender-competent gynecological surgeon who can perform this procedure in this provider directory.

Your Surgical Options Explained

Generally speaking, there are three approaches for removing the uterus. Hysterectomies are performed under general anesthesia and often require hospital stays after surgery. Transgender and non-binary patients generally prefer minimally invasive techniques like a vaginal or laparoscopic hysterectomy due to their faster recovery time and less visible scarring. We encourage you to consult with your OBGYN to see which approach would be best for you:

Vaginal hysterectomy

This approach involves removing the uterus through the vaginal canal. Patients undergo general anesthesia and are positioned in lithotomy, meaning they will lie on their back with their legs separated and placed in stirrups. A speculum is inserted in the vaginal canal in order to perform the procedure. No incisions are made on the abdomen unless a camera (laparoscope) is used for more visualization, meaning this procedure often leaves no visible scarring.

Laparoscopic hysterectomy:

While under general anesthesia, a small incision (10-12mm) is made near the umbilicus (the naval or belly button) along with two to three smaller incisions (5mm) in different areas of the lower abdomen that serve as ports where a small camera (laparoscope) and surgical instruments can be inserted to perform the procedure. Carbon dioxide gas is used to slightly inflate the abdomen to allow for better visualization of the abdominal cavity and create some space to maneuver the camera and instruments inside the abdomen.

The uterus is surgically removed from its surrounding structures and pulled out of the body through the incision near the umbilicus or through the vaginal canal. Then, the instruments and camera are removed and the abdomen deflated before the incisions are closed. Robotic systems can also be used to assist during the procedure for better precision (robotic-assisted laparoscopic hysterectomy).

Abdominal (or open) hysterectomy:

This approach is not as commonly performed unless there are any indications (i.e., larger uterus, other pelvic conditions, emergent conditions, etc) in which a minimally invasive approach is not feasible. The procedure usually leaves a more noticeable scar in the lower abdomen (10-20 cm) in order to remove the uterus.

Oophorectomy:

A bilateral oophorectomy (the removal of both ovaries) or a unilateral oophorectomy (the removal of one ovary) are not obligatory to undergo a hysterectomy. Many trans men and transmasculine non-binary patients still wish to have one or both of their ovaries removed as a part of gender-affirmation. If both ovaries are removed, the body’s main source of estrogen disappears and menopause symptoms can begin immediately after surgery. With oophorectomy procedures, patients will likely need to be on consistent hormone replacement therapy (HRT) as ovary removal is often associated with higher cardiovascular risk and reduced bone density. We encourage you to speak with your endocrinologist or hormone provider to see if you will need to adjust your testosterone dosage for bottom surgery.

Pre-Surgical Requirements and Recommendations

Gender-affirming hysterectomy is a surgical procedure that requires careful planning and preparation. Patients should consult with a board-certified, gender-competent Obstetrician-Gynecologist (OBGYN) to see if you meet the requirements to qualify for surgery and insurance coverage.

Gender dysphoria diagnosis

Even when hysterectomies are not performed to address a gynecological pathology (like excessive bleeding, cramps or to prevent cancer in high risk patients), some insurance providers may cover the procedure if a patient can provide a gender dysphoria diagnosis. You will need to present a support letter from at least one licensed mental health professional that includes this diagnosis. Even if you plan on paying for a hysterectomy out-of-pocket, your provider may ask you for a support letter.

Testosterone HRT

Insurance providers that cover gender-affirming hysterectomy often require that the support letter states that a patient has been taking 12 continuous months of testosterone HRT. Exceptions can be made if the patient has a medical contradiction with testosterone. However, if you plan on undergoing a hysterectomy with a bilateral salpingo-oophorectomy, your provider may require you to be undergoing HRT before or to start treatment after surgery.

Fertility Preservation

We strongly encourage patients who are interested in the possibility of having biological children to explore their fertility preservation options before undergoing irreversible sterilization procedures. While patients can opt to keep their ovaries when undergoing a hysterectomy, it is crucial to discuss with your OBGYN how this can affect your fertility in the future. If interested, you should consult with reproductive specialists to consider other fertility preservation options, such as freezing ovaries, eggs, or embryos. You can learn more about fertility preservation here.

Preoperative Evaluation

To get a surgery date, individuals will often need to undergo a comprehensive medical assessment, which includes physical examinations like a pap smear, diagnostic or laboratory tests, and discussions with healthcare providers to ensure that you are physically and emotionally ready for the surgery. Since the GCC does not offer hysterectomies at this time, please consult with your OBGYN about their requirements for undergoing this procedure.

Recovery Timeline and Expectations

Generally speaking, recovery for gynecological surgery will differ based on the type of surgery you undergo. For example, a vaginal hysterectomy often requires a shorter hospital stay and a lighter recovery process than an abdominal hysterectomy. That said, most non-invasive hysterectomy approaches have a 2-4 week recovery period.

Hospital discharge

Oftentimes, with a less invasive approach, hysterectomy patients can go home the day of surgery if there are no issues with pain control or urinating after the removal of a urinary catheter. Otherwise, patients may need to spend one or more nights in the hospital after surgery to have their recovery monitored.

Physical and sexual activity limitations

Depending on your surgeon’s instructions, patients will need to avoid heavy lifting (more than 10lbs) for 2-4 weeks after surgery. Patients will be advised to observe pelvic rest or avoid inserting anything in the vaginal canal for 6-8 weeks post-op to minimize infection or delayed healing.

Bleeding and discharge

Within the first week after surgery, patients can expect to have vaginal spotting or discharge that can appear red, pink, brown, or yellow as stitches dissolve internally. Patients who have their cervix removed as a part of a total hysterectomy will have sutures placed at the top of the vaginal canal to close it; it is perfectly normal for a suture to come out with vaginal discharge during recovery. More bleeding may occur when a patient stands up or after a patient urinates during the recovery process. However, heavy bleeding that completely soaks a large pad within an hour should warrant a call to your surgeon.