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Hysterectomy FAQs

Pre-op insurance requirements?

  • Insurance companies generally follow WPATH guidelines. WPATH guidelines currently require 2 letters from providers, one can be your primary care or hormone specialist and the other from a mental health specialist.

  • However, many insurance companies follow the previous WPATH recommendations of 3 letters: 1 from your hormone specialist and 2 mental health letters from 2 separate mental health providers. For more details on the letter requirements, please go under our new patient tab and choose the letter option.

California sterilization state law requirements:

  • Non-Federally funded (not Medi-cal or Medicaid) patients, must be 18 years old to undergo elective sterilization surgery. 

  • Federally funded (have Medi-cal or Medicaid) patients, must be 21 years of age to undergo elective sterilization surgery.


Do I have to have the uterus removed prior to a metoidioplasty?

  • If you are electing to have the vagina removed then the uterus must be removed  first. If you are keeping the vagina, then the uterus does not have to be removed.

Do I have to have my fallopian tubes removed?

  • If you are having the uterus removed, then doctors are recommending removal of the fallopian tubes.

  • Fallopian tubes have been shown to be a source of ovarian cancer and without the uterus, they do not provide any benefit.


What about my ovaries?

  • Reasons to keep ovaries include future fertility and recent studies show they are still producing estrogen, even with testosterone.  This estrogen can help protect bones and prevent cardiovascular issues like stroke or heart attacks.


How long will I be in San Francisco? 

  • We require patients stay in our area for 2 night after surgery. There is a pre-op visit which can be up to 1 week prior to surgery and then a post-op visit 2 weeks after surgery is required. Everyone needs to be seen in person pre-operatively. This cannot be done over the phone. A physical exam is needed, but not necessarily a pelvic exam. 

How long is surgery?

  • Once we are in the operating room, this surgery takes usually takes 1-1.5 hours.


Will I go home the day of surgery?

  • Yes, this is usually a same day procedure.


Will I have a large scar?

  • No, we offer minimally invasive surgical options: laparoscopic or robot assisted laparoscopy.

Why is it important to have an active relationship with a mental health provider?

  • Preoperative World Professional Association for Transgender Health requires assessment prior to an irreversible surgery like those involving sterilization procedures.

  • Post-Operatively: No matter what the surgery, there is a post-operative blues condition that occurs for everyone. The bigger the surgery, the bigger the blues. On average it occurs 2-3 months after a big surgery. This will manifest as an inability to concentrate, fatigue and depression. It is important to have a mental health provider visit scheduled about 2 months after surgery for when these symptoms start to manifest as occurrence can be variable. The episode lasts approximately 2-4 weeks but is different for everyone. It is important to have a provider that knows you in order to be able to guide you through this experience. 

  • It is also helpful to let your support system know ahead of time about the above symptoms, in order to signal you to make your appointment with your mental health provider.

Can have have a metioidioplasty at the same time as the hysterectomy?

  • We can provide both those services for you.

  • We would need to know ahead of time that you wish to have both procedures, as these are two consults.

  • At this time, it is difficult to coordinate with other surgeons outside the group due to different operating room schedules.

  • If you have another surgeon for the meta, we recommend the hysterectomy approximately 3 months or more before your meta or phalloplasty.

The picture below of uterus, fallopian tubes and ovaries can cause dysphoria.
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