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 from mental health providers (1 provider needs to be a PhD or MD). Please check with your insurance carrier for their specific requirements.

 

California sterilization state law requirements:

  • Non-Federally funded (not Medi-cal or Medicaid) patients, must be 18 years old to undergo elective sterilization surgery. Exceptions to this rule include the following: under 18 years of age and have entered into a valid marriage OR is on active duty with the U.S. armed services OR received a declaration or emancipation OR is at least 15 years of age, live apart from your parents or guardians, and manage your own financial affairs.

  • 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 3 weeks. A pre-op visit 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. 

How long is surgery?

  • The surgery, once we are in the operating room 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 in inability to concentrate, fatigue and depression. It is important to have a mental health provider visit scheduled about 2 months after surgery or 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. 

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