Hysterectomy for FTMs, part 3

This is the 3rd article in the series about hysterectomies for transgender people. We’ll address the two biggest concerns that come up during the process, and specific steps to take towards making this a reality for you.

In the previous article we went over reasons trans* people consider hystos, and common questions, while the first article, went over the basics of the procedure.

Biggest Concerns

Once they have made the big decision, a lot of people still have to jump through hoops and navigate other bumps in the road to make it a reality.

Finding a surgeon

Our biggest concern as transpeople usually revolves around finding a surgeon who will not just validate our identity, but who is willing to perform this surgery on someone who is otherwise healthy, often quite young and within reproductive age. Secondary to this is, especially for those who unmistakably look like men, is finding a doctor (and their staff) who will not laugh at you, disrespect you, or outright deny to treat you, because most gynecologists have only ever had patients who are women.

Finding a surgeon who has a history of seeing trans patients will put you steps ahead, as they will likely be familiar with your needs and desires, and also aware of possible insurance workarounds.

Even though someone has never heard of FTM, neutrois, transgender, androgyne, or genderqueer people before, there are many doctors who are open to working with us to meet our needs. Since most of the times refusal for care stems from ignorance and fear, it helps to provide them information beforehand. For instance, sending them to websites of other surgeons who perform hysterectomies on FTMs and other trans people can help your doctor understand that, while slightly less common, it’s not something unheard of, and that other respectable surgeons do it. This will also give them an idea of what other surgeons require or don’t require (like letters of consent), and a chance to contact that doctor to be further educated.

It sounds silly, but doctors are generally scared of doing something that could get them in trouble, and transgender health care is still a fuzzy gray area which to them might be a bit mysterious. Relaying information through a medical colleague is a great way to safely lift the veil on something they’ve probably never heard of.

Insurance Coverage

The second biggest concern is cost. Or rather, avoiding it, usually by obtaining insurance coverage.

(Note: most of this is applicable only in the US, or wherever there is private insurance. I would love it if others shared their experiences in other countries in the comments section below.)

The good thing is there are many different ways one can approach this. The best route is to talk with your surgeon about options. They could recommend a number of tactics, like scheduling several visits to establish “a history of” something (like painful cramps). Getting tested for actual medical conditions to establish medical necessity is another (not to mention, you should do this anyway for your health).

It is generally advised to keep the “female” marker on insurance records, rather than changing it to male. While I’ve heard many success stories with people listed as male, going through this with an F increases your chances of a smooth process. So if you’re at a point where you can delay this change, it might be something to consider.

Another tidbit is you should always tread carefully when calling up your insurance company for information, such as avoid outing yourself as trans. Most insurance plans have specific exclusions when it comes to transgender-related surgeries, and should they somehow “figure out” that you are trans, you could be denied coverage of this procedure, even if were to be covered under normal circumstances. Even when your plan does cover trans surgeries, the process tends to involve a lot of hoops, like an official GID diagnosis or being on hormones for a certain period of time before you’re eligible, which might make it harder for some people to obtain it.

Insurance coverage varies widely. A lot of this will highly depend on your insurance company, specific insurance plan, personal medical history, and the state you live in. Below, I’ll outline a few caveats that I know of. Plenty of trans* people manage to get this surgery covered, so it is totally doable!

Voluntary Sterilization

My hysterectomy was covered as a medically necessary procedure under voluntary sterilization. As far as I know, it is mandatory for insurance companies to cover this in the state of California. The CA government definition of voluntary sterilization includes a hysterectomy: “A woman may be sterilized by disconnecting and tying her fallopian tubes, or by removing her ovaries or uterus.” Furthermore, you cannot be denied the procedure in a non-private hospital if you are over 21, at least in CA.

In the US, voluntary sterilization should supposedly be covered by all health plans as of August 2012 (although I couldn’t get more substantial information on this, which strikes me as odd and suspicious):
The U.S. Department of Health and Human Services announced new guidelines in Washington Monday requiring health insurance plans beginning on or after August 1, 2012 to cover several women’s preventive services, including birth control and voluntary sterilization. - CNN Health News and CNS News.

Lastly, Planned Parenthood‘s site has a section for sterilization. Although it does not specifically talk about hysterectomies, it could be beneficial to contact your local PP for more information.

History of…

Most people – cis-women and trans alike – undergo a hysterectomy because it is medically necessary.

There are a number of risk factors for uterine or ovarian cancer, development of fibroids, PCOS, and other conditions, that either personal or family history can reveal. Excessive or irregular bleeding or painful cramping is another common reason a hysto would be medically advisable. As a last resort, you can regularly complain about painfully intolerable cramps – just make sure to formalize these complaints with a visit to your physician or gynecologist. While it could get tricky if you have been on testosterone and don’t get a period, there is no test or machine that can establish the veracity of this, and it’s a truly legitimate medical justification for a hysterectomy.

There is ample room to find reason for your surgeon to deem a hysterectomy “medically necessary” for you, making it a bit more straightforward to claim insurance coverage for it.

Lastly, if you do go to a gynecologist and they refuse to authorize you for a hysterectomy, try to find another doctor.

Steps to Scheduling a Hysterectomy

So your curiosity has been satisfied, and you want to get the wheels rolling on this. Even if it’s just an initial consultation, talking to a real doctor can give you a lot of insight.

1. Find a gynecologist

The first step to finding a gynecologist is to ask around for a referral. Use trans* and queer local listserves and mailing groups, online communities and blogs, visit LGBT centers and clinics, talk to your primary doctor, and ask other trans* friends.

Chances are there is at least one other transgender person in your area who has gotten a hysterectomy. The internet is a big place, it can be tricky to find each other, but we’re all here!

2. Schedule a consultation

Once you have a name or two, check out their websites and call their offices to schedule a consultation. It doesn’t have to be anything more than talking. Ask whether they have experience with trans patients, how insurance will be handled, and any other questions you might have about the procedure, about your health, and about your body. Most times these questions can’t be answered over the phone, but asking them allows you to gauge the staff’s comfort level with trans* people, and gives you a sense of how welcoming they might be.

If for whatever reason you don’t like the surgeon – they’re not respecting your identity, they refuse to work with you on insurance, or they’re asking letters, hormones, or other requirements you cannot meet – then go back to step 1 and find someone else.

Gynecologists are not rare, there will be another one. Just because one said no doesn’t mean they will all say no. Just keep looking!

3. Schedule the surgery

You’d be surprised how quickly things move after that! Pretty soon you’ll have scheduled the surgery and be on your way.

There are a number of things to do in between. Start making preparations, like clearing out your schedule for recovery, and mentally readying yourself for pre-op and recovery periods. Gather the necessary paperwork, like lab results, previous pap tests, or referral letters. Talk to the hospital and arrange billing. Most importantly (if you are going through insurance) double-check that your insurance has authorized it.

Lastly, celebrate!

Questions

If you have questions, feel free to contact me. I may not be able to answer or all of them (see disclaimer below) but I’ll try my best to point you in the right direction. Good luck!

Resources

Disclaimer

I’m not a medical professional and I possess no formal medical knowledge. This summary is a layperson’s understanding of personal research. It may or may not be accurate.

8 responses to “Hysterectomy for FTMs, part 3

  1. Thank you very much for this series. I’m also a CA resident, so the insurance work-around with voluntary sterilization will be particularly helpful, I’m sure.

    If I may ask, around how much did you still need to pay out of pocket after insurance? (I know it’ll be different by provider, but a rough estimate would be cool.)

    • Good point, I will add that in.

      I’d say the doctors issue holds true, though admittedly in some countries it is much harder to “just” find another one.

  2. Do you know if one can opt out of selecting gender for insurance purposes (on the form)? I know that they can’t require you to identify gender or race/ethnicity on legal forms–is insurance the same? I’ve never been on insurance in my life, but when I get a job after I graduate, hopefully I will get insurance. By this time, though, I will be legally male.

    • It is optional (and sometimes illegal) to require gender/race on some demographic forms, like for job applications, namely to avoid discrimination. But insurances can discriminate all they want, and gender is a must. Moreover, it has to match your legal gender (now, which legal gender is an open question).

      In fact, a lot of plans cover specific services depending on your listed gender. For instance, if you are listed as Male some plans will refuse to cover a hysterectomy or a pregnancy. Any discrepancies can get flagged and put you at risk for denial of coverage; for instance, if you are listed as Female but the doctor submits the claim as Male, you could run into issues.

      Note that this isn’t true for all plans, and there are people who are listed as Male who get hystos covered, but generally it’s more complicated.

  3. Have you seen anything about the risk of pelvic organ prolapse when hystos are done on younger people? It seems like it’s a pretty big risk when they’re done in general, but I can’t figure out if it’s just because a lot of people who get them are middle aged or older. I’ve found someone who’ll do the surgery and my insurance will cover it, but I’m afraid 10 years from now my bladder will try to fall out or something. But not having to spend the rest of my life choosing between shots and shark week is really tempting.

    • The risks for pelvic prolapse are primarily: childbirth, age (50+), and menopause (meaning, you no longer produce estrogen). Also, this is only if you remove the cervix, I believe; you can opt to keep it, and get pap smears every year.

      I took everything out – including cervix – except my ovaries. I am young, healthy, no children, and regular paps, plus naturally producing estrogen, so very very low risk.

      This is something you should definitely discuss with your doctor further.

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