Trends in Transgender Care: A Decade of Gender-Affirming Hysterectomies and Ovarian Conservation

To investigate the trends in ovarian conservation during concurrent transgender or gender-diverse (TGD) hysterectomies across various time periods: before and after the expansion of gender-affirming health care in California (2010-2012 vs 2013-2019), before and after the 2016 U.S. presidential election (2010-2016 vs 2017-2019), and annually from 2010 to 2019.

The study was conducted within a large, integrated health care system from January 2010 to December 2019. Cisgender-related and TGD hysterectomies performed on patients who were 18 years of age and older and underwent a benign hysterectomy not associated with pregnancy were included. Hysterectomies performed with prior bilateral salpingo-oophorectomy (BSO) were excluded.

There were 41,341 hysterectomies performed within our large, integrated health network between 2010 and 2019, with 461 (1.1%) for TGD patients. Although the proportion of cisgender hysterectomies was similar in 2010 and 2019 (99.7% [n=3,750] vs 98.4% [n=4,361]), the proportion of TGD-related hysterectomies increased from 0.3% (n=10) in 2010 to 1.6% (n=70) in 2019 (P<.001). However, the proportion of hysterectomies with concomitant BSOs for TGD decreased from 90.0% in 2010 to 28.6% in 2019 (P<.001).

Gender-affirming hysterectomies and ovarian conservation increased from 2010 to 2019. Further research can help to explore the policies, sociopolitical climate, and patient care preferences driving these trends and their implications on patient outcomes and clinical practice.