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

OBJECTIVE: 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. METHODS: 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. RESULTS: 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