Background: Healthcare for transgender people can be unsafe and inequitable. Objectives: To explore the experiences of care surrounding hysterectomy as part of female to male (FtM) gender affirming surgery. Design: Qualitative observational study Setting: Aotearoa/New Zealand Participants: Ten people (out 12 people) who underwent FtM over a four-year period. Results: No one person’s experience of the FtM journey was affirming across the whole surgery journey. Transgender health literacy was central to inclusive practice as it mediated bodily autonomy being upheld. FtM (hysterectomy) surgery was described as “ life-saving”. The physical care environment influenced the experience of the healthcare encounter. For example, the waiting room was intimidating, with a gendered clinic name and toilets. Some participants took a female support person/partner so that “ people looking would assume that I was there supporting her, not the other way around.” Communication misalignments were evident around information provided/understood about fertility and ovarian preservation, requirement of a pre-operative pregnancy test, and post-operatively, about bleeding and when sexual intercourse could be resumed. Participants were also placed in the position of both receiving care and providing education: “ I also shouldn’t have to be going in there for treatment, and then being expected to educate the medical professional that’s meant to be helping me… I’m not getting paid to give you a TED talk on how my trans body works.” Conclusions: A whole care pathway approach to increasing transgender health literacy will facilitate better alignments in communication, uphold bodily autonomy and lead to equitable inclusive practice.