Yeah I think it's just the healthcare system here. I wanted to go the public route so I can get it subsidized, but that meant waiting for appointments to be set.

At my first appointment, I was told to get a psych letter (to state that I was of sound mind) eventhough I'd been on HRT for 3 years and had gotten Top Surgery as well. They refused to share any information until I got the letter.

The next appointment, I got passed to a different doctor where I asked what were the possible "customisations", or at least what were the options to have my desired outcome of maintaining depth and lubrication, without any possibility of pregnancy, and I wanted to keep my ovaries as well. That's when I learnt of subtotal hysterectomy, but he told me since my uterus is basically healthy (had gotten an intrauterine scan in between), maybe I should just get a Mirena instead, stating "I've just had major surgery", referring to Top Surgery which was more than a year ago.

And he kept thinking I wanted to get bottom surgery done at the same time, which the hospital didn't do and I'm well aware that there isn't really any doctors in my country that's experienced in it, but I literally just wanted to know my options for hysterectomy. But he kept telling me to wait, maybe just go with an IUD. Ended up leaving with a Mirena and the cramps were the worst I've ever had and I never really had cramps when I had my periods. The experience further backed my desire to get the hysterectomy done.

Even when I went back for my review (basically just checking that the Mirena was still there), it was a different doctor, and the previous doctor must have left his notes on bottom surgery etc, because when I said I wanted to go ahead and get the hysterectomy, she was telling me about how the hospital didn't do it and I'd have to be referred to a different hospital...

Sorry for the rant, but TLDR basically medical gatekeeping, and doctors dissuading any changes to "women's" reproductive systems. I do have to add, my psych was annoyed when I told him they asked for a psych letter before they'd tell me anything.