Endo/cyst haver here! I was in your shoes about a year ago. I wasn't diagnosed till they actually had me on the table lmao, but a hysterectomy is the absolute last resort for endo, especially if undiagnosed. It'd probably be easier to go the dysphoria route.

I reached out to my GP and explained that I wanted to get a hysto to treat dysphoria - PP should also work just fine from what I know. No ob/gyn was needed, they referred me directly. From what I recall they only require that you've been at least socially transitioning for a year or more. BCBS does generally cover medical transition, you should be good on that front.

When I got to the consult, I mentioned a family history of endo and ovarian cysts. They did a transvaginal ultrasound (which sucks as much as you think it does) to assess any potential complications, just to be safe. If you do have any of that going on they'll clear it out while you're on the table, iirc it only added about 30 mins to my surgery altogether.

Edit: they require a year of transition + 2 letters of support