Shifting cultural norms transform the uses and meanings of medical practices, and, in turn, medical practices have the capacity to alter social relations. In this article, I use hysterectomy as a case for understanding how reproductive health practices are constrained by and contribute to notions of gender, race, and stratified reproduction. Hysterectomy is regularly performed yet understudied and has been transformed by both technological advances and shifting norms in gender and reproduction. I draw on 100 in-depth interviews with individuals who had, want, or are considering hysterectomy to treat chronic reproductive health conditions or as gender-affirming care for trans and gender-nonbinary (TGNB) individuals. These comparative groups shed insight across three gender groups (cis women, trans men, nonbinary) as well as across race. Findings show divergent patient–provider interactions ranging from physician support to provider coercion to gatekeeping. Similarly, the data reveal that hysterectomy evokes a wide range of reactions—from delight to neutrality to grief. These distinct reactions and interactions map on to gender, race, and ethnicity, revealing persistent reproductive stratification by social positionality. Bringing together feminist science and technology studies with intersectional theories of the body and reproductive justice, I show how stratified reproduction operates when gender identities vary and introduce the concept of opting into infertility.