Are American Transgender Kids Being Rushed into Gender-Affirming Surgery?

Introduction

As the new administration takes shape in the US White House, many Americans are anticipating changes to their healthcare and educational access. This anticipation is especially poignant for the small number of children under 18 who identify with a gender different from their biological sex. Amidst concerns about a so-called surgical “trans-pocalypse,” a study published in JAMA Network Open in June 2024 by Harvard medical experts offers a clear response: there is no cause for alarm.

The Role of Evidence in the Discussion

While social media often amplifies fears regarding an alleged epidemic of gender-affirming surgeries for minors, it is crucial to rely on data and facts to guide our understanding. Let’s delve into the statistics surrounding this issue.

Number Crunching

Research Overview

Biostatisticians from Harvard’s T.H. Chan School of Public Health, in collaboration with physicians from Harvard Medical School, Boston Children’s Hospital, and Brown University’s School of Public Health, explored several key questions:
– How many children undergo gender-affirming surgery?
– Do children receive these surgeries at a higher rate than adults?
– What types of surgeries are being performed?

The team analyzed anonymized insurance records to determine the volume of gender-affirming surgeries conducted in the United States in 2019. They then verified whether these procedures were associated with a transgender diagnosis and noted the age of each patient.

Defining Gender-Affirming Surgery

The researchers based their definition of gender-affirming surgeries on prior work from institutions like Johns Hopkins University. According to their findings, gender-affirming surgery (GAS) includes various procedures designed to align a patient’s physical appearance with their gender identity. This definition is recognized by insurance companies and health researchers alike and applies to individuals whose gender identity corresponds with their sex as well as those whose identities do not.

Types of Procedures

The following procedures were categorized as gender-affirming based on the study’s supplementary materials:
– Creation of a penis or vagina
– Scrotoplasty
– Clitoroplasty
– Vaginoplasty
– Urethroplasty
– Hysterectomy and removal of reproductive organs
– Vaginectomy
– Vulvectomy
– Perineoplasty
– Testicular implants and removals
– Penectomy
– Mastectomy or breast reduction
– Nipple reconstruction
– Breast augmentation
– Jaw and facial cosmetic surgery
– Tracheoplasty
– Rhinoplasty

It is important to note that procedures involving intersex individuals were excluded from this analysis, as were reconstructive surgeries related to injury or congenital abnormalities.

Transgender Children and Gender-Affirming Surgery

Study Findings

The research team reviewed over 70 million insurance records, representing approximately one-fifth of the US population, allowing for extrapolation to national figures. They identified a total of 2,664 gender-affirming surgeries in 2019, with no surgeries performed on children under 12. Children aged 13 to 14 received up to three surgeries, while those aged 15 to 17 accounted for around 80 procedures. In total, only 85 transgender children received gender-affirming surgeries from the analyzed records, the vast majority being in the 15-17 age bracket.

Adult vs. Child Surgical Rates

Adults accounted for the highest number of gender-affirming surgeries, with a rate of 5.3 procedures per 100,000 adults. In comparison, the rate for teenagers was slightly lower at 2.2 per 100,000, indicating that children are not being rushed into surgery. This discrepancy highlights the stringent criteria required to qualify for such treatments.

According to the NIH, approximately 390 per 100,000 US adults identified as transgender in 2017, suggesting that only about 1.3% of transgender adults underwent gender-affirming surgery in any given year.

Types of Surgeries Conducted on Minors

Analysis of Procedures

Among the 85 gender-affirming surgeries performed on children, 82 were related to chest procedures. For context, in 2019, 787 breast reduction surgeries were conducted on both cisgender males and transgender individuals. Specifically, 636 of these surgeries were for adult men and transgender-identifying individuals, while 151 breast reductions were performed on male and transgender children, with the vast majority being for cisgender males.

Thus, it’s evident that the number of cisgender boys receiving breast reduction surgery significantly exceeds that of transgender children qualifying for similar procedures.

Conclusion

In summary, the data indicates that very few transgender children are undergoing gender-affirming surgery. When confronted with claims about a surge in such surgeries for minors, consider the following points:
– Gender-affirming surgeries can include common cosmetic procedures like rhinoplasty.
– Only 85 gender-affirming surgeries were identified for transgender children in over 22 million medical records.
– Nearly all of these surgeries were chest-related, and significantly more cisgender boys received breast reductions than transgender children.
– The rates of gender-affirming surgeries reflect a stringent qualification process, with 5.3 per 100,000 adults qualifying compared to 2.1 per 100,000 teenagers and 0.1 per 100,000 children aged 13 to 14.

References

– Dai D, Charlton BM, Boskey ER, et al. Prevalence of Gender-Affirming Surgical Procedures Among Minors and Adults in the US. JAMA Network Open. 2024;7(6): e2418814. doi:10.1001/jamanetworkopen.2024.18814
– Meerwijk EL, Sevelius JM. Transgender Population Size in the United States: a Meta-Regression of Population-Based Probability Samples. Am J Public Health. 2017;107(2):e1-e8. doi:10.2105/AJPH.2016.303578
– Hughto JMW, Hughes L, Yee K, et al. Improving Data-Driven Methods to Identify and Categorize Transgender Individuals by Gender in Insurance Claims Data. LGBT Health. 2022;9(4):254-263. doi:10.1089/lgbt.2021.0433
– Oles N, Darrach H, Landford W, et al. Gender Affirming Surgery: A Comprehensive, Systematic Review of All Peer-reviewed Literature and Methods of Assessing Patient-centered Outcomes (Part 1: Breast/Chest, Face, and Voice). Ann Surg. 2022;275(1):e52-e66. doi:10.1097/SLA.0000000000004728
– Oles N, Darrach H, Landford W, et al. Gender Affirming Surgery: A Comprehensive, Systematic Review of All Peer-reviewed Literature and Methods of Assessing Patient-centered Outcomes (Part 2: Genital Reconstruction). Ann Surg. 2022;275(1):e67-e74. doi:10.1097/SLA.0000000000004717