Are American transgender kids being rushed into gender-affirming surgery?
As the new administration sets up their stall in the US White House, many Americans will be preparing for changes to their health care and access to education. Few more so than the tiny number of children under the age of 18 who identify as having a gender that does not match their sex.
Should we be worried about this touted surgical trans-pocalypse? Writing in JAMA Network Open in June 2024, Harvard medical experts gave a resounding ‘No’.
While social media commentators like to make bombastic declarations about the epidemic of gender affirming surgery for kids, Medical News Bulletin readers know that here, we follow the evidence and use facts to draw conclusions. So let’s take a look at what the figures say for ourselves.
Number Crunching
Biostatisticians from Harvard’s T. H. Chan School of Public Health teamed up with doctors from Harvard Medical School, Boston Children’s Hospital and Brown University’s school of public health find out:
- How many kids get gender affirming surgery?
- Do kids get the surgeries more than adults?
- What surgeries are they getting?
The researchers used a set of anonymized insurance records to uncover out how many gender affirming surgeries were carried out in the United States in 2019. Once they found the gender affirming surgery, they checked whether it came with a diagnosis associated with being transgender. Next, they looked at the patient’s age when they had their procedure.
What Exactly is a Gender Affirming Surgery?
The researchers based their definition of a gender affirming surgeries on previous work performed by Johns Hopkins University researchers amongst others. “GAS [Gender affirming surgery] encompasses a variety of procedures that align an individual patient’s gender identity with their physical appearance”. This definition is used by insurance companies and health researchers and can apply to people whose gender identity aligns with their sex as much as those whose gender identity does not.
This is a non-exhaustive list of the types of procedure that the Harvard researchers characterised as gender affirming, taken from the supplementary materials that accompany the paper.
- creation of a penis or vagina
- scrotoplasty
- clitoroplasty
- vaginoplasty
- urethroplasty
- hysterectomy, removal of fallopian tubes or ovaries
- vaginectomy
- vulvectomy
- perineoplasty
- testicular implants
- testicular removal
- penectomy
- mastectomy or breast reduction
- nipple reconstruction
- breast augmentation
- jaw surgery
- facial cosmetic surgery
- Tracheoplasty
- rhinoplasty
Procedures involving intersex people were excluded from the counts, as were people who were having reconstructive surgery to repair damage done by injury or illness and people with congenital abnormalities. These included things like treatment for sleep apnea, repairing a vaginal prolapse or having prosthetic testicles fitted after recovering from testicular cancer.
As you can see, surgeries classed as ‘gender affirming’ run the gamut from an out patient eye lift or a nose job, to extensive reconstructive surgery on a person’s genitals.
How many transgender children got gender affirming surgery?
The researchers searched over 70 million insurance records – covering roughly 1/5 of the US population. This means that we can roughly extrapolate the numbers they determined to the whole of the US by multiplying by five.
First they scanned for the number of gender affirming surgeries provided to people with a transgender diagnosis. Of the 2664 gender affirming surgeries they found in 2019, zero were performed on children under the age of twelve. Surgeons gave up to three procedures to children between 13 and 14, and around 80 to 15-17-year-olds.
In total, of the 22,827,194 insurance records examined in 2019, only 85 transgender children received gender affirming procedures. The vast majority of those children would have been aged between 15 and 17 years old.
Who’s getting the surgeries?
Unsurprisingly, adults received the most gender affirming surgeries with a rate of 5.3 procedures per 100,000 adults. When you look at the numbers, this is a very small figure. At 5.3 per 100,000 this is only just over double the number that kids get (2.2 per 100,000), that’s not because children are being rushed to the operating theatre. Rather, it illustrates just how difficult it is to qualify for treatment.
The NIH put the number of transgender adults in the US at around 390 per 100,000 in 2017. This means in a given year, maybe 1.3% of transgender adults got a gender-affirming surgery.
So who is getting the surgeries? Turns out almost nobody.
What are the surgeries for?
Of the 85 gender affirming surgery cases reported in children, 82 were chest related. To put this into perspective, in 2019 doctors performed 787 breast reduction surgeries on cisgender males and trans identifying people in their sample.
Six hundred and thirty-six adult men and transgender identifying people got a breast reduction in 2019, 507 were cis-gendered males. Similarly, in male children and transgendered kids, doctors performed 151 breast reductions in 2019, 146 of those were for cis-males.
To be clear, the number of cis-gendered boys under 18 getting gender affirming breast reduction surgery dwarfs the number of transgender kids who qualify.
In short: few transgender kids are getting surgery
Next time you see a claim about the ‘out of control’ number of gender affirming surgeries performed on transgender children you can judge for yourself whether the claim passes muster:
- Gender affirming surgeries include common cosmetic procedures like rhinoplasty
- Researchers only identified 85 gender affirming surgeries on transgender kids in more than 22,000,000 children’s medical records
- Nearly all of those were chest related
- Nearly thirty times as many cis gendered boys got breast reductions as did transgender identifying children.
- 5.3 in 100,000 adults qualified for gender affirming surgery in the same year vs 2.1 in 100,000 teens between 15 and 17 and 0.1 per 100,000 kids between 13 and 14.
Sources
Are American transgender kids being rushed into gender-affirming surgery? As the new administration sets up their stall in the US White House, many Americans will be preparing for changes to their health care and access to education. Few more so than the tiny number of children under the age of 18 who identify as having a gender that does not match their sex. Should we be worried about this touted surgical trans-pocalypse? Writing in JAMA Network Open in June 2024, Harvard medical experts gave a resounding ‘No’. While social media commentators like to make bombastic declarations about the epidemic of gender affirming surgery for kids, Medical News Bulletin readers know that here, we follow the evidence and use facts to draw conclusions. So let’s take a look at what the figures say for ourselves. Biostatisticians from Harvard’s T. H. Chan School of Public Health teamed up with doctors from Harvard Medical School, Boston Children’s Hospital and Brown University’s school of public health find out: The researchers used a set of anonymized insurance records to uncover out how many gender affirming surgeries were carried out in the United States in 2019. Once they found the gender affirming surgery, they checked whether it came with a diagnosis associated with being transgender. Next, they looked at the patient’s age when they had their procedure. The researchers based their definition of a gender affirming surgeries on previous work performed by Johns Hopkins University researchers amongst others. “GAS [Gender affirming surgery] encompasses a variety of procedures that align an individual patient’s gender identity with their physical appearance”. This definition is used by insurance companies and health researchers and can apply to people whose gender identity aligns with their sex as much as those whose gender identity does not. This is a non-exhaustive list of the types of procedure that the Harvard researchers characterised as gender affirming, taken from the supplementary materials that accompany the paper. Procedures involving intersex people were excluded from the counts, as were people who were having reconstructive surgery to repair damage done by injury or illness and people with congenital abnormalities. These included things like treatment for sleep apnea, repairing a vaginal prolapse or having prosthetic testicles fitted after recovering from testicular cancer. As you can see, surgeries classed as ‘gender affirming’ run the gamut from an out patient eye lift or a nose job, to extensive reconstructive surgery on a person’s genitals. The researchers searched over 70 million insurance records – covering roughly 1/5 of the US population. This means that we can roughly extrapolate the numbers they determined to the whole of the US by multiplying by five. First they scanned for the number of gender affirming surgeries provided to people with a transgender diagnosis. Of the 2664 gender affirming surgeries they found in 2019, zero were performed on children under the age of twelve. Surgeons gave up to three procedures to children between 13 and 14, and around 80 to 15-17-year-olds. In total, of the 22,827,194 insurance records examined in 2019, only 85 transgender children received gender affirming procedures. The vast majority of those children would have been aged between 15 and 17 years old. Unsurprisingly, adults received the most gender affirming surgeries with a rate of 5.3 procedures per 100,000 adults. When you look at the numbers, this is a very small figure. At 5.3 per 100,000 this is only just over double the number that kids get (2.2 per 100,000), that’s not because children are being rushed to the operating theatre. Rather, it illustrates just how difficult it is to qualify for treatment. The NIH put the number of transgender adults in the US at around 390 per 100,000 in 2017. This means in a given year, maybe 1.3% of transgender adults got a gender-affirming surgery. So who is getting the surgeries? Turns out almost nobody. Of the 85 gender affirming surgery cases reported in children, 82 were chest related. To put this into perspective, in 2019 doctors performed 787 breast reduction surgeries on cisgender males and trans identifying people in their sample. Six hundred and thirty-six adult men and transgender identifying people got a breast reduction in 2019, 507 were cis-gendered males. Similarly, in male children and transgendered kids, doctors performed 151 breast reductions in 2019, 146 of those were for cis-males. To be clear, the number of cis-gendered boys under 18 getting gender affirming breast reduction surgery dwarfs the number of transgender kids who qualify. Next time you see a claim about the ‘out of control’ number of gender affirming surgeries performed on transgender children you can judge for yourself whether the claim passes muster:
Number Crunching
What Exactly is a Gender Affirming Surgery?
How many transgender children got gender affirming surgery?
Who’s getting the surgeries?
What are the surgeries for?
In short: few transgender kids are getting surgery
Sources
