Prevalence of Gender-Affirming Surgical Procedures Among Minors and Adults in the US | Surgery | JAMA Network Open | JAMA Network

The Nugget

Gender-affirming surgeries among minors are exceedingly rare, and mostly limited to chest-related procedures, while the majority of gender-affirming breast reductions are performed on cisgender males.

Make it stick

💡 Rates of gender-affirming surgery in minors are very low: only 2.1 per 100,000 for ages 15-17.
🔍 Chest procedures dominate: Nearly all surgeries in minors (96.4%) were chest-related.
🧩 Cisgender males lead in breast reductions: 97% of such surgeries in minors were for cisgender males.

The study utilized de-identified medical claims from Inovalon Insights covering the year 2019.
Gender-affirming procedures were identified using validated diagnostic and procedural codes.
The study population: 47 million adults and 23 million minors with insurance.
Procedures without gender-affirming motives (e.g., cancer, injury) were excluded to ensure accuracy.
Strength and limits: This was a cross-sectional study, relying on insurance claims data which may miss self-paid procedures or misclassify patients, but overall adheres to stringent observational study standards.

TGD (Transgender and Gender Diverse): Individuals whose gender identity differs from the sex assigned at birth.
Gender-affirming surgery: Procedures intended to align physical characteristics with gender identity, such as chest reconstruction.
Cisgender: A term describing individuals whose gender identity matches the sex they were assigned at birth.
Gynecomastia: Enlargement of breasts in males, which can lead to breast reduction surgery.

The study found that in 2019, no TGD minors under age 12 underwent gender-affirming surgeries.
Among minors aged 15-17, the rate was 2.1 per 100,000, markedly lower compared to adults (5.3 per 100,000).
For minors aged 13-14, the rate drops significantly to 0.1 per 100,000, and zero for those under 12.

In minors, the vast majority (96.4%) of gender-affirming surgeries were chest-related procedures.
Similarly, a significant portion (59.7%) of such procedures in adults were chest-related.

Of the breast reductions performed, the study highlighted that most were conducted on cisgender males rather than TGD individuals.
Specifically, 80% of adult breast reductions and 97% of those in minors were for cisgender males, indicating a broader use beyond just gender affirmation for TGD individuals.

"Gender-affirming surgeries among TGD minors are rare and almost exclusively chest-related."
"Cisgender males accounted for the majority of breast reductions, highlighting a broader medical use."

These findings counter claims suggesting high rates of gender-affirming surgeries among TGD minors, demonstrating instead a low incidence and adherence to clinical standards.
The high rate of breast reductions in cisgender males also touches on broader health issues like gynecomastia.

The study's reliance on insurance claims underscores the need for robust diagnostic coding but also limits visibility on self-funded procedures.

Amidst legislative efforts to restrict gender-affirming care for minors, these low rates highlight the gap between perceived and actual procedure frequencies.

This summary contains AI-generated information and may have important inaccuracies or omissions.