Transgender surgery rates tripled from 2016 through 2019 in patients of all ages, a new study shows.
And the number of the most popular operation for minors—top surgery, as it's called, to remove or "create" breasts—more than quintupled.
Researchers analyzed data from 2016–2020 on patients who had been diagnosed with gender identity disorder or transsexualism, or who had a personal history of sex reassignment.
They used information from a database documenting "major ambulatory surgical procedures at nearly 2,800 hospital-owned facilities in up to 35 states."
These surgeries included breast amputation for girls, the creation of "breasts" for boys, genital reconstruction, and facial reconstruction, according to the study published online by the Journal of the American Medical Association (JAMA).
Given these figures, the cost of those sex-change surgeries on children from 2016 to the end of 2019 likely ranged from $36 million to $73.5 million.
Doctors can anticipate a boom in sex-change surgeries in the states that keep it legal, he wrote.
"Physicians who provide GAC [gender-affirming care] will face a greater burden due to constraints in certain states and increasing demands for care," Dr. Ganor wrote.
Growing Trend
About 1 in 5 young adults now identifies as non-heterosexual, according to Gallup research. About 9 percent of LGBT adults identify as transgender, the research notes.Among members of Generation Z—born from 1997 to 2004—about 10 percent of LGBT adults identify as transgender.
Within the study group, 6,915 people who were undergoing sex-change surgery were white—far more than the 955 black patients and 1,050 Hispanics. Within the group studied, the number of surgical patients of other ethnicities totaled 1,380, and the races of 325 individuals weren't identified.
People of "high income" were the largest group pursuing sex-change surgery. The lower the income bracket, the less likely individuals were to undergo surgery.
Transgenderism has been growing quickly.
The number of people identifying as transgender doubled from 2000 to 2005, then doubled again from 2006 to 2011, study authors said.
Relatively few individuals undergo surgery to further the goal of living as the opposite sex, the study noted. More individuals receive cross-sex hormones or identify as transgender without receiving medical treatment, the researchers found.
But those who do pursue surgery are most likely to be ages 19 to 30, the study revealed. Within the studied group, people in that age group underwent 25,099 procedures—a little more than half of the 48,019 procedures performed.
Almost 8 percent of patients undergoing sex-change surgeries were ages 12 to 18, the researchers found. The study didn’t cover child use of sex-change hormones and puberty blockers.
Inconsistencies in medical records could have prevented researchers from tallying all of the sex-change surgeries, researchers said.
For instance, if a man who says he's a woman has medical records that reflect that he's female, a breast-creation surgery won't appear as a sex-change surgery in his medical records.
Instead, it will look as if the patient is a woman getting breast reconstruction surgery.
Surgery Process
"Most patients first experience gender dysphoria at a young age," the study authors wrote.Women live an average of 23 years with gender dysphoria before getting sex-change surgery, while men live an average of 27 years with gender dysphoria before getting sex-change surgery, the study found.
In the studied group of patients, nearly 57 percent underwent surgery for breast creation or breast amputation. About 35 percent had genital reconstruction, and almost 14 percent had facial and cosmetic procedures.
Some patients underwent more than one type of surgery.
Sex-change surgery tends to have good results such as "improved quality of life, high rates of satisfaction, and a reduction in gender dysphoria" and "is associated with decreased depression and anxiety," researchers wrote.
In the long term, sex-change surgery is "associated with acceptable morbidity" and reasonable rates of complications, they said.
But a growing number of detransitioners, as they're called, vehemently disagree. They tell about surgeries that didn't yield the results that they were told to expect.
Some expressed regret at surgeries that left them sterile or unable to breastfeed.
Money for Transgender Medicine
Who ultimately pays for sex-change surgery is changing.Federal policies played an important role in pushing insurers to cover sex-change procedures.
The Affordable Care Act (ACA) Section 1557 makes it unlawful to discriminate on the basis of “race, color, national origin, sex, age, or disability in certain health programs and activities.”
In 2016, President Barack Obama’s Department of Health and Human Services passed a rule that interpreted “sex” to mean "sexual identity or gender," not just “male or female.” These words were defined as "one’s internal sense of gender, which may be male, female, neither, or a combination of male and female."
During President Donald Trump’s administration, a federal court overturned this rule.
However, on Jan. 20, 2021, President Joe Biden wrote in an executive order, “It is the policy of my administration to prevent and combat discrimination on the basis of gender identity or sexual orientation, and to fully enforce Title VII and other laws that prohibit discrimination on the basis of gender identity or sexual orientation."
