Examining rates of gender-affirming surgery in the US

For adults and minors, most breast reductions performed on cisgender males and transgender and gender-diverse (TGD) people are performed on cisgender males, according to a research letter published online June 27 in JAMA Network Open.

Dannie Dai, from the Harvard T.H. Chan School of Public Health in Boston, and colleagues characterized the relative use of gender-affirming surgeries by TGD and cisgender populations. TGD people who received a gender-affirming procedure were identified; the rate of people who received a gender-affirming procedure with a TGD-related diagnosis per 100,000 total people was calculated for adults or minors. The proportion of breast reductions used by cisgender males without a TGD-related diagnosis and TGD people was compared.

In 2019, 47,437,919 adults who were insured and 22,827,194 minors (16.8, 11.9, and 71.3% ages 15 to 17, 13 to 14, and 12 years or younger, respectively) who were insured were included in the sample. The researchers found that the rate of undergoing a gender-affirming surgery with a TGD-related diagnosis was 5.3 per 100,000 total adults compared with 2.1, 0.1, and 0 per 100,000 minors aged 15 to 17, 13 to 14, and 12 years or younger, respectively.

Overall, 59.7 and 96.4% of gender-affirming surgical procedures identified among adults and minors were chest-related procedures. Eighty percent of the 636 breast reductions among cisgender male and TGD adults were performed on cisgender males; 97% of the 151 breast reductions among cisgender male minors and TGD male minors were performed on cisgender male minors.

“These findings suggest that concerns around high rates of gender-affirming surgery use, specifically among TGD minors, may be unwarranted,” the authors write. “Low use by TGD people likely reflects adherence to stringent standards of gender-affirming care.”

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