More people are getting gender-affirming care, under attack in many states. Few are kids

Ken Alltucker, USA TODAY
Updated Wed, August 23, 2023 

The number of people seeking gender-affirming surgeries such as breast and chest operations or genital reconstruction nearly tripled during the three years before the coronavirus pandemic, a new study shows.

The study tracked more than 48,000 patients who had operations in hospitals and same-day surgery centers from 2016 through 2020, the most recent data available. The number of patients getting these operations nearly tripled from 4,552 in 2016 to 13,011 in 2019, before decreasing slightly in 2020 amid the coronavirus restrictions that postponed or halted many types of non-emergency operations, according to the study published Wednesday in JAMA Network Open.

Gender-affirming surgeries were most popular with young adults; more than 25,000 people ages 19 to 30 received these procedures. Fewer than 8% of patients − a total of 3,678 − were 12- to 18-year-olds, a group scrutinized by lawmakers pursuing restrictions mainly in conservative states.

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Insurance coverage, awareness, satisfaction drive gender operations

Dr. Jason D. Wright, the study's lead author and an associate professor of gynecologic oncology at Columbia University, said the purpose of the study was to get an accurate count on such operations at hospitals and outpatient surgery centers.

The researchers sifted through databases to find people diagnosed with gender identity disorder, transsexualism or a personal history of sex reassignment. From there, researchers tracked whether those patients sought a range of gender-affirming surgeries.

More than half of the people in the study had breast and chest procedures, making it the most common type of gender-affirming operation. More than 1 in 3 people received genital reconstruction − a category that included any surgical intervention of the male or female genital tract. Others sought facial and cosmetic procedures such as hair removal, hair transplants, liposuction and collagen injections.

Gender-affirming surgeries are becoming more common as insurers offer more robust coverage. About 3 in 5 patients were covered by a private insurance plan, and 1 in 4 had Medicaid, the government health insurance plan for low-income and disabled residents.

People are also more aware these surgeries are available, Wright said.

"More patients have had access to these procedures," Wright said. "Not only are most of these procedures very safe from a complication standpoint, but they're also associated with favorable outcomes with relatively high rates of patient satisfaction."

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22 states restrict gender-affirming care for minors

Last week, North Carolina Republican state lawmakers overrode Democratic Gov. Roy Cooper’s veto and passed legislation barring surgical gender-transition procedures to anyone under 18, with some exceptions. The legislation, which takes effect immediately, also prohibits medical professionals from providing hormone therapy puberty-blocking drugs.

Minors who had begun treatment before Aug. 1 may continue receiving that care if their doctors deem it medically necessary and their parents consent.

Louisiana, Texas, Missouri, Florida and Nebraska are among states that passed legislation restricting gender-reassignment operations among minors or limiting other gender-affirming care. In all, 22 states have restrictions on gender-affirming operations or related care for transgender minors.

"These are happening in conservative, Republican-led states. The language being used to promote the policies is around protection," said Lindsey Dawson, associate director of HIV policy and director of LGBTQ+ health policy for KFF, a nonpartisan health foundation. "But really, the policies target gender-diverse young people and aim to restrict providers from delivering what is widely considered best-practice medical care."

Wright said the study provides data on how frequently gender-affirming surgeries are performed and requested − important information for doctors to consider when discussing care with patients.

"More patients are asking for information about these services," Wright said. "As these procedures become more common, we need to have the expertise to care for transgender populations who are interested in surgery."

Contributing: The Associated Press

This article originally appeared on USA TODAY: Gender-affirming surgeries nearly triple as states enact restrictions