National Estimates of Gender-Affirming Surgery in the US

Abstract

ImportanceWhile changes in federal and state laws mandating coverage of gender-affirming surgery (GAS) may have led to an increase in the number of annual cases, comprehensive data describing trends in both inpatient and outpatient procedures are limited.ObjectiveTo examine trends in inpatient and outpatient GAS procedures in the US and to explore the temporal trends in the types of GAS performed across age groups.Design, Setting, and ParticipantsThis cohort study includes data from 2016 to 2020 in the Nationwide Ambulatory Surgery Sample and the National Inpatient Sample. Patients with diagnosis codes for gender identity disorder, transsexualism, or a personal history of sex reassignment were identified, and the performance of GAS, including breast and chest procedures, genital reconstructive procedures, and other facial and cosmetic surgical procedures, were identified.Main Outcome MeasuresWeighted estimates of the annual number of inpatient and outpatient procedures performed and the distribution of each class of procedure overall and by age were analyzed.ResultsA total of 48 019 patients who underwent GAS were identified, including 25 099 (52.3%) who were aged 19 to 30 years. The most common procedures were breast and chest procedures, which occurred in 27 187 patients (56.6%), followed by genital reconstruction (16 872 [35.1%]) and other facial and cosmetic procedures (6669 [13.9%]). The absolute number of GAS procedures rose from 4552 in 2016 to a peak of 13 011 in 2019 and then declined slightly to 12 818 in 2020. Overall, 25 099 patients (52.3%) were aged 19 to 30 years, 10 476 (21.8%) were aged 31 to 40, and 3678 (7.7%) were aged12 to 18 years. When stratified by the type of procedure performed, breast and chest procedures made up a greater percentage of the surgical interventions in younger patients, while genital surgical procedures were greater in older patients.Conclusions and RelevancePerformance of GAS has increased substantially in the US. Breast and chest surgery was the most common group of procedures performed. The number of genital surgical procedures performed increased with increasing age.

Characteristics of a transgender and gender-diverse patient population in Utah: Use of electronic health records to advance clinical and health equity research

“…Thus, the number of individuals seeking out GAHT is expected to continue to grow. Furthermore, the number of GAS within this healthcare institution has nearly tripled from 2016 to 2019 [ 38 ]. Similar to the Wright et al’s cohort study, when stratified by age, patients 19–30 years-old had the greatest number of procedures; top surgeries were the most common [ 38 ].…”

“…These consensus-based guidelines have relied on findings from smaller cohort studies, but the number of larger scale studies is growing. Additionally, studies comparing health outcomes between those who underwent gender-affirming care (surgical or medical therapy) versus not is also growing [ 38 , 52 , 53 ]. The goal of creating this population cohort is to start answering clinically pertinent questions about patient outcomes as well as identifying health inequities.…”

Neovaginal Human Papilloma Virus–Related Squamous Cell Carcinoma in a Transgender Woman

“…Although rare, with only 5 SCC cases reported, the number of neovaginal SCCs may increase with improved access to GAS. The number of GASs tripled between 2016 and 2020 . Creating a neovagina involves inversion of penile-scrotal skin.…”

Gender Affirmation Surgery–related Hashtag Utilization on Instagram: Implications for Education and Patient Care

“…1 Numerous studies have revealed the significant impact of these procedures on psychosocial outcomes and quality of life in TGNC individuals. [2][3][4] Patient interest in each of the specific procedures varies, and not all patients elect to have all procedures performed. This preference stems from differing goals and sources of dysphoria but may be influenced by exposure to information about each procedure.…”