A new study of nationwide hospital databases found that at least 1,130 adolescents between 2016 and 2019 received “gender-affirming” chest surgeries in the U.S.
The study, published in JAMA Pediatrics, saw a 389% increase in adolescents (ages 12-17) obtaining chest surgeries from 2016 to 2019. An overwhelming majority (1,114) of the adolescents seeking this surgery were female (98.6%), and just 16 were male (1.4%).
“To our knowledge, this study is the largest investigation to date of gender-affirming chest reconstruction in a pediatric population,” the paper’s authors wrote, who are each affiliated with Vanderbilt University Medical Center. “The results demonstrate substantial increases in gender-affirming chest reconstruction for adolescents.”
But Leor Sapir, a fellow at the Manhattan Institute, believes the study significantly underestimates the number of adolescents who have received gender-related chest surgeries, as it only contains hospital-based data and not private surgery centers. The data was collected from the Nationwide Ambulatory Surgery Sample (NASS), an out-patient hospital surgery database in the United States.
“JAMA included only procedures performed in hospitals, not by plastic surgeons in private settings,” said Sapir. “Because these procedures yield around $10,000 per patient, many mastectomies take place outside of hospitals in surgery centers owned by plastic surgeons themselves.”
The ages of the pediatric patients ranged from 12 to 17, with 42 (5.5%) of the recipients between 12 and 14, 131 (16%) aged 15, 291 (34.5%) aged 16, and 365 (44%) aged 17.
Race and ethnicity were collected from hospital records only in 2019, the authors note. The vast majority of patients were white (77.9%), followed by Hispanics (12.2%), blacks (2.7%), Asian or Pacific Islanders (2.5%), and Native Americans (0.5%). About 4% were categorized as “other race.”
The median total charges for chest reconstruction were $29,886 ($21,285–$45,147), a number that was adjusted for inflation, the authors note. Most of the chest surgeries (61.1%) were covered by private health insurance, 16.5% used public health insurance including Medicaid, 15.8% paid out of pocket, and 6.7% indicated “other.”
Most adolescents included in the analysis lived in a densely populated area, with 68% living in a county with over one million residents, 21.9% lived in a moderately densely populated area, and only 9.8% lived in a county with less than a quarter million residents. Over half of those who obtained chest surgeries had a family annual income of over $82,000.
Psychiatric comorbidities for patients were listed, which included anxiety (21.1%) and depression (16.2%), but this is likely a significant underestimate since these numbers were much lower than the high rates of depression typically seen among trans-identified teens. It is therefore likely that mental health data in the hospital database were not comprehensive.
In July, the same four authors, with the addition of two others, published a separate study on adults who received “gender-affirming” chest reconstruction surgeries. Their results, also using NASS outpatient hospital data, found that 21,293 individuals obtained chest surgeries between 2016 and 2019, a 143.2% increase. The large majority of chest surgeries were performed on female patients, with 82.1% receiving double mastectomies; 27.9% of trans-identifying males received breast augmentations.