Transgender
Gender-Affirming
Chest Surgeries Increase by Nearly 5x in Teens -
10/17/22 Numbers of gender-affirming chest surgeries among transgender adolescents jumped 389% from 2016 to 2019, researchers reported. Drawing on data from the Nationwide Ambulatory Surgery Sample, an estimated 1,130 chest reconstructive surgeries were performed on transgender and gender-diverse (TGD) adolescents during these years, Rishub Karan Das, BA, of Vanderbilt University School of Medicine in Nashville, and colleagues found. Nearly all were masculinizing (chest reconstruction (e.g., mastectomy), with only 1.4% feminizing (chest reconstruction (e.g., augmentation mammaplasty) the group wrote in a research letter appearing in JAMA Pediatrics. Only about 100 of these surgeries were performed in 2016, after which they steadily became more popular, surpassing 200 surgeries in 2017 and 300 by 2018. Das and colleagues put the 2019 total at 489 (P<0.001 vs 2016). Ages of the adolescents ranged from 12 to 17, with a median of 16. For context, the researchers noted that approximately 300,000 adolescents between the ages of 13 and 17 identify as transgender in the U.S. today. "Reconstructive genital surgery is typically not performed in adolescents, but masculinizing chest reconstruction (e.g., mastectomy) and feminizing chest reconstruction (e.g., augmentation mammaplasty) may be performed in outpatient and ambulatory surgery settings," the researchers explained A slew of recent data has suggested that gender-affirming care -- even in early adolescence -- is linked to improved mental health for TGD individuals. But this care has been put in jeopardy with many states recently introducing bills to block this gender-affirming care for youth. Only 19.9% of adolescents who underwent gender-affirming chest surgeries in this sample also used gender-affirming hormone therapy. As for psychiatric comorbidities, 21.1% had anxiety and 16.2% had depression -- the two most commonly reported. Most surgeries (61.1%) were covered by private insurance. A total of 16.5% of individuals used public health insurance to cover the cost of surgery and 15.8% were self-pay. These percentages didn't change much during the study period. "Most TGD adolescents had either public or private health insurance coverage for these procedures, contrasting with the predominance of self-payers reported in earlier studies on TGD adults," Das and colleagues pointed out. The median inflation-adjusted total cost of gender-affirming chest surgeries largely held study during this time period, at about $30,000 (interquartile range $21,285-$45,147). That being said, over half of those opting for gender-affirming chest surgeries had a family income over $82,000 annually. Not surprisingly, there were wide racial disparities among surgery patients: in 2019, 77.9% were white, 12.2% were Hispanic, 2.7% were Black, 2.5% were Asian or Pacific Islander, and 0.5% were Native American. Around 4% were categorized as "other race." Most adolescents included in the
analysis lived in a densely population area -- 68% living in
a county with over 1 million residents. Trending down from
there, 21.9% lived in a moderately densely populated area
and only 9.8% lived in a county with less than a quarter
million residents.
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