Gender-affirming surgeries for trans people have tripled in 3 years. Experts explain 'significant' increase.

A trans person pictured topless at the beach with top surgery scars clearly visible.
Gender-affirmation surgeries nearly tripled between 2016 to 2019, which experts say highlights a greater need to support more trans health care overall. (Getty Images)

Gender-affirming surgeries have increased significantly in recent years, according to a new study.

Gender-affirming care is a way for transgender individuals to align their physical selves with their perceived sense of gender. Such care can include surgical procedures designed to give a more masculine or feminine appearance — such as facial reconstruction, hormone therapy, “top surgery,” when breasts are removed or implanted, and “bottom surgery,” which alters genitalia.

What the study says

The study found that gender-affirming surgeries nearly tripled from 2016 to 2019, with the vast majority of patients between 19 and 30 years old. Minors, between 12-18, accounted for 7.7% of all cases.

What are the key findings?

Published in the journal JAMA Network Open, the cohort study analyzed 48,019 people who had gender-affirming surgery between 2016 and 2020. Researchers found the number of procedures nearly tripled, from 4,552 in 2016 to 13,011 in 2019. That number declined slightly in 2020, the year the pandemic began, to 12,818.

Overall, the most common procedures were breast and chest surgeries (top surgery), accounting for 27,187 patients. The second most common was genital reconstruction (bottom surgery), for 16,872 patients. Meanwhile, 6,669 patients reported having had facial and other cosmetic procedures, including hair removal, liposuction and collagen injections.

Minors, of 12-18 years old, accounted for 3,678 (7.7%) of total patients. Overall, 3,215 of them had top surgery, 405 had bottom surgery and 350 of them reported undergoing other cosmetic procedures. Those between 19 and 30 years old accounted for the majority: 25,099 of all patients, with 16,067 opting for top surgery, 7,461 bottom surgery and 2,946 for other cosmetic procedures.

Meanwhile, 31-40 year-olds accounted for 10,476 of the total number of patients, with 4,918 of them having top surgery, 4,423 having bottom surgery and 1,729 having other cosmetic procedures, as noted in the report. The numbers decreased with age, with 2,958 of the total being 51 to 60 and 1,478 over 61.

Researchers also found an increase in health insurance companies' covering gender-affirming procedures, with 60.5% of patients being covered by private insurance — compared to 25.3% covered by Medicaid, 5.4% covered by Medicare and 5.9% who paid out of pocket.

Race also played a significant role. Researchers discovered the vast majority (65.1%) of total patients were white, compared to the 9.9% of patients who were Hispanic, 9% who were Black and 13% who identified as "other."

What experts think

The study’s lead researcher, Dr. Jason D. Wright, says the findings prove there's been "greater recognition of the safety and benefits of gender-affirming surgery," especially among health insurance companies.

“There were a number of age-specific trends that were illuminating," he tells Yahoo Life. "Notably, while breast and chest procedures were the most common procedures overall, breast and chest surgeries were most common in younger patients, while use of genital reconstructive procedures increased with age.”

Wright says genital reconstructive surgeries were more frequent in older patients because "genital reconstructive procedures are more complex and invasive than breast and chest procedures," since they are more often irreversible, with the removal of reproductive organs. "Therefore, there may be both patient and physician preference to delay these surgeries."

Dr. Fan Liang, medical director of the Johns Hopkins Center for Transgender Health, agrees, noting that the trend may be largely credited to the “logistical challenges” posed by top and bottom surgeries.

“For top surgery, the after care is relatively minimal,” she explains to Yahoo Life. “The surgery itself is an outpatient surgery and the complication risks are low." Bottom surgery, she says, requires a considerable amount of after care, which may be hard for younger patients to navigate.

As Liang explains, younger patients will typically tackle the “easier to recover” surgeries first. People who are older and have “more resources from a social or financial standpoint,” such as "work leave and medical experience," are better equipped to embark on more complex procedures.

Why it matters

The study's authors say that the findings suggest that medical professionals need to be more knowledgeable about gender-affirming surgery.

Dr. Michelle Forcier, a professor of pediatrics at the Alpert School of Medicine, Brown University, also points out that gender-affirmation surgeries should be viewed as a vital form of health care for trans people.

“Gender-diverse patients want, need and benefit from these gender-affirmation surgeries,” she tells Yahoo Life. “Restricting access because of a false political narrative is unethical, especially when we do have medical evidence as to their necessity, safety and benefits.”

Adds Wright, “There are now a number of state and local legislative efforts to limit gender-affirming surgery, particularly in adolescents. Continuing to monitor trends in use of gender-affirmation surgeries will be critical to determine how these opposing forces are impacting procedure use.”