“Little to no” gender-affirming surgeries are being performed on minors in the United States, and those that are performed are overwhelmingly on cisgender minors. 

Out of the 151 breast reductions that were performed in 2019 on American minors, 146 (97 percent) were performed on cisgender males, according to a new study published in JAMA. Out of the 636 breast reductions performed on adults, 507 (80 percent) were performed on cisgender males.

The study used data from 47,437,919 adults and 22,827,194 minors who were insured that year, finding that chest-related operations accounted for 1,591 out of 2,664 (59.7 percent) of surgical procedures performed on adults, and 82 of 85 (96.4 percent) of surgical procedures performed on minors. 

The rate of transgender and gender-diverse people undergoing a gender-affirming surgery was 5.3 for every 100,000 adults, and 2.1 for every 100,000 minors ages 15 to 17 years. Among minors ages 13 to 14 years, the rate of gender-affirming surgeries was 0.1 for every 100,000. There were no procedures among minors 12 years or younger.

“These findings suggest that concerns around high rates of gender-affirming surgery use, specifically among [transgender and gender-diverse] minors, may be unwarranted,” the report reads. “Low use by TGD people likely reflects adherence to stringent standards of gender-affirming care.”

Dannie Dai, lead author of the report, said the hope is that the study “will help policymakers understand how gender-affirming surgery is being used by both cisgender and TGD people,” as “health policy should be driven by facts” rather than partisan or religious views on sex and gender.

“Our findings highlight a bitter irony: that by banning gender-affirming care for only TGD people, these bills are targeting a group that in reality accounts for the minority of gender-affirming care use and for whom gender-affirming care has been most clearly shown to be lifesaving,” Dai said.