The Advocate

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Meta Fails to Moderate Content from Anti-Trans Hate Group on Instagram, Watchdog Group Says

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A report released by Media Matters for America, the media watchdog group, on Tuesday, criticizes Instagram, for its alleged failure to effectively moderate content posted by the controversial anti-trans organization Gays Against Groomers. 

The report, which The Advocate is reporting exclusively, highlights a series of instances where Gays Against Groomers is accused of spreading harmful rhetoric about LGBTQ+ people on the platform, clearly violating Instagram’s community guidelines against hate speech, harassment, and misinformation.

One of the primary concerns raised by the report is the apparent inconsistency in Instagram’s enforcement of these content policies. While other prominent platforms, including PayPal and Google, have taken decisive action to ban Gays Against Groomers for alleged violations of their content guidelines, Instagram, which is owned by Meta, has allowed the group’s content to remain accessible for over a year, according to Media Matters.

This discrepancy has led to widespread questioning of Instagram’s commitment to effectively moderating harmful content, particularly content that targets marginalized communities. Gays Against Groomers has been labeled an extremist hate group by the Anti-Defamation League.

The report points out that Gays Against Groomers has faced multiple suspensions from the platform formerly known as Twitter, X, including at least one suspension for using the derogatory anti-LGBTQ+ “groomer” slur. The contrast between platforms raises questions about Instagram’s relative leniency in dealing with content violations, especially compared to sites that have taken more aggressive measures.

Gays Against Groomers Violates Instagram Terms

Gays Against Groomers has leveraged Instagram as one of its primary platforms, amassing over 357,000 followers since its creation in June 2022. The group has also joined Threads, Meta’s Twitter-like platform, where it has continued to post content criticized as hateful and false about LGBTQ+ people, according to the report.

The Instagram community guidelines emphasize the platform’s commitment to fostering a diverse and positive community. Expressly, these guidelines prohibit content that contains credible threats or hate speech, especially attacks on sex, gender, gender identity, or sexual orientation. 

Instagram’s rules also direct users to Facebook’s hate speech policy, which prohibits content targeting people or groups based on their sexual orientation, gender, or sex.

The Media Matters report documents Gays Against Groomers’ alleged repeated use of derogatory terms like “groomers” and their dissemination of false narratives about the LGBTQ+ community. The accusations range from claims that LGBTQ+ people are actively “grooming” children to promoting harmful stereotypes. Some of the group’s posts also target companies and individuals publicly supporting LGBTQ+ rights.

Gays Against Groomers has repeatedly employed derogatory rhetoric, referring to the LGBTQ+ community as “groomers” and alleging that they are actively involved in nefarious activity with kids. These claims have raised concerns and sparked widespread outrage within the LGBTQ+ community and their allies.

Meta, however, seemingly has done little to curb this.

“It’s an age-old problem that we’ve seen with Meta,” Media Matters research director Kayla Gogarty told The Advocate. “One of my biggest concerns is that they’re seeing Elon Musk’s kind of backsliding on enforcement and things like that [and] they’re seeing that almost as a permission structure for them to also backslide.”

After Musk acquired Twitter in October last year, he promptly fired much of the platform’s trust and safety team, responsible for content moderation. Since then, Musk has removed safeguards that protect transgender people and even wrote that he considered the word “cisgender” as a slur on his social media site.

Gays Against Groomers Employs “Groomer” Libel

Meanwhile, on April 28, Gays Against Groomers posted on Instagram, asserting that LGBTQ+ people “are actively grooming kids into the Rainbow Cult,” seemingly citing a report that indicated “1 in 4 high school students identifies as LGBTQ.” 

The group implied that this statistic resulted from LGBTQ+ individuals “grooming” children.

Further, the organization shared a TikTok video depicting children celebrating LGBTQ+ Pride, labeling it an “indoctrination ceremony.” 

The caption on the post claimed that “Indoctrinated kids are groomed kids.”

The group’s rhetoric didn’t stop there. They also criticized a clip from Sesame Street celebrating Pride, accusing it of “grooming children for sexual orientation and sexual preference.” The caption characterized the video as “teaching toddlers about sex” and “grooming, point blank.”

Gays Against Groomers attacked Target for promoting LGBTQ+ clothing and products aimed at children, even calling for a boycott of the retail giant. The group replaced the Target sign with the word “groomers” in an image, claiming they would “no longer allow these companies to pervert our youth and groom them into the Gender Cult.”

These allegations have been met with strong opposition from LGBTQ+ advocates and organizations. Many have criticized Gays Against Groomers for spreading baseless claims and harmful stereotypes about LGBTQ+ people and their supportive initiatives. Medical organizations have also debunked their assertion that gender dysphoria is a “social contagion.”

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Who are Gays Against Groomers?

Despite Gays Against Groomers’ self-presentation as a grassroots coalition dedicated to protecting children, Media Matters revealed that this group is composed of right-wing individuals with established ties to such organizations, linking the group’s founder, Jaimee Michell, and its former chair and co-founder, David Leatherwood, to right-wing firms and figures.

After Florida Gov. Ron DeSantis pushed a widely criticized homophobic video attacking former President Donald Trump, a conflict within GAG resulted in Leatherwood leaving the organization over Michell’s continued support for DeSantis.

Nonetheless, in a recent Instagram post on June 10, the group claimed to be a volunteer-driven, grassroots effort, stating, “No one has pocketed a dime, and we have had zero big donors.”

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Delaware Becomes 17th State to Outlaw ‘Gay and Trans Panic’ Defense

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Delaware has become the 17th state to ban the “gay and trans panic” defense. 

Gov. John Carney signed a bill to this effect into law September 24. It states in part, “In any prosecution or sentencing for an offense, a defendant is not justified in using force against another based on the discovery of, knowledge or belief about, or the potential or actual disclosure of the victim’s actual or perceived sexual orientation, sex, gender, gender identity, or sex assigned at birth.”

State Rep. Eric Morrison, a gay man, was chief sponsor of the bill in the House of Representatives, and Sen. Sarah McBride, a transgender woman, was primary sponsor in the Senate. Delaware’s other LGBTQ+ legislators, Reps. Marie Pinkney, DeShanna Neal, and Kerri Evelyn Harris, were involved in the effort as well, as was Equality Delaware.

Much of the work to pass the bill centered on educating legislators, Morrison tells The Advocate.“Many of them were absolutely shocked that this existed,” he says. “Once you educated them about that, they said this is outrageous.”

The panic defense seeks to justify a defendant’s action on the basis that the defendant lashed out due to being deeply upset about nonforcible sexual advances from or sexual contact with an LGBTQ+ person. It hasn’t been used a lot in Delaware, but Morrison says he knows of at least five instances. It’s hard to track because it’s usually used as a secondary defense in conjunction with a plea of self-defense or insanity, he says.

“Gay and trans panic defenses are rooted in antiquated ideas that being LGBTQ is a mental illness, and rely on the assumption that it is reasonable for a perpetrator to react violently to discovering the victim’s sexual orientation or gender identity or to a romantic advance by an LGBTQ victim,” notes a 2021 report from the Williams Institute, a think tank on LGBTQ+ issues at the University of California, Los Angeles, School of Law. “Since the 1960s, the gay and trans panic defenses have appeared in publicly reported court opinions in approximately one-half of the states.”

The Delaware bill had widespread support in both chambers of the legislature, Morrison says, but a question arose in the House about why it didn’t address panic defenses involving other aspects of a victim’s identity, such as race or religion. But the panic defense is specifically an LGBTQ+ issue, he says, and he and others sought to keep the spotlight on LGBTQ+ people.

Another state that banned the defense recently was New Hampshire, where Gov. Chris Sununu signed that bill into law in August. In addition to the 17 states, the District of Columbia has banned it.

Ten years ago, the American Bar Association passed a resolution saying all states and the federal government should outlaw the defense. Legislation has been introduced at the federal level but has not advanced.

Delaware has been a leader in pro-LGBTQ+ legislation, having been an early adopter of marriage equality and civil rights protections for trans people. But this is the first pro-LGBTQ+ law it enacted since 2018, when it barred licensed professionals from subjecting minors to conversion therapy.

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While LGBTQ+ Community Embraces Open Marriages, Straight Society Is Scandalized: Poll

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New Pew Research Center polling revealed a range of opinions about open marriages among Americans across various demographic groups, with the LGBTQ+ community accepting this relationship arrangement at significantly higher levels than other groups.

According to the study, published Thursday, exactly half of respondents were either somewhat or entirely against open marriages, where both partners agree to pursue relationships or intimacy outside of the marriage. Thirty-seven percent of respondents considered these unions totally unacceptable, while 13 percent deemed them somewhat acceptable.

Researchers also found that adults hold contrasting opinions about open marriages. Half of the respondents expressed disapproval, while 33 percent said they accepted such unions. Divergent perspectives on this issue were evident based on gender, race, ethnicity, age, marital status, sexual orientation, and political affiliation.

The survey revealed a stark contrast between acceptance rates based on sexual orientation. Bisexual, lesbian, and gay adults expressed significantly greater acceptance, at 75 percent, than heterosexual adults, at 29 percent. Even when accounting for age differences, this discrepancy persists.

A substantial portion of opinions were shaped by political affiliation. Sixty-four percent of Republicans deemed open marriages unacceptable, while only 20 percent approved. Democraticviews were more varied, with 47 percent supporting and 36 percent opposing such unions.

Conservative Republicans were the most likely to disapprove, with a 74 percent majority, while liberal Democrats were the most accepting, with 63 percent.

Compared with women, men tended to be more accepting of open marriages, with 36 percent finding them somewhat acceptable versus 30 percent for women.

The background of someone’s race and ethnicity also shaped their viewpoints. Asian adults endorsed open marriage the most, with 44 percent approving. About a third of white (33 percent), Hispanic (32 percent), and Black (31 percent) adults expressed similar support.

In general, younger adults favored open marriages more than older adults. Most respondents under 30 (51 percent) found them acceptable, but their acceptance waned with age.

Only 41 percent of those 30 to 49 approved, 26 percent of those 50 to 64, and only 15 percent of those 65 and older did. Open marriages were unacceptable to 70 percent of respondents in the most senior age bracket.

The marital status of adults also influenced opinion, with 57 percent of married adults and 61 percent of divorced, separated, or widowed adults opposing open marriage — conversely, respondents living with a partner viewed such unions most favorably, with 56 percent in favor.

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Transgender Woman Wins $125,000 After Settling Discrimination Suit with American Samoa

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A U.S. Justice Department lawsuit against the American Samoa Government (ASG) over allegations that the ASG unfairly treated a former employee because she was transgender has been settled.

According to Title VII of the Civil Rights Act, it is illegal to discriminate based on sex or gender identity at one’s workplace.

In a consent decree approved by the court, ASG agreed to pay Simeonica Tuiteleleapaga $125,000 as compensation for the harassment she suffered at the hands of her supervisor during her employment at ASG, a DOJ press release said.

In addition, the consent decree mandates that ASG implement comprehensive policies and procedures to address complaints of sex-based discrimination and provide training to its employees, ensuring that they are well-equipped to handle such matters with sensitivity and adherence to the law.

According to the lawsuit, Tuiteleleapaga’s supervisor, Meki Solomona, the ASG’s Department of Human and Social Services director, consistently harassed Tuiteleleapaga and another transgender colleague despite numerous employee complaints.

Solomona once asked Tuiteleleapaga, in front of other employees, whether she was a “girl or a boy” and told her to “take it off” and “let us see if you are a woman.” 

Solomon berated her for nearly an hour after she departed the meeting.

The ASG failed to do anything to intervene.

Tuiteleleapaga’s discrimination claim was referred to the Justice Department for enforcement after the EEOC’s Hawaii District Office investigated and tried to resolve it.

Assistant Attorney General Kristen Clarke of the Justice Department’s Civil Rights Division said, “Discrimination against transgender employees is discrimination based on their sex, and no employee should have to tolerate a supervisor’s hostile comments about their gender identity.”

She continued, “Transgender employees must be free from discrimination, harassment or derision in the workplace.”

The case serves as a stark reminder of the importance of proactive measures to prevent and address discrimination in the workplace.

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The Nation’s Oldest LGBTQ+ Bookstore Is Ready for 50 More Years

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Katherine Milon was strolling Philadelphia’s picturesque Pine Street when she saw the awning for Giovanni’s Room. Wait, that’s a gay book, Milon thought. This is a gay bookstore!

Soon after, Milon began volunteering at the venerable queer and feminist bookseller — named for James Baldwin’s classic 1956 novel — becoming co-manager a few years later. In the past five years, Milon has witnessed COVID decimate business, the store’s pivot to e-commerce during the pandemic, the return of foot traffic in 2021, and, just this summer, the 50th anniversary of Giovanni’s Room, which is the oldest continuously operating LGBTQ+ bookstore in the nation. A joyous block party in front of the location heralded Giovanni’s half-century, with live readings, performances, and parties marking the occasion.

For the store, a love of literature and the embrace of the local queer community has staved off a fate that’s befallen similar spaces across the country — only about 50 LGBTQ+ bookstores remain. But the people behind Giovanni’s Room, from the earliest owners to current management, also made decisions that ensured the store’s survival. The store actually closed its doors in 2014 when it could no longer turn a profit. That’s when Philly AIDS Thrift, a local 501c3 that offers donations, proceeds, and microloans to communities affected by HIV, offered to partner up.

“What they proposed at the time was to create an integrated business model where we still order and sell new books, but we also have thrifted goods available in the store and that helps cut back on overhead,” Milon says. “We have a room with all the new books but we have people coming in to buy 29 cent cassette tapes or looking at our thrifted clothing, so there’s a real community feel.”

That type of creative thinking has carried through from Giovanni’s earliest days when it was opened in 1973 by three members of the Gay Activists Alliance, Bernie Boyle, Dan Scherbo, and Tom Wilson Weinberg, who were enamored with the Oscar Wilde bookstore in New York City (which closed in 2009). But running a queer business in the early ’70s was extremely challenging.

“This was during the time when if you’re opening a gay bar or club it was clandestine,” Milon says. “You had to go down alleyways or know someone who could get you in. So this was a gay business where the windows were open and they had the stock in the windows. They let you know who they were and what they were doing.”

The owners had to do battle with censorship and a society that labeled anything about gay life “pornographic.” (How little has changed.) 

“We actually got in trouble with the first couple rounds of landlords because they would see the kinds of books sold and suddenly the rent would go up 3,000 percent,” Milon says.

Boyle, Scherbo, and Weinberg would soon sell the business to Pat Hill, a local lesbian activist. Hill encountered her own troubles keeping the business afloat, going on welfare at one point.

There were more ownership changes through the years, but Milon describes the 1990s as Giovanni’s glory days, when gay authors like Leslie Feinberg and Michael Cunningham were churning out hits, and the internet hadn’t yet widely affected consumer culture. Following the hybrid thrift store/bookstore model, things looked up, partly thanks to a team of volunteers who helped staff the store for next to nothing. Then, came COVID. After the lockdowns lifted, “if we had five customers in the store [total], it was a good day.”

Thankfully, foot traffic returned in 2021, improved even more last year, and “2023 has been off the charts,” Milon says. It helps that Giovanni’s Room is more than a bookstore; it remains a locus of queer life in Philadelphia, with in-person readings, an in-person book club, and various other events that keep people coming back and spending money. Queer author bell hooks remains a perennial favorite, and, of course, Baldwin. Contemporary writers like Brandon Taylor, Torrey Peters, Julia Serrano, and Alice Oseman’s Heartstopper books are also big sellers. Milon uses Feinberg’s Stone Butch Blues book as an example of the community’s embrace of her store; while the 1993 novel is available for free on Feinberg’s website, people still line up to buy the printed version from Giovanni’s Room.

“This is definitely a store the community has kept alive through sheer love and dedication,” Milon says. “When they moved into the latest building, volunteers built our main staircase, cut the shop windows, cut the door. We are literally the product of the community coming together year after year, decade after decade, to keep us alive.”

Support Giovanni’s Room at queerbooks.com.

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Gender-Affirming Care Access Improves Mental Health: Study

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The first randomized controlled study of its kind from Australia indicates that people with gender dysphoria who are able to access gender-affirming care and treatment are significantly more mentally well-adjusted and less suicidal when their access to care is delayed.

The research was published in the American Medical Association’s open-access journal. 

As part of the recently published study, 64 transgender and gender-diverse participants were randomly assigned either to receive testosterone treatment immediately or to be placed in a group that had to wait three months before receiving testosterone treatment. Those in the study were looking for masculinization. 

Before the beginning of the study, both groups were evaluated for depression, gender dysphoria, and suicidality, employing a comprehensive assessment. The two groups underwent a reassessment after three months in the study.

There was no placebo drug or no treatment at all given to the control group; instead, they had to wait for more extended periods before they received treatment than those in the treatment group.

As opposed to a treatment group that began hormone therapy within a week of enrolling in the program, this group waited three months before starting hormone therapy.

Researchers found that hormone therapy significantly reduced suicidal thoughts, depression, and gender dysphoria among those treated with testosterone.

Testosterone therapy initiated immediately reduced gender dysphoria significantly more than testosterone therapy initiated later. Additionally, testosterone therapy resulted in clinically significant reductions in depression and suicidal thoughts.

There was a 55 percent reduction in transgender individuals’ suicidality among transgender individuals after receiving immediate access to gender-affirming care, while the control group saw a 5 percent reduction.

Compared to the control group, depression scores in the treatment group decreased by half, while rates of gender dysphoria also significantly reduced during the treatment.

According to the study’s researchers, “The findings of this trial suggest that testosterone therapy significantly decreases gender dysphoria, depression, and suicidality in transgender and gender-diverse individuals desiring testosterone therapy.”

If you are having thoughts of suicide or are concerned that someone you know may be, resources are available to help. The 988 Suicide & Crisis Lifeline at 988 is for people of all ages and identities. Trans Lifeline, designed for transgender or gender-nonconforming people, can be reached at (877) 565-8860. The lifeline also provides resources to help with other crises, such as domestic violence situations. The Trevor Project Lifeline, for LGBTQ+ youth (ages 24 and younger), can be reached at (866) 488-7386. Users can also access chat services at TheTrevorProject.org/Help or text START to 678678.

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Campus Pride Dumps Florida and Texas Universities from Best of Best List

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Campus Pride won’t include Florida or Texas schools in its list of best colleges and universities for LGBTQ+ students to attend. Instead, the organization issued a “red alert” warning the schools will inevitably fall in rankings and that state leaders have put institutions’ academic reputations at risk. 

“Campus Pride stands by every campus being negatively impacted by anti-LGBTQ+ laws in the states of Florida and Texas,” said Campus Pride founder, CEO, and executive director Shane Mendez Windmeyer. “Higher education must instill values of diversity and inclusion in order to create a quality, productive workforce. The classroom must be safe, and create a welcoming academic learning environment.”

The national organization, in existence since 2001, each year releases its Best of the Best LGBTQ-Friendly Colleges and Universities list. 

But Mendez Windmeyer said new laws instituted in both states compromise that environment.

Florida Gov. Ron DeSantis in May signed a law barring the state’s public colleges and universities from spending any funds on diversity, equity and inclusion initiatives programs or classes. Campus Pride specifically cited that law in a release announcing both the University of Central Florida and the University of North Florida, despite appearing in the rankings in the past, would be dumped this year. That’s despite UNF topping the list of universities in the Southeast United States in 2022, and UCF receiving the highest listing for any Florida school in 2021.

Meanwhile, Texas Gov. Greg Abbott also signed a similar law, which has forced the closure of LGBTQ_ resource centers for students on Texas campuses. This means Texas Tech University and the University of Texas at Dallas, which both have earned Campus Pride recognition on its Best of the Best lists in years past, won’t receive the accolades this year. The two campuses were the only ones in the Southwest United States to make the list last year.

Moreover, Campus Pride cautions students considering higher education in either state as anti-queer crusades continue in Austin and Tallahassee.

“These laws are being weaponized against LGBTQ+ people, needlessly endangering the safety and well-being of students on campuses across the states of Florida and Texas,” Mendez Windmeyer said. “Already we are hearing from prospective students and families that they are choosing colleges elsewhere.”

“It is truly sad, when political leaders use people as pawns,” said Manny Velásquez-Paredes, director of the LGBTQ Center at the University of North Florida, in a press release about the exclusion. “It is clear to every rational human being that diversity, equity, and inclusion are meant to create awareness and embrace, celebrate, and include our differences. However, we have found ourselves in the middle of a political culture war that is meant to divide us. Their attacks on the LGBTQ+ community have been deeply felt this past legislative session, with over 500 anti-LGBTQ+ bills introduced in the U.S.”Institutes in the states will still be included in the

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California Mom Blames Bullying for Gay Son’s Death

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The mother of a teenage boy who died by suicide in California is grieving publicly after his death. She says he was bullied relentlessly by kids who teased him because he was gay.

In the aftermath of her son Salvador’s death, Eunice Rios posted a video on TikTok explaining her grief, San Diego NBC station KNSD reported.

She said that she had hoped to shield her son from the bigotry of the world. Unfortunately, she thinks that the spitefulness of young bullies led to her son taking his life in August.

“I support the gay community, always. Always. Love is love. But as a mom, it was not easy to accept that my son was going to be exposed, go through all these ordeals because the world is so mean,” Rios explained. “My son, he experienced embarrassment, humiliation, pain.”

She told the television station that her son suffered relentless bullying at the hands of cruel classmates at two schools who targeted the teen.

The things that those who tormented her son said to him were too difficult to read, she said.

“I don’t want to know because I don’t want to read the messages, and I will never read the messages because this is the reason I think he took his life,” she stated.

Rios said she contacted the San Diego Unified School District to file a complaint with the agency.

The district did not respond KNSD’s request for comment.

After burying her son, Rios intends to keep his memory alive by continuing to engage in activism. She is determined to make sure that the LGBTQ+ community is treated with respect and dignity in the wake of his tragic death.

If you are having thoughts of suicide or are concerned that someone you know may be, resources are available to help. The 988 Suicide & Crisis Lifeline at 988 is for people of all ages and identities. Trans Lifeline, designed for transgender or gender-nonconforming people, can be reached at (877) 565-8860. The lifeline also provides resources to help with other crises, such as domestic violence situations. The Trevor Project Lifeline, for LGBTQ+ youth (ages 24 and younger), can be reached at (866) 488-7386. Users can also access chat services at TheTrevorProject.org/Help or text START to 678678.

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Maryland Parents Charged With Murder Over Death of Transgender Teenager

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A Maryland transgender boy with disabilities died last year in what police are calling a case of criminal neglect by his parents, who have been charged with second-degree murder.

Morgan Moore died May 10, 2022, at age 17 at his home in Montgomery Village. His passing is just now being recognized as one of the violent deaths of transgender people in 2022, as some media reports at the time of his death misgendered him.

Police and paramedics were called to his home, where they found him unresponsive. He weighed only 79 pounds, and his father and mother, Dominique and Cynthia Moore, said he hadn’t seen a doctor in two years, according to local media and the Disability Day of Mourning website. He had diabetes and multiple sclerosis and was suffering from long-term effects of COVID-19. He had lost the ability to walk and had an abscess on his back.

There were 10 adults and children living in the home. Authorities removed six minor children from the Moores and placed them in foster care. Court documents showed the home was filthy, with animal feces throughout, nonfunctioning toilets, little lighting, and not enough beds for family members, Washington, D.C.’s Fox affiliate reports. The children were homeschooled and isolated, communicating with people outside the family only through video games.

Morgan was out as transgender, but not all family members recognized or respected his identity. He was “a celebrated artist, self taught guitarist, cook, keyboard player, gamer and all around great person,” according to an online tribute page. He had expressed a wish to travel to Japan.

“I just want my brother to be remembered as the artist and the person he was,” one sibling told the Fox station. “He was as good person, and I want people who are transphobic and not accepting of their children to accept their kids for who they are and love them no matter what.”

The local medical examiner did not officially classify Morgan’s death as a homicide until April. Then in May, his parents were both charged with second-degree murder and six counts of neglect of a minor.

“What happened to Morgan was inhumane,” said a statement from Tori Cooper, director of community engagement for the Human Rights Campaign’s Transgender Justice Initiative. “Morgan deserved the same respect and love from his parents as he received from his siblings, who were such a loving support in his life. Morgan’s beautiful memory is a reminder to all of us that we need to do better. Folks living with disabilities, Black and Brown people, and transgender people require the same love and respect that is given so freely to the many who take it for granted. We’ll remember Morgan as the bright artist and good person that he was.”

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Gender-Affirming Surgeries Have Risen, Likely Due to Better Insurance: Study

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The number of gender-affirming surgeries in the U.S. nearly tripled from 2016 to 2019, likely due to more insurers covering the procedures, with top surgery more common than genital surgery, according to a new study.

The study was published online Wednesday in the American Medical Association’s JAMA Network Open. It was conducted by faculty at the medical schools of Columbia University in New York City and the University of Southern California in Los Angeles, using data from the Nationwide Ambulatory Surgery Sample and the National Inpatient Sample.

The study identified 48,019 patients who underwent gender-affirming surgery from 2016 through 2020. The authors found that the number of these surgeries rose from 4,552 in 2016 to a peak of 13,011 in 2019, then declined slightly to 12,818 in 2020. The decline in 2020 is likely due to restrictions on in-person health care during the COVID-19 pandemic, the researchers observed.

In the period covered by the study, 27,187 patients (56.6 percent) had breast or chest surgery, 16,872 (35.1 percent) underwent genital surgery, and 6,669 (13.9 percent) had facial and other cosmetic procedures. Some patients had more than one type of surgery. “Breast and chest procedures made up the greatest percentage of the surgical interventions in younger patients while genital surgical procedures were greater in older patients,” the study noted.

The study backs up what has been pointed out as states pass or debate bans on gender-affirming surgery for minors — genital surgery is not usually suggested for young people and is rate among them. Among patients aged 12 to 18, 87.4 percent had breast or chest surgery, while only 11 percent had genital surgery, the researchers found. Most bans that have been enacted or proposed deal with people under age 18, with 18 considered the age of majority.

Gender-affirming surgeries “were most common in patients aged 19 to 30 years,” the authors reported. “This is in line with prior work that demonstrated that most patients first experience gender dysphoria at a young age, with approximately three-quarters of patients reporting gender dysphoria by age 7 years. These patients subsequently lived for a mean of 23 years for transgendermen and 27 years for transgender women before beginning gender transition treatments.”

While the right wing sometimes claims there is “social contagion” leading more people to seek out these treatments, the study’s authors proposed a different explanation. “The increase in [gender-affirming surgery] is likely due in part to federal and state laws requiring coverage of transition-related care, although actual insurance coverage of specific procedures is variable,” they wrote. The majority of patients in the study — 60.5 percent — had private insurance coverage, while 25.3 percent were Medicaid recipients.

The study noted the benefits of gender-affirming care at a time when it’s under attack, with states banning it for minors and some banning it for certain adults, such as those whose health care is covered by Medicaid.

“Despite many medical societies recognizing the necessity of gender-affirming care, several states have enacted legislation or policies that restrict gender-affirming care and services, particularly in adolescence,” the authors wrote. “These regulations are barriers for patients who seek gender-affirming care and provide legal and ethical challenges for clinicians. As the use of [gender-affirming surgery] increases, delivering equitable gender-affirming care in this complex landscape will remain a public health challenge.”

The study has some limitations, the researchers added. One of them is that “while we comprehensively captured inpatient and ambulatory surgical procedures in large, nationwide data sets, undoubtedly, a small number of procedures were performed in other settings; thus, our estimates may underrepresent the actual number of procedures performed each year in the US,” they wrote.

Still, the information is valuable, Dr. Jason D. Wright, the lead researcher and the chief of gynecologic oncology at Columbia University Vagelos College of Physicians and Surgeons, told The New York Times.

“There’s been a sense that more patients are asking about it, and ultimately pursuing it, but there wasn’t good data,” he said. “Ours is one of the first studies to quantify the age groups and the procedures they’re undergoing.”

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