How many underage children get sex change operations
Executive summary
Available data show that gender‑affirming surgery for minors in the United States is rare but not zero: insurance‑claims and surgical‑database analyses count anywhere from a few dozen to several hundred procedures in multiyear windows depending on methods and definitions, and advocacy group tallies claim larger totals but use different inclusion rules and have clear policy aims [1] [2] [3] [4].
1. What numbers the peer‑reviewed and academic analyses produce
Large, peer‑reviewed and academic data sets report very low rates of minors receiving gender‑affirming surgery: one study found zero procedures among children aged 12 and younger, 0.1 per 100,000 for those 13–14, and 2.1 per 100,000 for ages 15–17 in a national claims analysis [2], while a pediatric surgical database recorded only four gender‑affirming surgeries in 2018 rising to 59 in 2021 among minors, illustrating both small absolute counts and a steep relative increase from a very low baseline [5].
2. What insurance‑claims and investigative reporting counted
An insurance‑claims analysis cited by Reuters and summarized by FactCheck reported that across 2019–2021, 776 minors with a diagnosis of gender dysphoria had breast‑removal surgeries and 56 had genital surgeries, figures that are often referenced in media debates but come with caveats about coding and definitions [1] [6].
3. Larger watchdog and advocacy tallies — why they differ
Do No Harm, an advocacy group opposed to gender‑affirming care, published a database claiming 5,747 minors had “sex‑change surgery” and roughly 13,994 received some form of gender‑reassignment treatment from 2019–2023; the group says it used conservative counting rules, but the project is produced by an organization with explicit policy goals, which affects interpretation and requires scrutiny of inclusion criteria and data sources [3] [4].
4. Additional snapshots and reconciliations
Other institutional summaries find similarly low absolute counts: a retrospective review of a national pediatric surgical database identified only 108 trans minors who received any form of gender‑affirming surgery across 2018–2021 [7], and JAMA/other analyses conclude that gender‑affirming surgeries and medications among adolescents remain uncommon, suggesting that concerns about mass surgicalization of children are not supported by these datasets [8] [9].
5. Limits of the data and why precise national totals can’t be stated
No single comprehensive national registry exists, and different studies use different age cutoffs, diagnosis codes, insurance claims versus surgical registries, and inclusion/exclusion rules (for example excluding surgeries linked to differences in sex development or cancer), so estimates range from dozens to several hundred in short windows in neutral academic work to multiple thousands in advocacy databases that apply broader definitions—these methodological differences and the lack of full national capture mean it is not possible from the available sources to produce one definitive national count [2] [1] [4].
6. What the evidence supports and the policy context
Taken together, the best peer‑reviewed and institutional evidence supports the conclusion that gender‑affirming surgery in people under 18 is rare—measured in dozens to low hundreds across short multi‑year periods in the datasets published so far—while advocacy groups claim larger numbers and political actors use both kinds of figures to argue for or against restrictions, making transparent methodology and source motives essential when interpreting headline counts [5] [7] [3].