How many gender affirming surgeries have happened to trans youth?
Executive summary
Across multiple peer‑reviewed studies and investigative reports, gender‑affirming surgeries for minors in the United States are consistently described as rare; exact counts vary by dataset and definition, but concrete examples include 56 genital surgeries among 13–17‑year‑olds from 2019–2021 (Komodo/Reuters) and about 405 youths receiving genital surgeries across a four‑year window in national hospital samples, while a pediatric surgical chart review identified just 108 trans minors who had any form of gender‑affirming surgery from 2018–2021 [1] [2] [3].
1. The most reliable, peer‑reviewed tallies: small absolute numbers
Large academic analyses and national hospital datasets estimate only hundreds — not thousands — of gender‑affirming surgeries in minors over multi‑year periods: a national ambulatory and inpatient sample analysis found youths aged 12–18 made up 7.7% of procedures and recorded about 405 genital surgeries across four years, and a cohort study covering 2016–2019 showed overall GAS tripled but that growth was driven by adults and older young adults rather than minors [2] [4].
2. Investigative counts and NGO databases: higher totals but different methods
Some watchdog groups and media reports publish much larger tallies — for example, claims of more than 5,700 minors undergoing “gender reassignment” from 2019–2023 (Fox) or a database itemizing over 13,000 procedures on minors (The Center Square reporting Do No Harm) — but those figures come from different datasets, aggregation methods and definitions that are not equivalent to peer‑reviewed claims‑based or hospital‑sample studies and are disputed in academic coverage [5] [6].
3. What is being counted matters: chest vs. genital, cis vs. trans
A consistent finding across sources is that most procedures recorded in minors are chest surgeries, and many operations classified in surgical databases are performed on cisgender youth for conditions like gynecomastia rather than for gender transition — one pediatric surgical database review found 108 trans minors who had surgery over four years and noted the vast majority were chest‑related, with only a tiny number under 16 [3] [7].
4. Why studies disagree: data sources, codes and definitional limits
Researchers warn that claims‑based and administrative datasets rely on diagnostic and procedure codes to infer both transgender status and clinical intent, which can misclassify patients; insurance‑covered data exclude self‑paid procedures; and national samples differ in which facilities they capture, so reported totals are sensitive to methodology and not directly interchangeable [8] [4].
5. Policy context and competing narratives
The scarcity of surgeries among minors is cited by researchers and public‑health institutions to counter political claims of widespread pediatric surgical transition; at the same time, advocacy groups and watchdogs use alternative datasets to argue the opposite, and state policy battles — including bans in multiple states — shape access, reporting and public perception, complicating any single “true” count [9] [3] [10].
Bottom line
Multiple peer‑reviewed and investigative sources converge on the conclusion that gender‑affirming surgeries for minors are rare: concrete, methodologically transparent estimates include 56 genital surgeries in 13–17‑year‑olds between 2019–2021 (Komodo/Reuters), roughly 405 youths receiving genital procedures across a four‑year window in national hospital samples, and a pediatric surgical review identifying 108 trans minors with any GAS from 2018–2021 — while higher claims from advocacy or watchdog databases exist, they reflect different methods or definitions and cannot be treated as directly comparable without further methodological harmonization [1] [2] [3] [5] [6]. Reporting limitations — notably coding misclassification and exclusion of self‑paid care — mean no single published source definitively captures every case [8].