Gender-affirming surgeries in the US nearly tripled before pandemic dip - new study

[IwantToRetire]

I am not sure that these figures are new, and the article doesn't present them very well.

About 48,000 patients underwent such surgeries during the five years studied, with about 13,000 procedures done in 2019, the peak year, and 12,800 in 2020.

A little more than half the patients were ages 19 to 30. Surgeries in patients 18 and younger, were rare: fewer than 1,200 in the highest volume year.

Among the youngest patients, the most common surgeries were breast and chest procedures, with more than 3,000 young people undergoing such operations during the five-year period.

These were likely transgender males — generally high school graduates — having their breasts removed, said Dr. Loren Schechter of Rush University Medical Center in Chicago, who specializes in gender-affirming surgery and was not involved in the study. Having breast surgery at that age allows them to “go to the next phase of their life in a body with which they’re comfortable and is synchronous with their identity," he said.

The gender identities of the patients were unclear in the data and couldn't be inferred in categories like breast reconstruction, which could be for either transgender males or females.

Private insurance covered most patients who had such surgeries, the researchers found. About 1 in 4 patients received coverage through Medicaid, the federal-state health care insurance program that helps pay for health care for low-income people.

https://www.independent.co.uk/news/jason-wright-ap-medicaid-obama-columbia-university-b2398073.html

Have now found original article. Seems quite long but maybe more informative https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2808707

I feel I've seen a twitter thread where there's criticism of the way the ages are banded.

Here

x.com/benryanwriter/status/1694363996613161247?s=46&t=A2fpFNgDRyXF2d6ye97wEA

It's a helpful thread

Mastectomies are the most common procedure till aged 40.

Ah no to age 30. Then it evens out till 40.

Mastectomies are the most common procedure till aged 40.

I haven't had time to read the actual report but am confused by the phrase Breast or Chest Surgery. Does this mean they have put in one group women / girls having breast removal, and men having false breast created.

If they have combined these two, not helpful.

Okay have now seen this highlighted on the twitter thread:

44% breast creation
31%: trans male top surgery

So

44% men
31% women

?????

Of hadn't even thought of that - very bad of me to assume and I hadn't spent much time looking at the breakdown.

The accusations of issues with the data are that the age ranges obscure accuracy around minors and clearly there's a lot of obscurity around what the data is.

What ever that data is, it demonstrates a hyper focussed issue around the upper body in particular, in the 19-30s group.

And it would be really important to know how the data breaks down in the younger age group as it could be that there's a higher or similar rate of mastectomies there as in the 19-30s, If the 19-30s included more males getting breast implants.

It feels as if younger males go for hormones first and chest surgery later on when the outcome is not very good?

The data is confusing anyway because there's a lot of "unknowns" under the sex breakdown

Without the unknowns, females take a far higher % of the surgeries over all.

If they're non binary, it tends to be that it's females who get surgery, to remove breasts. Males tend not to do anything.

This sentence in the report jumped out at me

For those with hospital admissions with gender identity disorder, 10 625 (11.8%) of admissions were for GAS.

I'd like to know what required a hospital admission for the other 88% of patients with gender identity disorder. How many of these admissions were for revision surgery, mental health needs or something else?

As with most of these gender related
medical records, there's more not said, than is.

Is GAS generalised anxiety (something?) or something else?

GAS = Gender affirming surgery.

One statistic that don’t show up is the number who were booked for surgery prior to any lockdown but who never went through with it. There are a detransitioners who report that if it wasn’t for lockdown they would have had some form of surgery.

I'd totally forgotten that before I got caught up in the figures, this was actually one of the main reasons for posting:

The increase likely reflects expanded insurance coverage for transgender care after the Obama administration and some states actively discouraged discrimination based on gender identity, lead author Dr. Jason Wright of Columbia University said. The dip in 2020 can be attributed to the pandemic.

One of the biggest chances in the US was when gender dysphoria was taken of the approved medical listing as a mental health issue, which meant that medical trans surgery could then be covered by personal medical insurance. So a win win for big pharma and private health care insurers.

However report did show this: (anyone know what SE in brackets stands for)

Characteristic: No. (SE) - % (SE)
Mental health: 7351 (419) - 15.3 (0.7)
-> Psychoses: 186 (23) - 0.4 ( 0.0)
-> Depression: 7192 (412) - 15.0 (0.7)

which seems quite low as based on UK practice one of the arguements for proceeding to surgery is to improve mental health.

I suppose that's another possible difference between insurance led health care and nhs led.

What date did the switch happen from MH? What evidence was it based on or was it lobbying?

SE might = standard error as in likely size of statistical error (chance of variability/wobble) in the data.

If so the whole thing looks very muddied

Pharma companies are benefiting hugely by medicalising young children with mental health problems. These children would be helped by talking therapies not drugs and surgeries, which many will later regret. Obama has a lot to answer for on this.

Thanks Festivfrenzy re "SE" - now you've said it seem sort of obvious.

It looks like 2012 was when Gender Dysphoria was no longer classified as a mental illness by the American Psychiatric Association.

But I think it was some years later that that it was then include on most (not all) medical insurance polices. In fact I am sure I read about in on FWR but cant remember the name of the organisation that compiles the list so cant find it!

Dont have time to read this so may not be helpful but going by the title:

The insurance battle for gender-affirming care
https://edition.cnn.com/2018/05/31/health/transgender-surgery-insurance/index.html