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Report: thousands of US girls underwent trans ‘top surgeries’

Proponents downplay the prevalence of these surgeries. Credit: Getty

August 13, 2024 - 9:30pm

A report from the Manhattan Institute this week revealed that “gender-affirming” mastectomies for patients under 18 are more common than previously believed.

While cross-sex genital surgeries are rare in the US for both adults and minors, mastectomies — also known as “top surgery” in the context of transgender medicine — are widely available to minors and are the most common transgender surgery for this population. Around 5,000 to 6,000 girls underwent “gender affirming” double mastectomies in the US from 2017 to 2023, according to the Manhattan Institute, and at least 50 of those patients were younger than 12-and-a-half years old.

While the US medical establishment and trans activists have long argued that cross-sex surgeries for children are exceedingly rare, evidence is emerging of a large and growing surgical industry impacting thousands of children, despite the ongoing lack of authoritative data on precisely how many minors are undergoing the procedures.

The new report demonstrates a higher prevalence of “gender-affirming” mastectomies for minors than previous estimates when broken down by year. One estimate published in the Journal of the American Medical Association found 3,125 “top surgeries” were performed on patients aged 12-18 from 2016 to 2020 — a lower per-year estimate despite including 18-year-olds, which the Manhattan Institute’s data excluded. A 2022 report from Reuters estimated 776 top surgeries on minors from 2019-2021, a significantly lower per-year estimate.

The actual prevalence of these surgeries is likely considerably higher than the latest estimate, since it relies on health insurance data and therefore does not include procedures obtained without using insurance.

The apparent increase in surgeries in recent years may be related to the growing prevalence of transgender identification among youth, along with the growing popularity of the affirmation approach, which takes children’s self-described transgender identity at face value.

Proponents of cross-sex medical interventions downplay the prevalence of these surgeries. The Human Rights Campaign declared last April that “gender affirming surgeries are NOT performed on children”, and the Association of American Medical Colleges wrote, “GAC surgery among youth is rare, experts say.” Marci Bowers, plastic surgeon and president of the World Professional Association for Transgender Health (WPATH), the leasing standard-setting organisation for transgender medical treatments, has made a similar argument. “Surgery really is not done under the age of 18, except in severe cases . . . And even that is rare, I think the estimates are something like 57 surgeries under the age of 18,” Bowers said in 2023.

But their insistence that surgeries for children are rare should not be confused with repudiation of such surgeries. On the contrary, activists strongly oppose restrictions on trans surgeries for kids. When the Biden administration tempered its support for childhood gender transitions this summer by opposing surgeries for minors, there was swift blowback from the trans lobby. State lawmakers called the move a “betrayal” in a letter to Biden, and the HRC said the decision was “flat out wrong”.

The growing body of evidence demonstrating the availability of irreversible cross sex surgeries for minors is only the latest development chipping away at trans activists’ narrative in the US. The American Society of Plastic Surgeons recently became the first major medical organisation in the US to publicly reject the GAC model, acknowledging that  “the existing evidence base is viewed as low quality/low certainty”, the Manhattan Institute reported. Previously, the ASPS lobbied against state restrictions on cross-sex treatments for minors.

“The main justification for “gender-affirming care” for minors in the United States has been that “all major U.S. medical associations” support it,” Manhattan Institute Fellow Leor Sapir wrote in the report. “But the U.S. consensus now appears to have its first big fracture.”


is UnHerd’s US correspondent.

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Ex Nihilo
Ex Nihilo
1 month ago

Just imagine how much will be lost when the ability to question and push back against controversial ideas is muted by the censorship descending upon us.

John Murray
John Murray
1 month ago

 “at least 50 of those patients were younger than 12-and-a-half years old”
Josef Mengele ain’t got nothing on modern American gender clinics. Diabolical.

Benjamin Greco
Benjamin Greco
1 month ago

I might have found this article more convincing if the author had included the total number of teenage girls there are in the United States. I am always interested in what advocates leave out of their argument, so I looked it up.
As of 2021 there were roughly 16 to 17 million girls between the age of 10 to 17 in the United States. Six thousand surgeries in that population would be 0.035%, and this doesn’t include 18-year-olds which would make the percentage even smaller.
I would call that exceedingly rare.
I am against gender affirming care, but I am in favor of good reasoning.

Arthur King
Arthur King
1 month ago
Reply to  Benjamin Greco

Each one was someone’s daughter.

Benjamin Greco
Benjamin Greco
1 month ago
Reply to  Arthur King

In 2021 2,590 children were killed by gun violence. If someone was arguing for banning gun in the US, you could say each one was someone’s son or daughter. But would you?

UnHerd Reader
UnHerd Reader
1 month ago
Reply to  Benjamin Greco

To Mr Greco: I’m not sure of the point the you are making in your response to Mr King, specifically your last question. Seems to be a unnecessary slam, and some presumption on your part on his (unstated) beliefs regarding deaths from gun violence. You are correct that the percentage of children undergoing the described surgery is quite small percentage-wise, but you are also remiss in citing a statistic regarding youth gun deaths without a corresponding denominator.

Brett H
Brett H
1 month ago
Reply to  Benjamin Greco

What point are you trying to make.

Jim Veenbaas
Jim Veenbaas
1 month ago
Reply to  Benjamin Greco

What aboutism

Norfolk Sceptic
Norfolk Sceptic
1 month ago
Reply to  Benjamin Greco

And it’s not as though banning legal guns would bring the death toll to zero.

It might even go up!

Brett H
Brett H
1 month ago
Reply to  Benjamin Greco

You might have found the article more convincing if you thought more about it’s content. The point of the article is not about percentages but about how the number of mastectomies performed on girls under 18 is more than thought and how the numbers were downplayed by Association of American Medical Colleges and others, which amounts to lying. Why did they find it necessary to lie? Maybe you might think about that.

Tyler Durden
Tyler Durden
1 month ago
Reply to  Benjamin Greco

It’s a huge number of children submitting to barbarism. Still I suppose you could compare it to bombing Hamas children in Gaza.

David Morley
David Morley
1 month ago
Reply to  Benjamin Greco

Good post. I do this as well, and get downvotes for it too. Numbers do matter.

Brett H
Brett H
1 month ago
Reply to  David Morley

“Numbers do matter.”
Care to explain that in context of this story.

Hugh Bryant
Hugh Bryant
1 month ago
Reply to  David Morley

No. In this case numbers don’t matter at all. This should not happen to a single child.

Hugh Bryant
Hugh Bryant
1 month ago
Reply to  Benjamin Greco

Yes. Can’t understand the fuss about October 7th either. After all, it was only a tiny fraction of Israelis who were butchered, raped and thrown in ovens.

No child should have their breasts removed for no good reason. Ever. The psychopathic doctors involved should be jailed for life.

Matt Sylvestre
Matt Sylvestre
1 month ago

Why is this so hard for the Trans Lobby: Adults may do as they wish, kids get supportive physco-emotional care (no drugs no surgery until 18), Sex is male and female while gender is what you make of it, no males in female competitive sports or dressing rooms (more single use rooms please) and prisons, no forced language or restrictions on speech, equal protection for all including trans adults with the intent that trans people are treated as, well, people (the law forces equal protection while society promotes acceptance and engagement of trans folks)…. For god sakes… I really think anyone who does not accept such is looking for attention or, if against, a bigot who should mind their own business…

Jim Veenbaas
Jim Veenbaas
1 month ago
Reply to  Matt Sylvestre

I would say about 80% of the west believes this. The question for me is why has the trans lobby gained so much power?

Hugh Bryant
Hugh Bryant
1 month ago
Reply to  Jim Veenbaas

I’d say 98%.

Josef Švejk
Josef Švejk
1 month ago

This story has elements of the Children’s Crusade about it. A mass delusion is being fed by what I believe to be a small group of medical practitioners, primarily paediatricians, psychiatrists and surgeons. The medical colleges and associations whose leadership rarely represents the average practitioner are complicit. I dread to think what medical insurance coverage will cost doctors in ten years time when patient regret sets in.

Tyler Durden
Tyler Durden
1 month ago

It’s unsurprising as the US is a mental health disaster led by the mania of social media and the disciples of Satan upon the Earth: the Democratic Party.