Gender-affirming Surgery is on the Rise but Black Trans Less Likely to Undergo Surgery

The number of Americans deciding to have gender-affirming surgery is on the rise, but for Black transgender individuals barriers persist.

New research conducted by JAMA Network reveals that gender-affirming surgery tripled between 2016 and 2019. During that period, more than 48,000 patients — about half of them between 19 and 30 years of age — underwent some form of gender-affirming (GAS) surgery, research indicates. About 4,500 of those procedures were performed in 2016. By 2019, that figure rose to a high of 13,000, a number that dipped only slightly in 2020.

“A lot of scare pieces are being written about how many trans people there seem to be all of a sudden, but this is not about a skyrocketing number of people who all of a sudden are trans and all of a sudden are seeking these procedures,” said Kellan Baker, a transgender health care policy expert. “This is about the fact that before 2016 it was just not possible for many of these patients to get the medical care they needed because of discriminatory exclusions.”

The study’s lead author, Dr. Jason Wright, pointed to several possible reasons for the rapid increase. One, he said, is a greater awareness of the procedures among patients and health care providers.

“And there is a growing body of literature that the procedures are generally safe and associated with high satisfaction,” said Wright, chief of gynecologic oncology at Columbia University College of Physicians and Surgeons in New York City.

“There have also been a number of initiatives to improve insurance coverage for these operations, which likely make them more accessible to patients,” he added.

Gender-affirming surgery is one of the treatments — alongside behavioral therapy and hormonal therapy — available to patients struggling with gender dysphoria.

Gender dysphoria is a concept that describes the distress an individual in under when the gender a person is assigned at birth does not match the gender with which one identifies.

Between 2016 and 2020, just over half (52%) of the patients were between 19 and 30 years of age, while about 22% were between 31 and 40. Fewer than 8% were between the ages of 12 and 18. Most lived in the West (46%) or the Northeast (26%). About two-thirds underwent a single GAS procedure. More than a quarter of patients had two.

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The study does not look at the race of those who underwent gender-affirming surgery. However, a recent Pew Research Report stated that about 1.4% of Black adults are transgender or nonbinary—meaning their gender is something other than the sex they were assigned at birth.

However, according to another study conducted by the Williams Institute, an estimated 16% of the transgender population in the United States identifies as Black or African American, which is significantly higher than the 12% of US citizens identifying as Black or African American. Yet, despite an over representation within the transgender community, Black individuals only account for 2.6%–9.7% of all patients undergoing gender affirming surgery. According to the institute, this discrepancy is most likely due to a whole host of socioeconomic and systemic issues, with provider mistrust being one of the most pertinent contributors

“There is clearly a need to further explore the very rapid rise in the number of procedures performed each year,” he said, in order to get a better handle on exactly what’s behind it.

“Trans people have always been here,” Baker said. “The numbers we’re seeing now just reflect the fact that people have finally gotten some legal recognition, social visibility and the ability to be open about who they are and to get the medical care they need.”

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