Bottom Line: Genital surgery increased among transgender patients seeking gender-affirming surgeries and most patients paid out of pocket for the procedures.
Why The Research Is Interesting: Many transgender patients may seek gender-affirming interventions to have unison between self-identified gender, physical appearance and function. Gender-affirming interventions can include hormone therapy and surgical procedures such as genital or breast surgery and facial contouring. Little is known about trends in these procedures in the United States.
Who and When: 37,827 patient encounters from 2000 to 2014 identified by a diagnosis code of transsexualism or gender identity disorder; 4,118 (10.9 percent) of all the encounters involved gender-affirming surgery
What (Study Measures): Comparison of demographics, health insurance plan and type of surgery for patients who sought gender-affirming surgery between 2000-2005 and 2006-2011, as well as annually from 2012 to 2014.
How (Study Design): This was an observational study. Researchers were not intervening for purposes of the study and cannot control all the natural differences that could explain study findings.
Authors: Brandyn D. Lau, M.P.H., C.P.H., Johns Hopkins University School of Medicine, Baltimore, and coauthors
The percentage of patients who paid for procedures out of pocket decreased over time after 2012 but 46.4 percent of patients still paid for procedures out of pocket from 2012-2014. The number of patients seeking these procedures who were covered by Medicare or Medicaid increased to 70 in 2014 from 25 in 2012-2013.
Study Limitation: The diagnosis codes used for this study may have resulted in an underestimate of the true number of hospitalized transgender patients.
Study Conclusions: As insurance coverage for gender-affirming procedures increases, likely so will the demand for qualified surgeons to perform them.
Related material: The commentary, "Trends of Gender-Affirming Surgery Among Transgender Patients in the United States," by Marie Crandall, M.D., M.P.H., of the University of Florida College of Medicine, Jacksonville, is available on the For The Media website.
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For more details and to read the full study, please visit the For The Media website.
(doi:10.1001/jamasurg.2017.6231)
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Journal
JAMA Surgery