{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T20:27:45Z","timestamp":1791836865159,"version":"4.3.4"},"reference-count":22,"publisher":"American Medical Association (AMA)","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n While changes in federal and state laws mandating coverage of gender-affirming surgery (GAS) may have led to an increase in the number of annual cases, comprehensive data describing trends in both inpatient and outpatient procedures are limited.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To examine trends in inpatient and outpatient GAS procedures in the US and to explore the temporal trends in the types of GAS performed across age groups.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This cohort study includes data from 2016 to 2020 in the Nationwide Ambulatory Surgery Sample and the National Inpatient Sample. Patients with diagnosis codes for gender identity disorder, transsexualism, or a personal history of sex reassignment were identified, and the performance of GAS, including breast and chest procedures, genital reconstructive procedures, and other facial and cosmetic surgical procedures, were identified.<\/jats:p>\n <\/jats:sec>\n \n Main Outcome Measures<\/jats:title>\n Weighted estimates of the annual number of inpatient and outpatient procedures performed and the distribution of each class of procedure overall and by age were analyzed.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n A total of 48\u202f019 patients who underwent GAS were identified, including 25\u202f099 (52.3%) who were aged 19 to 30 years. The most common procedures were breast and chest procedures, which occurred in 27\u202f187 patients (56.6%), followed by genital reconstruction (16\u202f872 [35.1%]) and other facial and cosmetic procedures (6669 [13.9%]). The absolute number of GAS procedures rose from 4552 in 2016 to a peak of 13\u202f011 in 2019 and then declined slightly to 12\u202f818 in 2020. Overall, 25\u202f099 patients (52.3%) were aged 19 to 30 years, 10\u202f476 (21.8%) were aged 31 to 40, and 3678 (7.7%) were aged12 to 18 years. When stratified by the type of procedure performed, breast and chest procedures made up a greater percentage of the surgical interventions in younger patients, while genital surgical procedures were greater in older patients.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n Performance of GAS has increased substantially in the US. Breast and chest surgery was the most common group of procedures performed. The number of genital surgical procedures performed increased with increasing age.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2023.30348","type":"journal-article","created":{"date-parts":[[2023,8,23]],"date-time":"2023-08-23T11:36:12Z","timestamp":1692790572000},"page":"e2330348","source":"Crossref","is-referenced-by-count":190,"title":["National Estimates of Gender-Affirming Surgery in the US"],"prefix":"10.1001","volume":"6","author":[{"given":"Jason D.","family":"Wright","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ling","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yukio","family":"Suzuki","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koji","family":"Matsuo","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of Southern California, Los Angeles"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dawn L.","family":"Hershman","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New 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comprehensive, systematic review of all peer-reviewed literature and methods of assessing patient-centered outcomes (part 2: genital reconstruction).","volume":"275","author":"Oles","year":"2022","journal-title":"Ann Surg"},{"issue":"5","key":"zoi230875r5","doi-asserted-by":"publisher","first-page":"721","DOI":"10.1016\/j.jsxm.2017.01.022","article-title":"Quality of life and patient satisfaction following male-to-female sex reassignment surgery.","volume":"14","author":"Papadopulos","year":"2017","journal-title":"J Sex Med"},{"issue":"4","key":"zoi230875r6","doi-asserted-by":"publisher","first-page":"263","DOI":"10.1177\/2292550318767437","article-title":"Gender-affirming surgery for transgender individuals: perceived satisfaction and barriers to care.","volume":"26","author":"El-Hadi","year":"2018","journal-title":"Plast Surg (Oakv)"},{"issue":"3","key":"zoi230875r7","doi-asserted-by":"publisher","first-page":"228","DOI":"10.21037\/tau","article-title":"Patient reported outcome measures and quality of life assessment in genital gender confirming surgery.","volume":"8","author":"Dy","year":"2019","journal-title":"Transl Androl Urol"},{"issue":"2","key":"zoi230875r8","doi-asserted-by":"publisher","first-page":"286","DOI":"10.1097\/PRS.0000000000003529","article-title":"Male-to-female sex reassignment surgery using the combined technique leads to increased quality of life in a prospective study.","volume":"140","author":"Papadopulos","year":"2017","journal-title":"Plast Reconstr Surg"},{"issue":"7","key":"zoi230875r9","doi-asserted-by":"publisher","first-page":"609","DOI":"10.1001\/jamasurg.2017.6231","article-title":"Temporal trends in gender-affirming surgery among transgender patients in the United States.","volume":"153","author":"Canner","year":"2018","journal-title":"JAMA Surg"},{"issue":"4","key":"zoi230875r10","doi-asserted-by":"publisher","first-page":"824","DOI":"10.1097\/PRS.0000000000006012","article-title":"Health insurance coverage of gender-affirming top surgery in the United States.","volume":"144","author":"Ngaage","year":"2019","journal-title":"Plast Reconstr Surg"},{"issue":"4","key":"zoi230875r11","doi-asserted-by":"publisher","first-page":"244","DOI":"10.1089\/lgbt.2016.0099","article-title":"Coverage for gender-affirming care: making health insurance work for transgender Americans.","volume":"4","author":"Padula","year":"2017","journal-title":"LGBT Health"},{"issue":"1","key":"zoi230875r14","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1097\/00005650-199801000-00004","article-title":"Comorbidity measures for use with administrative data.","volume":"36","author":"Elixhauser","year":"1998","journal-title":"Med Care"},{"issue":"4","key":"zoi230875r16","doi-asserted-by":"publisher","DOI":"10.1097\/GOX.0000000000001738","article-title":"Trends in gender-affirming surgery in insured patients in the United States.","volume":"6","author":"Lane","year":"2018","journal-title":"Plast Reconstr Surg Glob Open"},{"issue":"6","key":"zoi230875r17","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.25906","article-title":"National trends in gender-affirming surgical procedures: a google trends analysis.","volume":"14","author":"Merrick","year":"2022","journal-title":"Cureus"},{"issue":"3","key":"zoi230875r18","doi-asserted-by":"publisher","first-page":"592","DOI":"10.1097\/AOG.0000000000005087","article-title":"Trends in hysterectomy rates associated with the coronavirus disease 2019 (COVID-19) pandemic.","volume":"141","author":"Emont","year":"2023","journal-title":"Obstet Gynecol"},{"issue":"3","key":"zoi230875r19","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.1236","article-title":"Age at first experience of gender dysphoria among transgender adults seeking gender-affirming surgery.","volume":"3","author":"Zaliznyak","year":"2020","journal-title":"JAMA Netw Open"},{"issue":"8","key":"zoi230875r20","doi-asserted-by":"publisher","DOI":"10.1016\/j.xcrm.2022.100719","article-title":"Legislation restricting gender-affirming care for transgender youth: Politics eclipse healthcare.","volume":"3","author":"Kraschel","year":"2022","journal-title":"Cell Rep Med"},{"key":"zoi230875r1","unstructured":"American Psychiatric Association. What is gender dysphoria? Accessed July 6, 2023. https:\/\/www.psychiatry.org\/patients-families\/gender-dysphoria\/what-is-gender-dysphoria"},{"key":"zoi230875r12","unstructured":"NIS overview. Agency for Healthcare Research and Quality. Accessed March 3, 2023. https:\/\/hcup-us.ahrq.gov\/nisoverview.jsp"},{"key":"zoi230875r13","unstructured":"NASS overview. Agency for Healthcare Research and Quality. Accessed March 3, 2023. https:\/\/hcup-us.ahrq.gov\/nassoverview.jsp"},{"key":"zoi230875r15","unstructured":"HCUP methods series calculating national inpatient sample (NIS) variances for data years 2012 and later. Agency for Healthcare Research and Quality. Accessed July 6, 2023. https:\/\/hcup-us.ahrq.gov\/reports\/methods\/2015_09.jsp"},{"key":"zoi230875r21","unstructured":"Youth access to gender affirming care: the federal and state policy landscape. Accessed July 6, 2023. https:\/\/www.kff.org\/other\/issue-brief\/youth-access-to-gender-affirming-care-the-federal-and-state-policy-landscape\/"},{"key":"zoi230875r22","unstructured":"US News and World Report. States that have restricted gender-affirming care for trans youth in 2023. 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