*of note this blog today focuses on surgeries to affirm the gender of trans and/or gender diverse patients. While many people with differences in sex development may also identify as trans or gender diverse, this article is not reviewing surgeries in people with DSD. Interact has some amazing information on surgeries and activism at their website.

To be clear, gender affirming surgeries in trans or gender diverse minors are relatively rare. Most insurance companies do not provide coverage until age 18 based on the previous WPATH SOC7. With the removal of age limits in SOC8 published in September 2022, it will be interesting to see if there are any changes in insurance coverage. With the relatively poor access and previously more restrictive guidelines, you can imagine there is very limited research on gender affirming surgeries in minors. It seems the most commonly accessed procedure is gender affirming chest reconstruction with bilateral mastectomy. 

I was unable to find any articles that quantified or qualified gender affirming surgeries in minors. This may be in part to surgeons request anonymity when discussing gender affirming surgeries on minors, particularly surgeries involving gonadectomies. However, one paper indicates some anecdotal reports of vulvovaginoplasty occurring under age 18¹.

General trends in gender affirming surgeries for trans and gender diverse people (not necessarily youth) indicate that older patients are more likely to have had GAS. One study found a 4% increased likelihood of having had GAS for each additional year of age². Additionally, not specific to youth but one meta-anaylsis looked at a total of 27 studies, pooling 7928 transgender patients who underwent any type of GAS found the pooled prevalence of regret after GAS was 1% (95% CI <1%-2%)³.

The papers on gender affirming chest reconstruction with bilateral mastectomy showed generally positive outcomes. The conclusions from Dr. Olson-Kennedy’s paper found that chest dysphoria was high among presurgical transmasculine youth, and surgical intervention positively affected both minors and young adults⁴. This is an area where more research is needed but in the current political climate, I question whether that is even possible. Several surgeons who previously treated youth have stopped due to fear for their safety and the safety of their staff. This is heartbreaking.

1. Milrod C, Karasic DH. Age Is Just a Number: WPATH-Affiliated Surgeons' Experiences and Attitudes Toward Vaginoplasty in Transgender Females Under 18 Years of Age in the United States. J Sex Med. 2017 Apr;14(4):624-634. doi: 10.1016/j.jsxm.2017.02.007. Epub 2017 Mar 17. PMID: 28325535.
2. Nolan IT, Dy GW, Levitt N. Considerations in Gender-Affirming Surgery: Demographic Trends. Urol Clin North Am. 2019 Nov;46(4):459-465. doi: 10.1016/j.ucl.2019.07.004. PMID: 31582020.
3. Bustos VP, Bustos SS, Mascaro A, Del Corral G, Forte AJ, Ciudad P, Kim EA, Langstein HN, Manrique OJ. Regret after Gender-affirmation Surgery: A Systematic Review and Meta-analysis of Prevalence. Plast Reconstr Surg Glob Open. 2021 Mar 19;9(3):e3477. doi: 10.1097/GOX.0000000000003477. Erratum in: Plast Reconstr Surg Glob Open. 2022 Apr 28;10(4):e4340. PMID: 33968550; PMCID: PMC8099405.
4. Olson-Kennedy J, Warus J, Okonta V, Belzer M, Clark LF. Chest Reconstruction and Chest Dysphoria in Transmasculine Minors and Young Adults: Comparisons of Nonsurgical and Postsurgical Cohorts. JAMA Pediatr. 2018 May 1;172(5):431-436. doi: 10.1001/jamapediatrics.2017.5440. PMID: 29507933; PMCID: PMC5875384.