Gender-affirming surgeries are on a steep rise in the US, according to the first study of its kind.
Genital operations increased four-fold between 2000 and 2014 for patients with government-subsidized health insurance alone.
According to the most recent estimates, more than 1.3 million Americans identify as transgender.
Based on the new report from The Johns Hopkins University School of Medicine, more and more of that population is seeking surgery to align their anatomies with their identities as they gain insurance coverage for their operations.
Genital operations for transgender people increased by four-fold between 2000 and 2014
Transgender issues – including civil rights, military service, or medical care – have come to the forefront of the public eye in the last several years.
After President Trump attempted to ban transgender Americans from serving in the military last year, the first openly transgender person officially signed up for service earlier this week.
But until very recently, health insurance providers have refused to cover surgeries for gender-affirmation.
Until 2014, Medicare did not cover gender transition-related surgeries.
In the new study, published in JAMA surgery this week, the authors suggest that the introduction of the Obama-era Affordable Care Act that year may have contributed to broader coverage and the dramatic increase in the surgeries.
‘This expansion of coverage may represent an important first step in enabling transgender patients to access previously unaffordable, yet necessary, gender-affirming care,’ the study authors wrote.
Gender-affirmation surgeries include a broad range of procedures to alter the appearance of physical features to more closely align with a person’s identity. They range from breast augmentations and reductions to body contouring and penis construction, among others.
The health effects of undergoing these surgeries are mixed, according to research. Some studies have linked gender-reassignment surgery to greater job satisfaction and better overall mental health, while others have suggested that the operations have little effect on psychological well-being.
Regardless, the transgender and LGBTQ community have fought hard for the right to elect to have these operations, and for them to be covered by insurance.
By 2017, many medical associations, such the American Medical Association had come out in support of expanded care for transgender people, and the ‘medical necessity’ of gender affirming surgeries.
Some private insurance providers have denied coverage for the operations, a decision that has been the subject of unresolved legal debate.
The Johns Hopkins study examined only data from surgeries Medicare and Medicaid, which may or may not cover gender-affirming surgeries, depending on state laws.
There were 4,118 gender-affirming surgeries performed between 2000 and 2014, the research found.
Between 2000 and 2011, about half of these operations were not covered by insurance.
But by 2014, only 39 percent of gender-affirming operations were not covered by insurance, according to the study, suggesting that Medicare’s 2014 decision to cover the operations may have had a significant effect.
The study authors recognized that the data they collected do not paint the full picture, largely because so many patients’ insurers refuse to cover the procedures, forcing them to pay out of pocket for their operations and making them more difficult to track.
‘Policies banning discrimination based on gender identity among third-party payers are essential to engage transgender patients in care and ensure coverage of these medically necessary procedures,’ the study authors wrote.