The actual prevalence of these surgeries is likely considerably higher than the latest estimate, since it relies on health insurance data and therefore does not include procedures obtained without using insurance.

The apparent increase in surgeries in recent years may be related to the growing prevalence of transgender identification among youth, along with the growing popularity of the affirmation approach, which takes children’s self-described transgender identity at face value.

Proponents of cross-sex medical interventions downplay the prevalence of these surgeries. The Human Rights Campaign declared last April that “gender affirming surgeries are NOT performed on children”, and the Association of American Medical Colleges wrote, “GAC surgery among youth is rare, experts say.” Marci Bowers, plastic surgeon and president of the World Professional Association for Transgender Health (WPATH), the leasing standard-setting organisation for transgender medical treatments, has made a similar argument. “Surgery really is not done under the age of 18, except in severe cases . . . And even that is rare, I think the estimates are something like 57 surgeries under the age of 18,” Bowers said in 2023.

But their insistence that surgeries for children are rare should not be confused with repudiation of such surgeries. On the contrary, activists strongly oppose restrictions on trans surgeries for kids. When the Biden administration tempered its support for childhood gender transitions this summer by opposing surgeries for minors, there was swift blowback from the trans lobby. State lawmakers called the move a “betrayal” in a letter to Biden, and the HRC said the decision was “flat out wrong”.

The growing body of evidence demonstrating the availability of irreversible cross sex surgeries for minors is only the latest development chipping away at trans activists’ narrative in the US. The American Society of Plastic Surgeons recently became the first major medical organisation in the US to publicly reject the GAC model, acknowledging that  “the existing evidence base is viewed as low quality/low certainty”, the Manhattan Institute reported. Previously, the ASPS lobbied against state restrictions on cross-sex treatments for minors.

“The main justification for “gender-affirming care” for minors in the United States has been that “all major U.S. medical associations” support it,” Manhattan Institute Fellow Leor Sapir wrote in the report. “But the U.S. consensus now appears to have its first big fracture.”

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is UnHerd’s US correspondent.

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