Gender-affirming surgery appears to be a more common option for transgender individuals than it used to be, with four times as many Americans undergoing procedures between 2000 and 2014.

A recent study in JAMA Surgery identified individuals who had diagnosis codes of transsexualism (TS) or gender identity disorder (GID) between 2000 and 2014, and the authors found that 10.9% of their overall sample had undergone gender-affirming surgical procedures. The percentage of patients seeking genital surgery alone seems to be increasing; 72.0% of patients seeking gender-affirming surgery in 2000-2005 pursued genital surgery only, while 83.9% of the 2006-2011 sample did.

The authors additionally report that the percentage of patients who were self-payers for these procedures has dramatically decreased over time. Meanwhile, the percentage of patients receiving gender-affirming procedures while covered by Medicare or Medicaid increased by threefold between 2012 and 2014. The authors conclude that the coverage of transition-related services by Medicare, which started in 2014, may have been an “important first step in enabling transgender patients to access previously unaffordable, yet necessary, gender-affirming care.”

The authors also note that this is, to their knowledge, the first study to evaluate temporal trends of gender-affirming surgeries in the United States. Gender identity data collection is necessary to assess and improve treatments, and the authors urge providers to use the two-step approach adopted by the Center of Excellence for Transgender Health at the University of California, San Francisco (asking about sex at birth and gender identity) to ensure that this data is collected without pathologizing transgender people. The authors argue that widespread adoption of gender identity data collection in health care settings is the way providers will be able to improve care for transgender patients, particularly those seeking gender-affirming surgery.

You can access the full text in JAMA Surgery here: