CC BY-NC-ND 4.0 · Indian J Plast Surg 2024; 57(01): 047-053
DOI: 10.1055/s-0043-1778096
Original Article

Trends in Gender-Affirming Surgeries in the United States from 2010 to 2021

Ally Ha
1   Department of Surgery, Division of Plastic and Reconstructive Surgery, Anschutz Medical Campus, Aurora, Colorado
2   University of Colorado School of Medicine, Aurora, Colorado
Elijah Hale
2   University of Colorado School of Medicine, Aurora, Colorado
Ty Higuchi
3   Department of Surgery, Division of Urology, Anschutz Medical Campus, Aurora, Colorado
Julian Winocour
1   Department of Surgery, Division of Plastic and Reconstructive Surgery, Anschutz Medical Campus, Aurora, Colorado
David W. Mathes
1   Department of Surgery, Division of Plastic and Reconstructive Surgery, Anschutz Medical Campus, Aurora, Colorado
Christodoulos Kaoutzanis
1   Department of Surgery, Division of Plastic and Reconstructive Surgery, Anschutz Medical Campus, Aurora, Colorado
› Author Affiliations


Introduction: In 2017, an estimated 1.6 million adults and 150,000 teenagers identified as transgender in the United States. With ever-changing legislative developments regarding health care benefits for this population and the increasing number of patients presenting for gender-affirming surgery (GAS), there is a scarcity of literature on the temporal trends within the past decade. The objective of this study was to examine the temporal trends of the utilization of GAS.

Methods: We conducted a cross-sectional study using TriNetX, a federated research network containing deidentified aggregate patient data. Using International Code of Disease (ICD) and Current Procedural Terminology (CPT) codes, we identified patients with a diagnosis of gender dysphoria who underwent GAS from 2010 to 2021. Basic demographic information and complications were analyzed. Complications of interest included site failure, infection, and systemic complications.

Results: We identified a total of 8,403 patients who underwent GAS between January 2010 and December 2021. The number of procedures per year increased nearly 500% between 2016 and 2021 from 421 procedures to 2,224 procedures. Our demographic results were consistent with previous survey-based studies. The average age of patients who underwent masculinizing surgeries was consistently younger than those who underwent feminizing surgeries. Most patients undergoing GAS were of white race. The overall complication rate was 4.7%.

Conclusion: In conclusion, our study reveals a significant and rapid rise in the utilization of GAS in the United States, with a fivefold increase in procedures between 2016 and 2021. The demographic characteristics and low complication rates observed highlight the evolving landscape of health care for transgender individuals and the need for ongoing assessment and support in this field.

Publication History

Article published online:
04 January 2024

© 2024. Association of Plastic Surgeons of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (

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  • References

  • 1 Winter S, Diamond M, Green J. et al. Transgender people: health at the margins of society. Lancet 2016; 388 (10042): 390-400
  • 2 Herman JL, Flores AR, Brown TNT, Wilson BDM, Conron KJ. Age of Individuals who Identify as Transgender in the United States. 2017 Accessed December 16, 2023 at:
  • 3 Reisner SL, Poteat T, Keatley J. et al. Global health burden and needs of transgender populations: a review. Lancet 2016; 388 (10042): 412-436
  • 4 Bockting WO, Miner MH, Swinburne Romine RE, Hamilton A, Coleman E. Stigma, mental health, and resilience in an online sample of the US transgender population. Am J Public Health 2013; 103 (05) 943-951
  • 5 James SEHJ, Rankin S. The Report of the 2015 U.S. Transgender Survey. Accessed December 16, 2023 at:
  • 6 Grant JMML, Tanis J, Harrison J, Herman JL, Keisling M. Injustice at Every Turn: A Report of the National Transgender Discrimination Survey. Accessed December 16, 2023 at:
  • 7 Coleman E, Radix AE, Bouman WP. et al. Standards of care for the health of transgender and gender diverse people, version 8. Int J Transgender Health 2022; 23 (S1): S1-S259
  • 8 Berli JU, Knudson G, Fraser L. et al. What surgeons need to know about gender confirmation surgery when providing care for transgender individuals: a review. JAMA Surg 2017; 152 (04) 394-400
  • 9 Hage JJ, Karim RB. Ought GIDNOS get nought? Treatment options for nontranssexual gender dysphoria. Plast Reconstr Surg 2000; 105 (03) 1222-1227
  • 10 Bradford J, Reisner SL, Honnold JA, Xavier J. Experiences of transgender-related discrimination and implications for health: results from the Virginia Transgender Health Initiative Study. Am J Public Health 2013; 103 (10) 1820-1829
  • 11 Health and Human Services Department. Nondiscrimination in Health Programs and Activities. Accessed December 16, 2023 at:
  • 12 Stroumsa D. The state of transgender health care: policy, law, and medical frameworks. Am J Public Health 2014; 104 (03) e31-e38
  • 13 Human Rights Campaign. State Maps of Laws & Policies: Transgender Healthcare. Accessed December 16, 2023 at:
  • 14 Movement Advancement Project. Equality Maps: Healthcare Laws and Policies. Accessed December 16, 2023 at:
  • 15 Movement Advancement Program. Healthcare Laws and Policies: Private Insurance Nondiscrimination Laws & Related Policies. Accessed December 16, 2023 at:
  • 16 Zaliznyak M, Jung EE, Bresee C, Garcia MM. Which U.S. States' Medicaid programs provide coverage for gender-affirming hormone therapy and gender-affirming genital surgery for transgender patients?: a state-by-state review, and a study detailing the patient experience to confirm coverage of services. J Sex Med 2021; 18 (02) 410-422
  • 17 Padula WV, Heru S, Campbell JD. Societal implications of health insurance coverage for medically necessary services in the U.S. transgender population: a cost-effectiveness analysis. J Gen Intern Med 2016; 31 (04) 394-401
  • 18 Tran BNN, Epstein S, Singhal D, Lee BT, Tobias AM, Ganor O. Gender affirmation surgery: a synopsis using American College of Surgeons National Surgery Quality Improvement Program and National Inpatient Sample Databases. Ann Plast Surg 2018; 80 (4, Suppl 4): S229-S235
  • 19 Baker KE. The future of transgender coverage. N Engl J Med 2017; 376 (19) 1801-1804
  • 20 Wiegmann AL, Young EI, Baker KE. et al. The affordable care act and its impact on plastic and gender-affirmation surgery. Plast Reconstr Surg 2021; 147 (01) 135e-153e
  • 21 Franciscan Alliance, Inc. v. Burwell
  • 22 TriNetX. The global health research network. Accessed December 16, 2023 at:
  • 23 Centers for Medicare & Medicaid Services. Billing and Coding: Gender Reassignment Services for Gender Dysphoria. Accessed December 16, 2023 at:
  • 24 American Society of Plastic Surgeons. Gender Affirmation Surgeries. Transgender-Specific Facial, Top and Bottom Procedures. Accessed December 16, 2023 at:
  • 25 Canner JK, Harfouch O, Kodadek LM. et al. Temporal trends in gender-affirming surgery among transgender patients in the United States. JAMA Surg 2018; 153 (07) 609-616
  • 26 Kailas M, Lu HMS, Rothman EF, Safer JD. Prevalence and types of gender-affirming surgery among a sample of transgender endocrinology patients prior to state expansion of insurance coverage. Endocr Pract 2017; 23 (07) 780-786
  • 27 Nolan IT, Kuhner CJ, Dy GW. Demographic and temporal trends in transgender identities and gender confirming surgery. Transl Androl Urol 2019; 8 (03) 184-190
  • 28 Sineath RC, Woodyatt C, Sanchez T. et al. Determinants of and barriers to hormonal and surgical treatment receipt among transgender people. Transgend Health 2016; 1 (01) 129-136
  • 29 Lane M, Ives GC, Sluiter EC. et al. Trends in gender-affirming surgery in insured patients in the United States. Plast Reconstr Surg Glob Open 2018; 6 (04) e1738
  • 30 Obama B. United States health care reform: progress to date and next steps. JAMA 2016; 316 (05) 525-532
  • 31 Buncamper ME, van der Sluis WB, van der Pas RSD. et al. Surgical outcome after penile inversion vaginoplasty: a retrospective study of 475 transgender women. Plast Reconstr Surg 2016; 138 (05) 999-1007
  • 32 Papadopulos NA, Zavlin D, Lellé JD. et al. Combined vaginoplasty technique for male-to-female sex reassignment surgery: operative approach and outcomes. J Plast Reconstr Aesthet Surg 2017; 70 (10) 1483-1492
  • 33 Ascha M, Massie JP, Morrison SD, Crane CN, Chen ML. Outcomes of single stage phalloplasty by pedicled anterolateral thigh flap versus radial forearm free flap in gender confirming surgery. J Urol 2018; 199 (01) 206-214
  • 34 Bouman MB, van Zeijl MC, Buncamper ME, Meijerink WJ, van Bodegraven AA, Mullender MG. Intestinal vaginoplasty revisited: a review of surgical techniques, complications, and sexual function. J Sex Med 2014; 11 (07) 1835-1847
  • 35 Morrison SD, Shakir A, Vyas KS, Kirby J, Crane CN, Lee GK. Phalloplasty: a review of techniques and outcomes. Plast Reconstr Surg 2016; 138 (03) 594-615
  • 36 Terrier JE, Courtois F, Ruffion A, Morel Journel N. Surgical outcomes and patients' satisfaction with suprapubic phalloplasty. J Sex Med 2014; 11 (01) 288-298