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August 13, 2024 - 9:30pm
A report from the Manhattan Institute this week revealed that “gender-affirming” mastectomies for patients under 18 are more common than previously believed.
While cross-sex genital surgeries are rare in the US for both adults and minors, mastectomies — also known as “top surgery” in the context of transgender medicine — are widely available to minors and are the most common transgender surgery for this population. Around 5,000 to 6,000 girls underwent “gender affirming” double mastectomies in the US from 2017 to 2023, according to the Manhattan Institute, and at least 50 of those patients were younger than 12-and-a-half years old.
While the US medical establishment and trans activists have long argued that cross-sex surgeries for children are exceedingly rare, evidence is emerging of a large and growing surgical industry impacting thousands of children, despite the ongoing lack of authoritative data on precisely how many minors are undergoing the procedures.
The new report demonstrates a higher prevalence of “gender-affirming” mastectomies for minors than previous estimates when broken down by year. One estimate published in the Journal of the American Medical Association found 3,125 “top surgeries” were performed on patients aged 12-18 from 2016 to 2020 — a lower per-year estimate despite including 18-year-olds, which the Manhattan Institute’s data excluded. A 2022 report from Reuters estimated 776 top surgeries on minors from 2019-2021, a significantly lower per-year estimate.
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.
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SubscribeJust imagine how much will be lost when the ability to question and push back against controversial ideas is muted by the censorship descending upon us.
“at least 50 of those patients were younger than 12-and-a-half years old”
Josef Mengele ain’t got nothing on modern American gender clinics. Diabolical.
We are in stage 2 of the usual progressive denial program and their help from the media.
1. It isn’t happening and you are a mouth breather conspiracy theorist for saying that.
2. It is happening but it is extremely rare.
3. It is not that rare but it is a good thing.
4. It isn’t a good thing – but it doesn’t cause lasting harm.
5. Experts raise doubts about this thing.
6. If we only knew then what we know now about the thing then we wouldn’t have supported it.
7. We never supported it – you are a mouth breathing conspiracy theorist for saying that we ever did.
I might have found this article more convincing if the author had included the total number of teenage girls there are in the United States. I am always interested in what advocates leave out of their argument, so I looked it up.
As of 2021 there were roughly 16 to 17 million girls between the age of 10 to 17 in the United States. Six thousand surgeries in that population would be 0.035%, and this doesn’t include 18-year-olds which would make the percentage even smaller.
I would call that exceedingly rare.
I am against gender affirming care, but I am in favor of good reasoning.
Each one was someone’s daughter.
In 2021 2,590 children were killed by gun violence. If someone was arguing for banning gun in the US, you could say each one was someone’s son or daughter. But would you?
To Mr Greco: I’m not sure of the point the you are making in your response to Mr King, specifically your last question. Seems to be a unnecessary slam, and some presumption on your part on his (unstated) beliefs regarding deaths from gun violence. You are correct that the percentage of children undergoing the described surgery is quite small percentage-wise, but you are also remiss in citing a statistic regarding youth gun deaths without a corresponding denominator.
What point are you trying to make.
What aboutism
And it’s not as though banning legal guns would bring the death toll to zero.
It might even go up!
The unspoken claim that banning guns would reduce gun deaths is baseless. Accepting guns are part of our culture, and more gun training would reduce gun deaths. I don’t hear liberals advocating for more gun ranges and subsidized training. With 400 million privately owned guns in the USA, what use is pretending they should “go away”. The guns aren’t going away.
Can we dig down into the logic here?
“Girls having their healthy breasts removed because they believe a lie” is wholly preventable by dismantling the arguments in favor of allowing it – the argument being to prevent suicide. Which has been disproved statistically. The rate of suicide increases after trans surgeries, it doesn’t decrease.
No. If there were 6000 such surgeries, then almost 6000 were someone’s son, born with the birth defect of having a female reproductive system — which is a birth defect in someone with a male gender.
You might have found the article more convincing if you thought more about it’s content. The point of the article is not about percentages but about how the number of mastectomies performed on girls under 18 is more than thought and how the numbers were downplayed by Association of American Medical Colleges and others, which amounts to lying. Why did they find it necessary to lie? Maybe you might think about that.
It’s a huge number of children submitting to barbarism. Still I suppose you could compare it to bombing Hamas children in Gaza.
Good post. I do this as well, and get downvotes for it too. Numbers do matter.
“Numbers do matter.”
Care to explain that in context of this story.
No. In this case numbers don’t matter at all. This should not happen to a single child.
Yes. Can’t understand the fuss about October 7th either. After all, it was only a tiny fraction of Israelis who were butchered, raped and thrown in ovens.
No child should have their breasts removed for no good reason. Ever. The psychopathic doctors involved should be jailed for life.
Israelis weren’t thrown in ovens. See Haaretz. It’s good to exercise skepticism when reading, at all times, but especially when reading about wars. There’s no need to believe the oven story to believe the Oct. 7 attack was a crime, that Hamas committed atrocities.
It’s also possible to believe that about Oct. 7, and that Israel had been murdering Palestinians that year on a scale not seen since 2006. That is, more than their practice of regularly “mowing the lawn” usually entails, ostensibly to weaken Hamas and augment the effect of deterrence. Yet evidence shows that the IDF has targeted civilian non-combatants and civilian infrastructure. UN agencies document that not only has most of the “lawn” been civilians mowed down, but that the “lawn” also of course includes a large percentage of children. Not all grass on a lawn is full-grown.
And yet knowing this, I also know Oct. 7 was a crime, and that Hamas committed atrocities.
The world is often not a simple, black & white place.
The reason “numbers are important” in this case is because the numbers are being marshalled to counter claims of the “US medical establishment and trans activists [who] have long argued that cross-sex surgeries for children are exceedingly rare” — a counter that is of course intended to add further doubt about the veracity of activists’ argument for such surgeries.
The other context to note is that the number refers to surgeries over a 6 year period. Denominators matter, and many situations also have a temporal aspect to consider as well.
Noting this context (denominator and time span) doesn’t take away from the argument that children shouldn’t have such surgeries.
Instead, it takes away from the argument that it’s not “exceedingly rare.” If this “industry” (a loaded word, conjuring a large-scale, factory-like context involving large numbers) is “impacting thousands of children,” that “thousands” is still “exceedingly rare” given the population represented by those getting surgery.
In other words, it’s not doing the work it’s presumed to do, of chipping away at the activists’ argument.
Something else to note: the author introduces the article by saying “A report from the Manhattan Institute…” Well, a “report” from an “Institute” sounds like a statistical study was done, especially when medical science is a key aspect. But the “report” is actually a journalistic one, containing no original scientific/statistical research. The Institute, if you look into it, is also ideologically oriented, a think-tank, and any such affiliation will have some important values different than those of a scientific one. I think the author should have indicated the nature of the institute, to make less work for those who don’t want to simply swallow whatever’s printed and want to know context. Put all the cards on the table, let me see what’s there.
To emphasize, none of this negates the core argument against such surgeries on children. Maybe no children should have it, maybe there are solid reason/s, on a case-basis, why a teensy number should. I don’t know enough, and I doubt anyone here knows enough, either. The best value in making this point about context and language choices is to remind us of the need to always exercise skepticism when reading or listening to reports. Skepticism, not cynicism — because the Manhattan Institute report does have content worth taking seriously.
I like your posts. Very well reasoned, not angry or apathetic like a lot of the comments on this site. Thanks for this.
Thank you, Philip!
Amen to your comment PH.
Any facts in this largely evidence free space of gender identity care are very welcome.
That’s like saying ‘only’ 35 people in a town of a hundred thousand?
Benjamin Greco: I note that you’ve got lots of downvotes. This is because you’ve used the wrong denominator.
It’s not the ratio of number of girls undergoing needless mastectomies to number of ALL TEEN GIRLS IN THE US that the piece finds alarming.
It’s the ratio of girls undergoing needless mastectomies to the number of girls in the country WHO CLAIM GENDER DYSPHORIA.
Still rare, probably, but much more common than trans activists claim.
Good reasoning requires using appropriate metrics.
To be even more careful, it’s worth noting that this piece doesn’t mention dysphoria, but “transgender identification among youth,” and taking “children’s self-described transgender identity at face value.” Which implies more leniency for allowing surgery than a diagnosis of that rare disorder. Which is alarming because it expands the potential denominator.
To flesh out my above reply, note that the Manhattan Institute source for the Unherd piece says:
But as they point out, acceptance for these surgeries isn’t limited to dysphoria, because therapists — the first gatekeepers — are discounting it and instead recommending surgery based on “self-described transgender identity”:
In other words, in practise the focus is not dysphoria in considering approval for surgery, it’s the belief (the child’s and/or the doctor’s) that the child is “transgender.” The potential denominator expands.
The Manhattan Institute report suggests that clinics are making it as easy as possible to get surgery:
For example:
They’re moving the goalposts — widening them — because claims of dysphoria are starting to be considered unreliable, and therefore the surgery meant to fix it is also in doubt. So they entertain other criteria, and downplay dysphoria. The potential denominator grows.
For example:
As for surgeons’ motivation that leads to these unnecessary surgeries, as the Manhattan Institute study shows it’s not purely defensive, owing to the fear of “debat[ing] any medical treatment or procedure, and especially when minors are the patients.” As usual, there’s more to it, and as usual, following the money adds more context:
Another way the potential denominator expands is because people are paying privately, a number which is not accounted for.
Given that although gender dysphoria is a key, but not the sole criterion to justify surgery, I think this implies that the piece finds alarming the ratio of girls undergoing needless mastectomies to the (increasing) number of girls in the country who voice a desire to simply look like boys or to look androgenous, period.
The question this inspires, the actual disorder of dysphoria aside, is why girls don’t want to look like girls, to feel like girls, and would prefer to either look and feel like they’re boys, or to look and feel like something in-between. Why do they feel repelled by being female?
*Just noticed Daniel Lee highlighted the latter point the day before. So… what he said!
“because therapists — the first gatekeepers — are discounting it and instead recommending surgery based on “self-described transgender identity”:”
Prove it, what you cited does not.
“Gender clinics across the country have adopted letter-of-support and letter-of-medical-necessity templates to ensure that adolescents seeking surgery get approval.”
That has been true for decades, it’s not new.
“Given that although gender dysphoria is a key, but not the sole criterion to justify surgery,”
It is the sole criteria per the actual standards of care involved, and always has been.
“The question this inspires, the actual disorder of dysphoria aside, is why girls don’t want to look like girls, to feel like girls, and would prefer to either look and feel like they’re boys, or to look and feel like something in-between. Why do they feel repelled by being female?”
Why not first demonstrate that is even involved?
Justify your assumption that gender has no physical, anatomical existence — or — that is is always identical to the sex of a person.
There is a qualification implied by the word “however” in the template cited. The Manhattan Institute notes that while the template confirms that a candidate has had “consistent and persistent gender dysphoria,” it introduces another way of framing context. I think their reasoning is that such framing “effectively” softens the emphasis on ROGD in this way. I think it stands to reason that if recommendations for surgery can be based on “tak[ing] children’s self-described transgender identity at face value,” that this would add to the numbers having such surgery.
I think that may be their point. Templates implying that “gender surgery for minors is a standard procedure rather than an extreme departure requiring strong evidence,” when this “strong evidence” has come under increasing doubt.
Who can doubt that a significant number of young women have trouble with body image, particularly during puberty? I have no reason to doubt this young woman, for example:
– Cass Review: Young person. Lived experience focus group.
Also of interest from the Review:
You are a butcher enabler. Like those who excused Hitler and Mussolini because the trains ran on time, you believe that morality can be found by ensuring that butchers only mutilate a small number.
Benjamin Greco wrote:
There it is. No doubt at all. Clearly standing opposed to the butchers.
He was making a point critical of the reasoning behind an argument that was itself meant to support opposition to butchering. He didn’t think it was doing a good enough job. Just because a person criticizes the quality of an argument doesn’t mean they support whatever it opposes.
You reacted so emotionally based on a mistaken assumption that you didn’t see or believe his last line.
It’s irrelevant if you think Benjamin Greco’s criticism is accurate or not. What matters is that he wasn’t making his point to support butchering, but to try to improve the quality of argument used to oppose it.
I think you owe him an apology.
Why is this so hard for the Trans Lobby: Adults may do as they wish, kids get supportive physco-emotional care (no drugs no surgery until 18), Sex is male and female while gender is what you make of it, no males in female competitive sports or dressing rooms (more single use rooms please) and prisons, no forced language or restrictions on speech, equal protection for all including trans adults with the intent that trans people are treated as, well, people (the law forces equal protection while society promotes acceptance and engagement of trans folks)…. For god sakes… I really think anyone who does not accept such is looking for attention or, if against, a bigot who should mind their own business…
I would say about 80% of the west believes this. The question for me is why has the trans lobby gained so much power?
I’d say 98%.
Dollars. Lots of nice, crispy Dollars.
That’s easy. The surging popularity of self-actualization is humanism on steroids. Listen to these diabolical statements.
“I can be anything I want to be, even trans-human.”
“There are no moral or ethical limits to genetic experimentation”
“Children are sexual creatures and should not be shielded from knowledge, even erotic knowledge”
The elites are taking their orders from Satan, and ascribing it to Progress. If you oppose them you are one of those bigoted Christians.
None of your “statements” ave anything to do with people being transgender, which people have been for all of recorded history.
“The elites are taking their orders from Satan” <– You are not sane. Make your witched from wicker you buy yourself, and burn those, do not trouble sane people.
$$$$$$$$$$$$
No more dollars than any other medical care.
More like only 20% think you are even sane.
There is no “Trans Lobby” just transgender people and people who love them and don’t want them to be tortured for the sake of your moral vanity.
Making a transgender woman use the men’s room makes them less safe, and imperils no women not already imperiled.
Equal protections means you use the pronouns someone prefers, or ultimately are charged with verbal assault — when you refuse, you are of course really saying the person does not really exist. It’s the same as calling a “black” person, “n~~~~r”, you’re only conceivable purpose is to get away insulting them and denying their humanity. And of course, the usual victims of you are cisgender women who aren’t pretty enough for you.
With regard to athletics the rational standard is the last two years of testosterone blood levels. That does not let you virtue signal, so you’ll reject that.
Seems like the people screaming the very cisgender Imane Khelif was a man were the ones looking for attention.
Imane Khelif is not “ciswoman”. Magnus Hirschfeld would have considered Imane one of the intermediate sexual types. Hirschfeld never misconstrued gender as biological sex, nor sexuality as either sex or gender. Nor did he mutilate the language and grammar in order to confound these categories. On the contrary, he enriched both our vocabulary and the ontological and conceptual horizon, by inviting us to add as many new categories as needed.
This story has elements of the Children’s Crusade about it. A mass delusion is being fed by what I believe to be a small group of medical practitioners, primarily paediatricians, psychiatrists and surgeons. The medical colleges and associations whose leadership rarely represents the average practitioner are complicit. I dread to think what medical insurance coverage will cost doctors in ten years time when patient regret sets in.
It’s unsurprising as the US is a mental health disaster led by the mania of social media and the disciples of Satan upon the Earth: the Democratic Party.
Every one of the surgeons who carried out these ops should be serving time for grievous bodily harm.
The American Society of Plastic Surgeons recently became the first major medical organisation in the US to publicly reject the GAC model,
ie Our insurance companies have warned us that we are likely to get our arses sued when the lawsuits for “low evidence based” irresversible surgeries start arriving.
But then again-I’m a cynic!
You’re probably right. Ethics and morality hmm… but they really don’t like it up em financially.
“the leasing (sic)standard-setting organisation for transgender medical treatments”. This really shouldn’t be said as the earlier release of the ‘WPATH files’ has demonstrated that this is a pressure group, staffed with activists, masquerading as a serious healthcare organisation which it surely isn’t
Thank you for noting, as the article should have done, that WPATH has now been largely discredited.
Can we call this what it is, mutilation? After all that’s what the West refers to what Africans do/did to their daughters.
The deeper question here is why so many girls have decided they don’t want to be girls. I think the answer will be found in the dramatic physical and emotional changes of puberty that affect them in much different ways than they do in boys, who welcome the increased musculature and other secondary sexual characteristics. Some non-zero number of girls, finding themselves occupying a much, much different and sometimes quite frightening position in the world by way of their own new physical characteristics, may be simply trying to default to what may feel like a safer non-female status, either as trans boys or non-binary “theys.” And in Western countries that seem to value traditional, equivalent but different gender roles for females less and less, it can seem like a reasonable choice. Many such ambivalent girls will eventually grow out of this period of anxiety about their new status, but hurrying them into irreversible surgical procedures only makes it permanent. Nothing in this view amounts to any form of mistreatment of girls and young women who find themselves in this position.
Dig just a tiny bit & you’ll find $$$$$$
there. Trans lobby is very happily supported by medical butchers.
the ability, and willingness, of the DemoProgUnionMedia cabal to paint anyone who is against this abuse as being anti-trans, is astonishing. Evil. And politically very effective.
.
no one wants to tell the Emperor that cutting his 14 y/o daughter’s breasts off is a really bad idea. It’s so trendy!
Uhuh.
Now, does Duggan have the honesty to report the regret rate resulting from such surgeries? It’s really low. Only regret at having such surgeries by the poeple having them is evidence against them being carried out.
I’ll report that regret rate gleefully, of course, because measured reality is on my side of this.
Well, since most of them are 2-3 years post-surgery, and not even 25 yet, regret has not set in. That will be in the next 10 years. You perverted psychotic grooming butchers have much to answer for.
No, most are not 2~3 years post surgery. There is no record of any increase in regret rate after age 25, or by 35. You are making up what you hope is true. There is no grooming and the psychosis is all on the “gender critical” side of this.
You insist even though all the evidence is against you, that one of these two falsehoods is actually true: That gender in fact has not physical existence, or, that it is always identical to the sex of a person.
Because you believe one of those two obviously false things, you are clearly deluded.
I found your Quora page. Your picture shows the “real you”. Sir, you do not pass.
When the special function of a woman’s body as the bearer of children is not valued, and on the contrary is viewed as a burden which inhibits their advancement in the workplace, then it shouldn’t be surprising that girls want to rid themselves of it. Furthermore, political forces have convinced young women that abortion is an acceptable route to avoiding the reproductive function (rape related abortions represent about 1% of all abortions), and so many have rejected giving birth as a lifestyle choice after conception.
Appalling.
The numbers are small compared to the number of British girls who have their genitals mutilated each year. Think about that.
What’s your point? Both are evil. Neither excuses or exempts the other.