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Trends in Gender Dysphoria and Gender Affirmation Surgery in Pediatric Hospitals
Rachel Danforth MD, Julia Cook MD, Eric Pittelkow MD, Sidhbh Gallagher MD, Patrick Gerety MD
Indiana University
2019-02-15
Presenter: Rachel Danforth
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting. The program director is responsible for making a statement within the confines of the box below specific to how much of the work on this project represents the original work of the resident. All authors/submitters of each abstract should discuss this with their respective program director for accurate submission of information as well as the program director's approval for inclusion of his/her electronic signature.
Director Name: William Wooden
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Background: The reported prevalence of gender dysphoria among American youth has increased significantly and is estimated to be 0.2 to 1.3%. Plastic surgeons are essential to serving the needs of the transgender population. The presence and treatment of gender dysphoria in adolescents at major tertiary pediatric centers is not well described nor is the incidence of gender affirmation surgery. This study analyzes these factors from a large multicenter database.
Methods: The Pediatric Health Information System (PHIS) database was used to identify patients with encounters for gender dysphoria. Criteria included age over 10 years and primary diagnosis code for gender dysphoria(ICD-9 302.6, 302.85; ICD-10 F64.1, F64.2). Records were reviewed for mental health disorder, CPT codes, and encounters per year.
Results: 4,731 encounters were identified among 2,514 patients. Mean age was 13.6 ± 2.9 years. Plastic surgeons were the primary provider in 71 encounters(1.6%). The number of encounters significantly increased from 67 in 2004 to 682 in 2018(p<0.01). Diagnosis of mental health disorder was present in 55.2% of patients(n=1387). Twenty-five patients had procedure codes consistent with gender affirmation surgery; mean age for this group was 16.9(±2.2) years. This included 20 mastectomy/breast reduction operations, 3 breast augmentations, 1 orchiectomy, and 1 clitoroplasty.
Conclusions: The number of encounters for gender dysphoria in pediatric tertiary centers has significantly increased since 2004. Treatment of adolescents in this setting for gender dysphoria and gender affirmation surgery remains rare. These numbers are likely to increase as expertise in the field and acceptance of the diagnosis become more widespread.
