Number rises to thousands of girls under age 18, according to Manhattan Institute analysis
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Since 2017, hundreds of females age 12 and younger with gender dysmorphia have undergone double mastectomies, according to analysis released by the Manhattan Institute this week.
The breast removal surgery, sometimes called "top surgery," aims to create a "more masculine-looking chest," as stated on Cleveland Clinic’s website.
Leor Sapir, PhD, a fellow at the Manhattan Institute whose areas of research include pediatric gender medicine, shared that anywhere from 5,288 to 6,294 double mastectomies were performed on girls under age 18 between 2017 and 2023 — and that 50 to 179 of those girls were just 12 years old or younger.
This was based on analysis of an "all-payer national insurance database," including patients who were previously diagnosed with gender dysphoria and had the treatment covered by insurance, Sapir wrote in an article revealing the findings.
The actual numbers could be higher, the Manhattan Institute claims, because researchers did not include patients who paid for the procedure themselves without submitting an insurance claim.
"The out-of-pocket costs of ‘top surgery' can be as low as $3,000, a sum many middle-class families can afford," Sapir wrote.
If any procedures were entered under different codes for billing, those would also not show up.
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Prior research has suggested different numbers.
An October 2022 study led by Vanderbilt University School of Medicine — published in JAMA Network — found that there were only 489 top surgeries performed on adolescents in 2019.
Since 2017, hundreds of females 12 and younger with gender dysmorphia have undergone double mastectomies, according to data analysis. (iStock)
In August 2023, however, researchers from Columbia University College of Physicians and Surgeons and the Department of Obstetrics and Gynecology at University of Southern California found that 3,678 minors received "gender-affirming surgery."
That study was also published in JAMA.
Those studies both used different and more limited data sources than Manhattan Institute's study, the company told Fox News Digital.
In June, the Biden administration spoke out against gender-affirming surgery for transgender minors for the first time, as reported by The 19th.
"These are deeply personal decisions and we believe these surgeries should be limited to adults," a White House spokesperson said in an email, according to the outlet.
"We continue to support gender-affirming care for minors, which represents a continuum of care, and respect the role of parents, families and doctors in these decisions."
‘Of deep concern’
Psychologists have spoken out about the mental health consequences of these types of procedures — including Dr. Jonathan Alpert, a Manhattan-based psychotherapist and author.
"Taking a scalpel to a psychological disorder is of deep concern to me, especially when it comes to minors," he told Fox News Digital.
Psychologists have spoken out about the mental health consequences of certain types of surgeries. (iStock)
Alpert said he takes issue with the phrase "affirming care and treatment."
"What does it really mean to affirm?" he asked. "In many cases, I have seen people suffer significantly because they have sought treatment from therapists who do just that — affirm."
"Taking a scalpel to a psychological disorder is of deep concern to me, especially when it comes to minors."
"They nod their heads, agree with everything their patient says, and validate all their thoughts, feelings and behaviors — even if it’s clearly unhealthy."
While it’s normal for kids and teens to question their evolving feelings about gender identity, Alpert said, "they are being rushed into gender-affirming treatment and surgeries, rather than having their thoughts explored and challenged."
While it’s normal for kids and teens to question their evolving feelings about gender identity, "they are being rushed into gender-affirming treatment and surgeries, rather than having their thoughts explored and challenged," a psychotherapist said. (iStock)
"This unhealthy trend can unwittingly trap therapy patients in a cycle where the patient relies heavily on the therapist to feel good and continue to get validation, and the therapist relies on the patient to maintain their business."
Developmental concerns must be considered, the doctor emphasized, as minors are still undergoing physical and emotional changes.
"Surgery is not appropriate for a child's ever-changing sense of identity," Alpert said, warning of long-term psychological consequences.
"Depression, anxiety and substance abuse are chief among these concerns," he added.
It’s also important to ensure that the minors and their parents fully understand the implications of such a "drastic intervention," according to Alpert.
Experts warn of the potential long-term psychological consequences of this particular type of surgery. (iStock)
"‘Wait and see’ might be preferred over taking action, as regret could very well be a consequence of surgical intervention, especially if gender identity evolves," he warned.
Dr. Marc Siegel, senior medical analyst for Fox News and clinical professor of medicine at NYU Langone Medical Center, said his view is the same as the current policy in the U.K. — "which is that gender-affirming surgery, including mastectomies, should not be performed on minors."
"There is too great a risk of [the patients] changing their minds later on," he told Fox News Digital.
The doctor also warned of the potential long-term risk of puberty-blocking drugs on bones, fertility and mental health.
"‘Wait and see’ might be preferred over taking action, as regret could very well be a consequence of surgical intervention."
"I think younger patients with gender dysphoria should be treated initially with psychotherapy and years spent exploring how they really feel — without the superimposition of politics or ideology," Siegel added.
"I think way too many of these [procedures] are done in the U.S., as the data shows."
Medical groups’ stances
Earlier this month, the American Academy of Pediatrics (AAP) reaffirmed its policy on supporting gender-affirming care for transgender youth, with plans to review new data and research that has been conducted since the original policy was released in 2018.
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The American College of Pediatricians (ACP) and allied groups styling themselves as "Doctors Protecting Children" have published a declaration urging mainstream American medical associations like the AAP to abandon support for gender-affirming care.
Hundreds of people attend the "1 Million March for Children" rally organized by the parents' group "Hands off Our Kids" at Queens Park in Toronto, Ontario, Canada, on Sept. 20, 2023. (Mert Alper Dervis/Anadolu Agency via Getty Images)
"As physicians, together with nurses, psychotherapists and behavioral health clinicians, other health professionals, scientists, researchers, and public health and policy professionals, we have serious concerns about the physical and mental health effects of the current protocols promoted for the care of children and adolescents in the United States who express discomfort with their biological sex," the declaration states.
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The American Society of Plastic Surgeons (ASPS), for its part, provided the below statement to Fox News Digital on Thursday.
"ASPS does not issue policies favoring or opposing any surgical procedure. The Society does issue Evidence-Based Clinical Practice Guidelines, which provide recommendations for patient care based on the best available evidence in the scientific literature. To date, ASPS has not issued a clinical practice guideline on gender surgery for adolescents or adults. We are currently in the stage of assessing the available evidence regarding gender surgery in minors, which, as we stated, is generally viewed as low quality/low certainty."
Fox News Digital also reached out to the AAP and the American Gynecological & Obstetrical Society (AGOS) for comment.
Chris Pandolfo of Fox News Digital contributed reporting.
Melissa Rudy is senior health editor and a member of the lifestyle team at Fox News Digital. Story tips can be sent to
