The numbers rose in all categories, with male-to-female confirmation surgeries climbing by 27 percent and female-to-male operations by 10 percent. The statistics reflect only procedures performed by board-certified members of the American Society of Plastic Surgeons, which only recently began tracking the procedures.
Until now, U.S. transgender data of all kinds have been hard to come by — because of poor research surveys, limitations in the gender language on medical records and the reluctance of the transgender community to discuss its status.
“The changes over the last four or five years — societal, insurance, the generally favorable media attention — have resulted in a dramatic increase in the number of surgeries,” said Loren Schechter, an ASPS member who has been performing transgender procedures in the Chicago area for the past two decades.
“The barriers were hospitals,” Schechter noted. “It was extremely difficult to get hospitals to agree. Some for financial reasons, some were faith-based institutions, some we never got clear-cut answers, they just said 'No.' At the time, many people had to leave the country for surgery. Then the winds started to change.”
A 2014 ruling by a U.S. Health and Human Services Department review board was a watershed moment, Schechter said, overturning Medicare's 33-year ban on covering gender-confirmation surgery. The earlier decision explained that the procedure was still considered experimental, medically risky and controversial.
A number of organizations, including the American Civil Liberties Union, sued in 2013 to end the ban. Their plaintiff was Denee Mallon, then 74. The Albuquerque senior had spent 30 years being denied the opportunity to fully transition from male to female. At first, it was the lack of support from psychiatrists, whom she needed to approve the surgery, then it was the lack of money.
It took suing the federal government for the funds to help her over the last hurdle. Mallon was shopping in Walmart when one of her lawyers reached her with news of the review board's action. She could have the surgery — if she could find a surgeon who took Medicare. Schechter, at Weiss Memorial Hospital in Chicago, was just the person she'd been looking for.
The following year, Mallon was wheeled into an operating room — becoming one of the 2,740 people to have a gender-confirmation procedure in 2015, according to the data just released by the American Society of Plastic Surgeons.
“When I woke up from surgery, I felt a certain sense of peace and tranquility,” she recounted Sunday.
Schechter pointed out that while Medicare “changed its blanket denial,” it allowed final coverage decisions to be made on a case-by-case basis.
Fewer than 100 board-certified plastic surgeons, in 11 states, are doing gender-confirmation procedures. Alan Matarasso, incoming president-elect for the ASPS, thinks their ranks will grow rapidly with more educational and training opportunities. And the number of surgeries could double in the next five years, he expects.
“Like many things, its time has come,” he said. “It often takes a series of events that makes the timing right. Media attention and Caitlyn Jenner didn’t hurt, also the political climate that we’re in that’s perhaps more accepting of this. We have a greater understanding of the needs of this population. … This is a biological condition, not an illness.”