False Parallels: How Misleading Comparisons Downplay the Severity of Widespread Child Sex Change Interventions

A 2024 paper published in JAMA Network Open tries to dismiss concerns over children being subjected to dangerous medical procedures for the purposes of “affirming” their self-professed gender.

But the authors’ arguments don’t add up.

The paper, titled “Prevalence of Gender-Affirming Surgical Procedures Among Minors and Adults in the US” by Dai, et. al, seeks to examine the extent to which children and adults received “gender-affirming” surgical procedures in 2019.

In doing so, it classifies procedures to treat gynecomastia (an abnormal increase in the amount of breast gland tissue) in “cisgender” males as “gender-affirming care,” and then uses this sleight-of-hand to downplay the severity of widespread child sex change interventions.

The authors sum up their argument here:

“[W]hen considering breast reductions among cisgender males and TGD [“transgender and gender diverse”] people—a surgery that can be considered gender-affirming among both populations—most were performed on cisgender males. Thus, these findings suggest that concerns around high rates of gender-affirming surgery use, specifically among TGD minors, may be unwarranted.”

There are a few problems with this reasoning.

First, and most saliently, it is simply inaccurate to conflate breast reductions performed on “cisgender” males for the purposes of addressing gynecomastia with breast reductions performed on healthy females for the purposes of aligning their bodies with the sex traits of men.

This is a category error at best, and outright misleading at worst. The JAMA article’s authors are inappropriately expanding the definition of “gender-affirming care” to encompass the former category. A boy suffering from gynecomastia isn’t receiving treatment to modify his body in accordance with the opposite sex. Conversely, a female who removes her healthy breast tissue to appear more like a male does not have any abnormal physical conditions.

This is comparing apples to oranges.

Second, the argument is a non sequitur. It does not follow that a high number of “cisgender” males undergoing such procedures means that concerns over females undergoing such procedures are somehow unwarranted; the authors concede that the procedures are still taking place!

And there’s a further wrinkle that undercuts the authors’ argument.

The prevalence of gynecomastia among adolescent males during puberty can range as high as 69%. The JAMA paper notes that 653 “cisgender” (507 adults and 146 minors) males received breast reductions in 2019. That’s a relatively small number amidst a massive denominator.

Conversely, the clinical prevalence of gender dysphoria ranges from anywhere between 4.6 and 7.5 per 100,000 individuals, based on reports authored within the last decade by many of those who were instrumental in WPATH’s Standards of Care-8. This is a drastically smaller pool of patients than those males with gynecomastia. 

Yet within this pool of patients with gender dysphoria, the surgical numbers are extraordinarily significant, especially when viewed as a percentage of the clinically-relevant population. The JAMA authors estimate that “the rate of undergoing a gender-affirming surgery with a [gender dysphoria]-related diagnosis was 5.3 per 100,000 total adults compared with 2.1 per 100,000 minors aged 15 to 17 years” – with the overwhelming majority (96.4%) of surgeries in minors being for “chest-related procedures.” 

In other words, gynecomastia is fairly common with a relatively small number of individuals receiving surgical treatment, and gender dysphoria is comparatively less common with a much higher percentage of individuals undergoing surgery. Given the very different sizes of the two groups, comparing the raw number of “cisgender” males receiving breast reductions to gender dysphoric females having similar surgeries is again a comparison of apples to oranges.

And finally, the JAMA authors make a very bizarre choice when deciding what data to use in their comparisons. The authors go on to compare only “breast reductions” for minors suffering from gender dysphoria to “breast reductions” for “cisgender” males.

But a breast reduction is not the only chest-related procedure for the purpose of “gender affirmation.” Indeed, many cosmetic breast alterations for the purposes of “gender affirmation” are not coded as breast reductions but as mastectomies, for example. That’s what we primarily saw in the Stop the Harm database when diving into the numbers; for 2019 approximately 5% of “chest-related procedures” were coded as breast reductions.

This will undoubtedly skew the results.

If anything, the authors should have at least compared the universe of pertinent “chest-related procedures” in individuals suffering from gender dysphoria to the universe of “chest-related procedures” in “cisgender” males, not cherry pick “breast reductions” alone. This would still be wrong as, again, a chest-related procedure for the purpose of treating gynecomastia is categorically different from one to “affirm” an individual’s gender, but it would at least be the accurate application of the authors’ own logic.

On multiple levels, the JAMA authors aren’t making like-to-like comparisons.

They’ve erroneously expanded “gender-affirming care” as a term beyond its use in gender dysphoria. They’ve then inflated a comparison of numbers between a relatively common physiological condition (gynecomastia) in males with the smaller – though still significant – population of those suffering from gender dysphoria. 

And, lastly, even using their own logic, they’ve very narrowly presented data on “breast reduction” instead of looking at the universe of “chest-related procedures.”  
The JAMA study seems to be an obfuscation to say the least.