Children’s hospital in Colorado halts ‘gender affirming’ surgeries, citing surge in requests

Denver, Colo., Jul 26, 2023 / 15:30 pm

Children’s Hospital Colorado will stop performing purported “gender-affirming” surgeries on patients aged 18 years and older, citing an “unprecedented” number of referrals and a need to focus on pediatric patients.

The surgeries involved “chest reconstruction,” the Denver Post reported. The procedures remove breast tissue to create a masculine appearance for women who identify as men. Staff are now referring prospective surgery patients to other hospitals.

The hospital said it has not performed such surgeries on patients under age 18, though it continues to provide puberty blockers and hormones and other services that aim to affirm the self-identified gender of some patients.

“We have been receiving unprecedented referrals for gender-affirming care, and in order to continue delivering expert multidisciplinary care to our pediatric patients and their families, we have made the difficult decision to no longer provide gender-affirming surgical procedures for adult patients 18 years of age and older,” the hospital told CNA in a statement.

Though a spokesperson for Children’s Hospital Colorado told the Denver Post last week that children’s hospitals have been “directly threatened as a result of the gender-affirming care provided in their institutions,” she later told NBC News that threats to other hospitals did not drive the decision.

The hospital’s TRUE Center for Gender Diversity still provides puberty-blocking medicines, cross-sex hormone therapy, and counseling as well as referrals to other services, according to its website.  

“Using puberty blockers can avoid body changes that do not align with your identity,” the TRUE Center website says. It says hormone therapy can help produce secondary sex characteristics like voice pitch and breast development “that align with your gender identity.”

Catholic ethics rejects the removal of healthy sexual organs as a form of mutilation, according to an FAQ by the National Catholic Bioethics Center. The Catholic vision of the person as a unity of body and soul means that a person cannot change his or her sexual identity.

Purported gender-affirming drugs and procedures, especially for minors, have also drawn political scrutiny, public protest, and sometimes threats.

In November 2022, the New York Times published an article questioning the use of puberty blockers, which are often presented as a safe, reversible option. There are various protocols for using the drugs, little documentation of patient outcomes, and the drugs are not government-approved for use in gender therapies.

The drugs are prescribed as early as age 8 so that self-identified transgender patients can begin cross-sex hormones at age 12 or 13. However, puberty can help clarify self-perceived gender, and patients could be making life-altering choices prematurely. Among those who have used the drugs, bone strength analysis finds that their bone growth does not fully rebound. 

There are also concerns that the drugs’ interference with hormonal development could disrupt mental growth and brain development in areas such as critical thinking, sophisticated self-reflection, social skills, and problem-solving skills.

“Our team is now working with impacted adult patients to explore referrals to the many other hospitals in the region that provide this care for adults,” the hospital said in its statement. “Children’s Hospital Colorado takes a holistic approach to ensure a patient’s mental and physical needs surrounding their gender identity and expression are met.”

An unnamed woman whose child was seeking to schedule chest reconstruction at Children’s Hospital Colorado after turning 18 this fall spoke about the changes to The Denver Post. 

Before they could schedule the surgery her child’s primary care physician and a psychologist had to evaluate the child’s physical health and ability to make a decision about the procedure. Health insurers also had to agree to pay for the procedure.

She said her child has now been referred to the University of Colorado Hospital’s surgery center. She told the Denver Post the whole process has to restart, thwarting her child’s goal of finishing the surgery before leaving for college next year.

Colorado is the first state to define gender-affirming care as an essential health benefit and requires coverage of it in individual plans and small group plans, according to the website of the Division of Insurance at the Colorado Department of Regulatory Agencies. Colorado’s Medicaid program will streamline the process to provide people on Medicaid access to the drugs and surgeries on Aug. 30, 9 News reported.

An October 2022 Reuters report on children seeking gender care said 776 U.S. patients aged 13 to 17 with a prior gender dysphoria diagnosis underwent mastectomies from 2019 to 2021. This figure, compiled by health technology company Komodo Health Inc., was based on insurance claims data and did not include procedures paid for out of pocket. Genital surgeries were performed on another 56 patients in this time period.

The procedure is uncommon for patients under age 18, with some hospitals and gender clinics requiring patients to be adults. The surgical procedures are irreversible and have a heightened risk of complications, Reuters reported.

At least 121,882 children ages 6 to 17 were diagnosed with gender dysphoria from 2017 through 2021, Reuters said. It defined this dysphoria as the distress caused by a discrepancy between a person’s gender identity and the gender assigned to them at birth.

In the same period, at least 4,780 adolescents started on puberty blockers and at least 14,726 started hormone treatment.