HHS report cites inaccurate data to claim more than 5,500 trans minors received 'sex change surgeries'

Claim: As cited by the U.S. Department of Health and Human Services, a database from anti-trans group Do No Harm proves that from 2019 to 2023, more than 5,500 minors in the United States had sex change surgeries. Rating: An August 2026 U.S. Department of Health and Human Services report claimed that "watchdog analyses tracking" had determined more than 5,500 minors had undergone "sex change surgeries" from 2019 to 2023. The "watchdog analyses tracking" references an anti-LGBTQ+ group that inflated the data by counting a vast number of procedures entirely unrelated to "sex change surgeries," including hair removal, surgical removal of excess eyelid skin and bladder drainage. These procedures were counted in the "sex change surgery" statistic as long as the patient had a gender dysphoria diagnosis or a psychiatric condition related to crossdressing (which is different from being trans). As with any other person's healthcare, there are many reasons why a trans person may need these procedures that have nothing to do with being trans. Credible data indicates that gender-affirming surgeries are rarely performed on minors, and most minors who receive them are not actually trans, but cisgender boys getting chest reductions. A peer-reviewed study from Harvard University researchers in 2024 determined that in 2019, only 85 trans minors received gender-affirming surgery and most of them were age 15 to 17. The Harvard study found no gender-affirming surgeries conducted on children under 12. In August 2026, the Department of Health and Human Services under U.S. President Donald Trump released a report alleging that according to "watchdog analyses tracking," more than 5,500 minors had undergone "sex change surgeries" from 2019 to 2023. Here's what Page 9 of the report says (emphasis ours): Watchdog analyses tracking billed charges for minors from 2019 onward estimate almost $120 million in total hospital and clinic billings nationwide, encompassing over 5,500 surgical procedures and 8,500 courses of hormones or blockers. (14) (14) "What We Found," Stop the Harm Database, accessed March 12, 2026, https://stoptheharmdatabase.com/about/. ($119,791,202 in total submitted charges; 5,747 minors had sex change surgeries; 8,579 minors received hormones and puberty blockers). Social media users across Facebook repeated the supposed statistic and cited the report, including Republican U.S. Rep. Diana Harshbarger, a pharmacist from Tennessee (screenshot). Similar posts included a video of Adm. Brian Christine, assistant secretary for health at HHS, who claimed that there were more than "5,500 sex-rejecting procedures" performed on minors (screenshot). Snopes readers searched the website to investigate the legitimacy of this statistic. The HHS report pulled this number from a database of supposed surgeries created by Do No Harm, an advocacy group that opposes gender-affirming care for trans minors and diversity, equity and inclusion efforts in medicine. The Southern Poverty Law Center, a civil rights organization that tracks extremist organizations, has designated Do No Harm as an anti-LGBTQ+ hate group. Do No Harm's methodology report lists insurance codes — standardized codes insurance companies use to describe various health care procedures and treatments — that the organization used to come up with the statistic. However, a Snopes review of the report found that many of these codes are entirely unrelated to "sex change surgeries," thus contradicting Do No Harm's claims. Furthermore, both a peer-reviewed study from Harvard University researchers and a Reuters analysis found far lower rates of gender-affirming surgeries among trans minors. In truth, for minors, these surgeries are exceedingly rare and occur only among older teenagers. As such, we have rated this claim as false. A spokesperson for Do No Harm, Caroline Anderegg, said in an email that answers to our questions could be found on Do No Harm's methodology page and report. Anderegg did not return a follow-up inquiry noting that the methodology report and page did not answer our questions about what insurance database the group used and how the group filtered the insurance codes to ensure the data included only "sex change surgeries." Methodology doesn't hold up to scrutiny Do No Harm's website for its "Stop the Harm Database" claimed that between 2019 and 2023, "5,747 minors had sex change surgeries." However, its methodology report said Do No Harm included insurance procedure codes for treatments that do not change a person's sex, including electrolysis for hair removal, bladder drainage, "removal of excessive skin of upper eyelid" and more (pages 17 through 20). These procedures are also not necessarily for gender-affirming care more broadly and can happen for many different reasons. Do No Harm said it included these procedure codes only when connected to a patient with a gender dysphoria diagnosis or transvestic disorder, a psychiatric condition where a patient experiences clinically significant distress or impairment due to sexual arousal while crossdressing (Page 17). However, a gender dysphoria code merely indicates that the patient is transgender, not that the procedure was done specifically to alleviate gender dysphoria, said Kellen Baker, senior adviser for health policy at the Movement Advancement Project, a nonprofit think tank known for tracking LGBTQ-related laws and policies. "I really cannot underscore to you how irregular the Do No Harm analysis is," Baker, whose work as a health services researcher involves identifying trans people in insurance claim databases, said in a phone call. There are many reasons why a trans patient might receive any number of these procedures that are unrelated to being trans. For example, a trans child could have a urine obstruction and need bladder drainage, or require excess skin removal for droopy eyelids impairing their ability to function. Furthermore, some of the codes, such as codes for intersex surgery, are used for intersex people, not transgender people. Intersex people are born with a variety of different sex characteristics that do not fit typical binary ideas of male or female bodies. Intersex infants and children in the United States sometimes receive surgeries, either for medical necessity or, more controversially, to align their bodies with more "typical" traits. Baker also pointed out that Do No Harm claims to use "an all-payer claims database" — a database with every open and shut insurance case — but did not reveal which database it used to find this information. He said that such a database with all insurance claim information does not actually exist. Gender-affirming surgeries rarely performed on minors There are very few studies on the number of gender-affirming surgeries done on minors, largely because the surgeries themselves are so rare, Baker said. However, Harvard researchers published a peer-reviewed study in 2024 that analyzed 2019 insurance claim data and found no incidences of a child under 12 receiving a gender-affirming surgery. Out of a total of about 22 million minors sampled, the study found only 85 instances of a minor undergoing a gender-affirming surgical procedure in 2019, with 82 of those instances involving chest-related procedures, presumably either a chest reduction or breast tissue removal, commonly known as top surgery. The vast majority of those instances involved teenagers ages 15 to 17. The study also found that far more cisgender boys — those who align with their gender assigned at birth — received gender-affirming chest reductions than transgender boys. Cisgender boys often receive these chest reductions because of gynecomastia, or physically harmless enlarged chest tissue that can affect their self-esteem and mental health. Snopes reached out to the Harvard researchers involved in the study for their thoughts on the Do No Harm database and did not immediately hear back. In 2022, Reuters, a credible news source, analyzed data from Komodo Health — considered the most complete health insurance database available — and found 238 mastectomies, or top surgeries, in 2019, 256 in 2020 and 282 in 2021 among trans minors. The analysis also found 56 genital surgeries among patients ages 13 to 17 with a prior gender dysphoria diagnosis from 2019 to 2021. However, the Reuters analysis did not appear to separate out trans youth who received these surgeries due to health issues unrelated to gender identity, unlike the peer-reviewed study from Harvard researchers. Furthermore, any increase in gender-affirming surgeries among trans minors has likely reversed due to the rise in anti-trans health care policies across the country and on the federal level, Baker said. The bottom line The data HHS cited in its report comes from an anti-LGBTQ+ group that used faulty analysis to inflate data on gender-affirming surgeries among trans minors. It's more accurate to say that from 2019 to 2023, more than 5,500 minors, many of whom had a gender dysphoria diagnosis at one point in time, received various procedures for any number of medical reasons, the vast majority of which were unrelated to being trans. Peer-reviewed research suggests that gender-affirming surgeries among minors are incredibly rare and usually involve cisgender boys undergoing chest reductions.