Transition-related surgery limited to teens, not 'young kids.' Even then, it's rare

Florida Gov. Ron DeSantis suspended Hillsborough State Attorney Andrew Warren, in part, for signing a pledge against the criminalization of gender-affirming health care.

Although Florida has not enacted any law prohibiting transgender medical treatment for children, DeSantis cited Warren's pledge not to prosecute doctors who offer these services as evidence of his neglect of duty.

DeSantis has mocked the term "gender-affirming care," which the U.S. Department of Health and Human Services says can include medical, surgical and mental health services for transgender and nonbinary people.

"When you have the 2021 letter saying … no matter what a state declares about protecting child welfare with respect, I mean, you know, they use these euphemisms," DeSantis said at an Aug. 4 press briefing announcing the suspension. "But what it is, is they're literally chopping off the private parts of young kids, and that's wrong."

This isn't the first time DeSantis suggested that "young kids" in the U.S. receive transition-related surgeries. DeSantis criticized these procedures in an Aug. 3 conference: 

"They want to castrate these young boys, that's wrong. We stood up and said, from the health and children's well-being perspective, you don't disfigure 10, 12, 13-year-old kids based on gender dysphoria."

We found no examples of doctors "literally chopping off the private parts of young kids," as DeSantis said. 

"That is not true under any existing medical guidelines," said Dr. Jack Turban, assistant professor of child and adolescent psychiatry at the University of California, San Francisco. "No medical or surgical interventions are considered for prepubertal children."

The governor's office sent PolitiFact two examples of people who received transition-related surgeries in their mid to late teenage years  — one at 15 and one at 17. DeSantis' Florida Department of Health differentiates between children (under 10) and adolescents (10-18).

In one case DeSantis provided, an individual from California received masculinizing chest surgery at 15. Under existing California law, an insurer cannot deny coverage for the surgery — which includes double mastectomies —  based on a patient's age alone. 

The procedure is mostly offered to teenagers 15 and older, The New York Times reported. However, we found one report of a 14-year-old who obtained the procedure, and there isn't a consensus on a specific age requirement among medical guidelines.

The other case involved Jazz Jennings, a transgender woman who stars in a reality television show on TLC. Jennings received genital reassignment surgery at 17.

Genital reassignment surgery should be reserved for those 18 and older, according to guidelines for the medical care of transgender patients developed by the Endocrine Society and the World Professional Association for Transgender Health, or WPATH.

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C.P. Hoffman, senior policy counsel for the National Center for Transgender Equality, told PolitiFact that cases like Jennings are not common. 

"Even when a minor has parental support for their transition, transition-related surgeries are not typically performed prior to the age of 18," Hoffman said. "While there are some reports of transgender teens between the ages of 16 and 18 receiving transition-related surgical care, these cases are exceedingly rare and based on the specific medical needs of the teen."

The American Academy of Pediatrics recommends what it terms a "gender-affirmative care model" for prepubescent children experiencing gender dysphoria  — distress people may experience because of the discrepancy between their gender identity and the sex assigned to them at birth. Gender-affirmative care is oriented toward understanding and appreciating a child's gender identity rather than providing puberty blockers, hormone therapy or surgery. 

"Before any physical interventions are considered for adolescents, extensive exploration of psychological, family and social issues should be undertaken," the WPATH guideline reads.

The beginning of puberty, which generally occurs between the ages of 10 and 12, is a baseline for medical intervention.

The Endocrine Society recommends against puberty blockers, which suppress the release of testosterone and estrogen during puberty, for prepubescent children. An adolescent can be prescribed the treatment at the onset of puberty.

Hormone therapy can follow the use of puberty blockers, although it isn't typically considered for patients younger than 16 years old, according to the Endocrine Society. 

WPATH recommends that "moving from one stage to another should not occur until there has been adequate time for adolescents and their parents to assimilate fully the effects of earlier interventions."

The association's criteria for initiating surgical treatment include "documentation of persistent gender dysphoria" and the "capacity to make a fully informed decision and to consent for treatment."

Under Florida law, a health care practitioner cannot provide or arrange medical services for a minor without parental consent. And many health insurance providers, including Aetna and Anthem, require a patient seeking genital reassignment surgery to be 18 or older to qualify for coverage.

Our ruling

DeSantis said, "They are literally chopping off the private parts of young kids."

DeSantis' office provided two examples of teenagers who received transition-related surgeries. The Florida Department of Health would define both cases as involving adolescents, and experts say the procedures are rare for minors and aren't typically recommended. There are no examples we could find, or the governor's office provided, of transition-related surgeries for people under the age of 14. 

Medical transitioning is not recommended for prepubescent children, as DeSantis suggested. We rate his claim Mostly False.