While there is no comprehensive data set tracking the number of children undergoing cross-sex procedures, and the cost of these procedures varies widely, existing data and experts in the field have shed light on a highly profitable and quickly growing market offering largely irreversible procedures to minors. Mastectomies and breast augmentations cost about $10,000, cross-sex genital surgeries cost about $25,000, plus several thousand dollars for anesthesia and a hospital stay, and facial and other cross-sex surgeries range from $2,000 to $15,000, according to the Philadelphia Transgender Surgery Center’s (PTSC) 2019 price list; those prices have gone up in recent years, an employee told the DCNF, but the clinic has not released an updated list and wouldn’t disclose its new prices without a patient consultation.

“There is no question that financial rewards play a role in the adoption of gender affirming care,” Dr. Stanley Goldfarb, board chair of Do No Harm and former Associate Dean for Curriculum at the University of Pennsylvania School of Medicine, told the DCNF. “Hospitals and physicians generate substantial payments from insurers or self-pay patients when children enter into the transition protocols.”

“No matter what other motives come into play, there is no way that the surgical and medical activities would be embraced by various gender clinics and hospitals if they were financially harmed by these clinical activities,” Goldfarb added. (RELATED: ‘Groomed And Preyed Upon’: Young Woman Was Pressured Into Mastectomy, Testosterone As A Child — Now She Regrets It)

About 300,000 children in the U.S. identify as transgender, according to the University of California Los Angeles Williams Institute, though not everyone who adopts a transgender identity seeks a medical transition. While many of these children undergo surgical procedures, particularly mastectomies, a larger portion receive puberty blockers and/or hormones, which provides a continuous stream of revenue to pharmaceutical companies and medical providers.

There are more than 100 gender clinics in the U.S. that treat children, according to Reuters, and each of these clinics would need to see at least 100 patients annually to be successful but are likely seeing as many as 300 a year, Goldfarb told the DCNF. By that estimate, there are likely at least 10,000 to 30,000 children undergoing some form of gender transition in the U.S. each year.

The overall cross-sex surgery market was valued at $1.9 billion in 2019 and is projected to rise to $5 billion by 2023, according to Grand View Research, which attributed rising market value to the increased prevalence of transgender identification and improved insurance coverage for the procedures. The rise in transgender identification has been heavily concentrated among the youth population.

The medical industry is acting on these financial incentives: Johns Hopkins Medicine has been lobbying the Maryland legislature to expand Medicaid coverage of transgender procedures to include a host of interventions typically considered cosmetic, such as Adam’s apple reduction, facial contouring and laser hair removal, according to a DCNF investigation. The American Society of Plastic Surgeons, a professional association, has been fighting against state legislation restricting child sex change procedures and advocating for expanded coverage of trans procedures since at least 2017.

A woman identified as Dr. Shayne Taylor of the Vanderbilt University Medical Center (VUMC) reportedly touted the profitability of gender surgeries during a lecture in 2018, the same year VUMC opened its gender clinic, according to the Daily Wire. VUMC offered hormones and double-mastectomies to minors who identified as transgender to help them present as the opposite sex until it paused the procedures in late 2022 following pressure from the state legislature.

“This is only including top surgery, this isn’t including any bottom surgery, and it’s a lot of money. These surgeries make a lot of money,” Taylor said. “So a female to male chest reconstruction can bring in $40,000. A patient who just got routine hormones treatment who I’m only seeing a few times a year can bring in several thousand dollars without requiring a lot of visits and labs. It actually makes money for the hospital.”

From 2017-2019 at least 56 genital surgeries and 776 mastectomies were performed on minors in the U.S., though this data only includes minors who had formal gender dysphoria diagnoses and had their surgeries covered by insurance, according to insurance data analyzed by health technology company Komodo Health Inc and originally reported by Reuters. The data set doesn’t account for the likely much higher numbers of children undergoing such surgeries in more recent years amid skyrocketing rates of youth transgender identification.

“There’s money to be made, but not from the single cost of a procedure,” Mary Hasson, director of the Person and Identity Project at the Ethics and Public Policy Institute, told the DCNF. “The gender docs are creating a steady money stream by converting adolescents with healthy bodies into ‘consumers’ of drastic medical procedures that turn them into lifelong medical patients, dependent on additional drugs, surgery, and psychological help to live a stable life.”

“Unfortunately, as we know from the suicide studies, the promised long-term happy result is illusory,” Hasson said.

Based on PTSC’s estimates, the 259 minors annually undergoing top surgery prior to 2020 likely brought in about $2.6 million — and this only includes minors whose surgeries were covered by insurance and who had formal gender dysphoria diagnoses. Genital surgeries are rare for children, but if about 19 minors had those procedures annually prior to 2020, as Komodo’s data suggests, that would bring in $570,000 per year for child genital surgeries.

A sex change patient who begins treatments during puberty incurs massive costs immediately; the puberty blocker Lupron-Depot-PED costs about $2,000 a month, according to Drugs.com, so a youth patient who takes the drug from age 14 to 16 would spend $48,000 over two years of treatment. Cross-sex hormones, the next step of medical transition, are far less expensive than blockers. They’re typically offered at age 16, according to England’s National Health Service, and though some may eventually stop taking them, patients must continue treatments for the duration of their lives to continue seeing its full effects, according to Duke Health.

Hormones cost about $10 per month, according to Lurie Children’s Hospital; a patient who starts hormones at 16 and continues until age 80, would spend about $7,600 on the drugs over the course of a lifetime. The cost of routine medical visits to monitor a hormone patient would presumably be much higher; Taylor estimated hospitals rake in “thousands” each year from one patient taking hormones.

Advocates for child gender transitions argue that the procedures are medically necessary to address the mental health and suicide risks among transgender people and to allow them to live as their authentic selves. Several DCNF investigations and reviews have disputed claims that medical gender transitions reduce mental health problems and suicide risks.

“While transgender activists have tried to pass off their cause as a civil rights movement, it is more accurate to describe it as a profit-making machine,” Terry Schilling, president of American Principles Project, a group that opposes child gender transitions, told the DCNF. “‘Gender transitions’ are a lucrative business, enriching Big Pharma as well as numerous hospitals and clinics. And as the number of people claiming a transgender identity has exploded, so has the industry catering to their desires.”

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