About 29% of transgender people in the United States have had at least one gender-affirming surgery, according to the 2022 U.S. Transgender Survey, the largest survey of trans Americans. That number is lower than many people expect, and the gap between who wants surgery and who has actually received it tells an important story about access, cost, and personal choice.
How Many Trans People Have Had Surgery
The 29% figure from the 2022 U.S. Transgender Survey represents any surgical procedure, from chest surgery to genital reconstruction to facial procedures. A separate study of over 2,100 transgender, nonbinary, and gender-diverse adults found a somewhat higher rate of 43.5% having undergone at least one form of gender-affirming surgery. The difference likely reflects how each study recruited participants and defined its population.
What both studies agree on is that a large portion of trans people who want surgery haven’t gotten it. In the second study, 94% of participants reported encountering at least one barrier to surgical care. The gap between desire and access is significant: many trans people actively want procedures they haven’t been able to obtain.
Which Surgeries Are Most Common
Not all gender-affirming surgeries are equally common. Among those who do have procedures, chest and breast surgeries account for about 57% of all operations performed. These include mastectomy (often called “top surgery”) for trans men and nonbinary people, and breast augmentation for trans women. Chest procedures are generally less expensive, involve shorter recovery times, and are more widely available than other options.
Genital reconstructive surgeries make up about 35% of procedures. For trans women, this typically means vaginoplasty. For trans men, options include phalloplasty or metoidioplasty. These are complex operations with longer recovery periods and fewer qualified surgeons, which partly explains their lower frequency.
Facial procedures, including facial feminization surgery, account for roughly 14% of gender-affirming operations. Among trans women specifically, only about 7% have had facial feminization surgery, even though 74% expressed interest in it in one survey. The gap is enormous, and insurance coverage is a major reason. Tracheal shave (a procedure to reduce the visible Adam’s apple) is the most consistently covered facial procedure, available through insurance policies in 30 states, while other facial surgeries remain excluded from most plans.
Why the Number Isn’t Higher
Cost is the single biggest factor. More than half (55%) of trans people who sought insurance coverage for surgery in the past year were denied. Even among those with some coverage, 42% reported their insurance only covered part of the surgical care they needed. Another 21% found that while their plan technically covered surgery, there were no in-network providers available to perform it. Out-of-pocket costs for genital surgery can range from $20,000 to over $100,000 depending on the procedure, putting it out of reach for many people without insurance support.
Beyond money, other barriers include long wait lists (sometimes stretching years for experienced surgeons), the requirement for letters from mental health professionals, geographic distance from surgical centers, and the reality that major surgery requires time off work and a support system during recovery. For some people, medical conditions may also complicate eligibility.
It’s also worth noting that not every transgender person wants surgery. Some are satisfied with hormone therapy alone. Others feel comfortable without any medical intervention. Being transgender doesn’t come with a requirement to pursue any particular treatment, and the percentage who want surgery varies depending on the type of procedure.
What About Nonbinary People
Nonbinary individuals, those who don’t identify strictly as male or female, pursue surgery more often than many assume. Research from the University of Melbourne found that 44% of nonbinary people want both hormones and surgery, while only 8% want neither. Nearly half of nonbinary respondents had either undergone surgery or wanted it.
Among nonbinary people assigned female at birth, 23% wanted surgery but hadn’t accessed it yet. For those assigned male at birth, that figure was 26%. The types of procedures nonbinary people seek can differ from binary trans individuals. Some want chest surgery but not genital procedures, or pursue specific facial changes without a full suite of feminizing or masculinizing operations.
Satisfaction After Surgery
Among those who do have surgery, regret is rare. A systematic review published in The American Journal of Surgery found that the regret rate after gender-affirming surgery is approximately 1% or less. That’s lower than regret rates reported after many other common surgeries and major life decisions. The review compared gender-affirming procedures to other surgical specialties and found it consistently at the bottom of the regret scale.
This high satisfaction rate holds across procedure types, though outcomes depend heavily on surgeon experience, the specific technique used, and whether patients had realistic expectations going in. Post-surgical satisfaction is one of the most consistent findings in this area of medicine.
The Numbers in Context
The 29% figure is a snapshot of a population facing real structural obstacles. It doesn’t reflect how many trans people would choose surgery if cost, insurance, and access weren’t factors. When researchers ask about desire rather than completed procedures, the numbers climb substantially. The more useful way to read the data: roughly a third of trans Americans have had surgery, a larger group wants it but faces barriers, and a smaller group doesn’t want or need surgical intervention at all. Insurance coverage has been slowly expanding, with commercial policies increasingly including facial and other procedures that were previously excluded, but the pace of change remains slow relative to demand.