Fact check: 'In the US, performing sex reassignment surgery is mandatory even against medical advice, even on children'

"How many gender reassignment surgeries have been performed on preschool children in Hungary in the last 5 years?" – this written question was submitted to Minister of Interior Sándor Pintér by Tamás Mellár, a member of the opposition party Párbeszéd. State Secretary Bence Rétvári ended up answering in a long document, in which he lists Danish, Swedish and American examples. Let's look at these in detail!

Rétvári's first statement was that "In Denmark, the number of children who want to change their gender has more than doubled compared to 2016".

According to a Danish study, between 1980 and 2020, the annual number of legal sex changes for persons born female increased from 5 to about 170, and for persons born male from 10 to about 150. The total number of legal sex changes in 2019 was 1,275 (biological female to male) and 1,422 (biological male to female). Sixty-six percent of legal sex changes were performed on people under 30.

The number of gender identity-related contacts with the health care system increased from a total of 30 between 1990-1999 to around 500 in 2017 (both sexes combined), including a tenfold increase between 2010 to 2017. However, this research only looked at people aged 18 and over, not children. It is also important to note that this does not refer to sex reassignment surgery, but to legal change, and that the research also included those who only contacted health providers but did not ultimately undergo a sex change.

However, we were unable to find the specific statistics cited by Bence Rétvári.

"The number of girls who think they are boys has increased by 1500 percent in Sweden. Eighteen times more minors have asked for a sex change in the past 5 years than before," writes Rétvári. This is almost entirely true: according to an article by The Atlantic, for example, there are clinicians who genuinely believe that there is cause for concern about the increased number of teenagers seeking sex reassignment surgery in Sweden. Mikael Landén, a professor of psychiatry at the University of Gothenburg said that the number has increased seventeenfold since 2010.

Sweden introduced restrictions on sex-affirmation treatment for minors a year ago, citing concerns about long-term side effects. This limited form of treatment does not involve surgery, only taking hormones. The number of diagnoses of gender dysphoria (anxiety resulting from a discrepancy between someone's sex at birth and their gender identity) has sharply increased in recent years in Sweden, with the Swedish Health Authority reporting that this trend is particularly pronounced among 13 to 17-year-olds whose biological sex at birth was female: the number of those diagnosed in this group increased by 1,500% between 2008 and 2018.

Gender dysphoria can also include a desire to change primary and/or secondary gender characteristics, but not all transgender or gender fluid people experience dysphoria.

Without doubt, Rétvári's strongest claim was that "in the US, sex reassignment surgery is mandatory, even on children, against medical advice".

This is not exactly true: according to the Human Rights Campaign, an LGBTQ+ rights organisation, "transgender and non-binary people who begin transitioning in childhood or adolescence", i.e. leaving their birth gender and taking on another gender, which may be non-binary, "work closely with parents and health care providers, including mental health providers, to determine what age-appropriate changes should be made at what time and what is in the best interest of the child. All decisions throughout each of the various stages are made jointly by parents, the young person in question and health professionals, and no permanent medical interventions are made until the transgender person is old enough to give truly informed consent".

Puberty blockers can be prescribed by a doctor in consultation with the child, the parents and, if necessary, a psychologist, to temporarily prevent the body from going through the unwanted physical and developmental changes of puberty. The next potential step in the transition, the administering of sex-affirming hormones, is usually not available until the age of 18. Although adolescents may receive such hormones from their late teens onwards, it may only happen with a doctor's approval, parental consent and the informed consent of the adolescent in question, and is typically reserved for adolescents who have already been taking puberty blockers.

It is also worth noting that there is not only one gender reassignment surgery, but this includes a wide range of procedures: for example, plastic surgery to change facial features, breast or waist surgery to achieve a more feminine or masculine appearance, or surgery to alter genitalia. Transgender and non-binary individuals are not allowed to have genital surgery until adulthood.

In all cases, gender reassignment surgery is only carried out after several consultations with mental health professionals and doctors (including endocrinologists and/or surgeons).

There are clear, well-established, evidence-based standards in the US for who and when can receive gender affirmation treatment. Also, according to the American Association of Medical Schools, surgery is only available to persons under the age of 18 in exceptional cases. In the latest recommendation from the World Transgender Health Alliance linked above, some surgeries may already be performed at the age of 15 and 17, but this does not mean they will be performed against medical advice. In addition, there are also specific criteria that doctors must follow when prescribing hormonal treatments, one of which is that the child must show signs of sexual dysphoria for at least six consecutive months.

We have sent questions to Secretary of State Bence Rétvári to ask him where the statistics we have not been able to find were taken from. We will update our article as soon as he answers.