Fact Check: Are schools performing transition surgeries on students without parental consent?

On August 30, 2024, former President Donald Trump claimed at a Moms for Liberty press conference that schools are pushing transgender youth through surgeries without parental consent. He alleged this occurs on campus in the span of a few days.

“But uh, the transgender thing is an incredible thing… your kid goes to school and comes home a few days later with an operation,” he said. “The school decides what’s going to happen with your child and you many of these childs [sic] 15 years later say ‘what the hell happened, who did this to me?’” 

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LGBTQ Nation evaluated the truthfulness of this claim and whether it has any grounds to stand on. LGBTQ Nation emailed the Trump campaign for comment, however they did not respond before publication of this article.

What Are Trans Surgeries & Guidelines

While there are a multitude of surgeries that trans people might choose to undergo, there are two particularly common types of surgeries that trans people may receive – top and bottom surgery. Top surgery refers to procedures that either remove breasts and breast tissue, such as mastectomies and breast reduction surgeries, or surgeries that enhance the size of breasts. Bottom surgeries, on the other hand, refer to surgeries that alter the genitalia, with the most common involving the removal of testicles (orchiectomy), construction of a vagina (vaginoplasty) or the construction of a penis (phalloplasty, mastoidoplasty, etc.).

Minors scarcely receive any form of gender-affirming surgery. In 2019, a study found that only 85 minors in the United States received any form of gender-affirming surgery at all. Of these minors, 96.4% received some type of top surgery, most commonly breast reductions. Almost all of the surgeries conducted were on minors between the ages of 15 and 17, and none were performed on minors under the age of 12. This same study found that cisgender boys with gynecomastia, a condition that leads to unwanted breast development, were more likely to get gender-affirming surgeries at a rate of 146.

This low prevalence is in part due to the stringent guidelines protecting minors from receiving any type of care, especially that of surgeries. The World Professional Association for Transgender Health is currently the leading organization advising transgender healthcare across the globe, including in the United States. Their latest rendition of their standards of care, SOC8, details what types of care are deemed acceptable for minors to receive.

For any type of gender-affirming care, WPATH emphasizes that parents should be involved every step of the way. WPATH also insists that, as long as it can be done legally and feasibly, parents should be consulted for giving adolescents any form of gender-affirming care. They write: “We recommend when gender-affirming medical or surgical treatments are indicated for adolescents, health care professionals working with transgender and gender diverse adolescents involve parent(s)/guardian(s) in the assessment and treatment process, unless their involvement is determined to be harmful to the adolescent or not feasible.”

In fact, they actively encourage parental involvement, as it can be very helpful for youth. “Parent and family support of TGD youth is a primary predictor of youth well-being and is protective of the mental health of [transgender and gender-diverse] youth… Therefore, including parent(s)/caregiver(s) in the assessment process to encourage and facilitate increased parental understanding and support of the adolescent may be one of the most helpful practices available”

As for the surgery, they start with top surgeries, writing, “Chest masculinization surgery can be considered in minors when clinically and developmentally appropriate as determined by a multidisciplinary team experienced in adolescent and gender development.”

As for bottom surgery, the answers are mixed. For vaginoplasty and related procedures on youth born with a penis, they write, “While the sample sizes are small, these studies suggest there may be a benefit for some adolescents to having these procedures performed before the age of 18. Factors that may support pursuing these procedures for youth under 18 years of age include the increased availability of support from family members, greater ease of managing postoperative care prior to transitioning to tasks of early adulthood (e.g., entering university or the workforce), and safety concerns in public spaces (i.e., to reduce transphobic violence).”

In describing phalloplasty and related procedures, they’re much more conservative on such a procedure, writing,

“Given the complexity of phalloplasty, and current high rates of complications in comparison to other gender-affirming surgical treatments, it is not recommended this surgery be considered in youth under 18 at this time.”

For all types of surgeries, they emphasize that “given the complexity and irreversibility of these procedures, an assessment of the adolescent’s ability to adhere to post-surgical care recommendations and to comprehend the long-term impacts of these procedures on reproductive and sexual function is crucial.”

These statements only apply to adolescents who have begun puberty. No such surgeries are done on those who have not started puberty, with instead social transition being the primary goal. They only recommend starting these conversations when children approach puberty so they can have a few years to prepare for what type of interventions they may want.

The SOC8 doesn’t mention schools as decision-makers when it comes to trans youth’s bodies.

It’s not just the WPATH but most mainstream medical organizations – including the American Medical Association, the Endocrine Society, the American College of Physicians, the American Psychological Association, the World Medical Association, and many other organizations – that support affirming trans youth’s gender identities. Notably, none of these organizations mention schools providing or facilitating gender-affirming care, and many often refer to WPATH for information regarding this care.

Are schools breaking these rules and operating on students?

Dr. Jack Turban, pediatric psychiatrist and author of the book Free to Be: Understanding Kids & Gender Identity, told LGBTQ Nation via email: “Under medical guidelines, adolescents must have a comprehensive mental health assessment prior to any gender-affirming medical intervention being considered. This assessment includes work with parents or legal guardians, who must also provide consent for any medical interventions being considered.“

Brandon Wolf, the National Press Secretary for the Human Rights Campaign, said in a statement: “It’s negligent, immoral, and dangerous to spread disinformation like this about our schools. Medical decisions involving young people – including young trans people – should be and are made in a doctor’s office, alongside their families, and in accordance with best practice medical standards. Trump’s lies are nothing more than a distraction, a bad-faith effort to keep people from noticing that he has no solutions, no vision for our country — only fear-mongering, chaos, and division.”

LGBTQ Nation reached out to the Trump campaign for comment but did not receive an answer. CNN asked the Trump campaign for any examples of of schools operating on students behind their parents’ backs and the campaign could not produce any.

Other media organizations were also unable to find any instance of this happening.

Snopes investigated this claim and ultimately concluded there is zero evidence for it. They wrote, “We uncovered no evidence of children going to school to receive any sort of sex-change operation or gender-affirming surgery. For this reason, and another we’ll mention shortly, we rated this claim as ‘False.’”

NBC News similarly found no evidence for this, writing – “There is no evidence that a student has ever undergone gender-affirming surgery at a school in the U.S., nor is there evidence that a U.S. school has sent a student to receive such a procedure elsewhere.”

CNN also concluded that “Trump’s claim is false. There is no evidence that US schools have sent children into gender-affirming surgeries without their parents knowing or performed gender-affirming surgeries on site.”

However, in a press release sent to LGBTQ Nation,  Moms for Liberty disagreed with CNN. Co-founder of the organization Tiffany Justice claimed that Trump was “right” to make the statement because, she insisted, schools are “the ON-RAMP for gender transitioning of minor children.” She said that schools are letting students “SOCIAL TRANSITION OF THEIR GENDER” which leads “to MEDICAL TRANSITION with hormone therapy, and then SURGICAL TRANSITION with gender reassignment surgery.”

In other words, she chose not to defend Trump’s claim or provide evidence of it and instead defended a different claim. Moreover, there is no evidence for this claim within the peer-reviewed literature either, with the only sources for this being other far-right organizations.

Justice also claimed that Minnesota is transitioning children without parental consent, something that LGBTQ Nation has previously debunked.

Finally, her and the representative from their organization pointed to five lawsuits filed concerning schools where children were allowed to socially transition. However, none of these lawsuits concern medical transition procedures, and simply filing a lawsuit doesn’t mean that the claims put forth are true. As of right now, they are only allegations.

Conclusion

Based on the above evidence, LGBTQ Nation rates this claim as false – there is no evidence that schools are helping children undergo medical transitions without parental consent. This claim does not come from a dispassionate review of the facts but rather one that seeks to discredit a widely accepted medical practice for the sole purpose of getting Trump elected.

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