A medical watchdog organization, Do No Harm, released a comprehensive report on Tuesday detailing the extent of child gender-transition procedures administered in the U.S. between January 2019 and December 2023, revealing significant figures and trends.

According to the data, 13,994 minors received gender-transition treatments during the four-year period. This included 5,747 children who underwent sex-change surgeries, and 8,579 who were treated with hormones and puberty blockers. The majority of these procedures were performed on children around the age of 15, marking a significant number of body-modification treatments on individuals still in their formative years.

The methodology used by Do No Harm to compile the numbers involved matching gender and prescription medical codes to diagnosis codes for gender dysmorphia, a condition where individuals feel a mismatch between their gender identity and their biological sex. Dr. Stanley Goldfarb, chairman of Do No Harm, emphasized the meticulous nature of their data-gathering process, cautioning that the figures presented likely undercount the true extent of these procedures, as certain “gray area” cases and data from some healthcare providers were excluded.

“We’ve really been meticulous in trying to make sure that the data are as clear as possible and are as accurate as possible,” Goldfarb said in a press call with reporters. “If anything, we’re showing the lower limits of what’s going on in this whole arena.”

The database, which tracks interventions on children aged 0 to 17.5 years, adheres strictly to federal privacy laws, ensuring no personal details about the patients are disclosed. This was done in compliance with the Health Insurance Portability and Accountability Act (HIPAA), which protects patient confidentiality.

Do No Harm’s figures were drawn from publicly available insurance claim data obtained from a variety of sources, including clearinghouses, health systems, payers, and government entities like the Centers for Medicare and Medicaid Services. The data includes claims from commercial insurers, Medicare, Medicaid, and the Department of Veterans Affairs, though it excludes claims from Kaiser plans, internal VA claims, self-pay patients, and charity payments.

National Review reports of the nonprofit, known for its advocacy against child gender transitions and discrimination in medicine. One of the key takeaways from the report is the concentration of gender-transition procedures at specific children’s hospitals across the country. Do No Harm identified a “dirty dozen” of facilities responsible for the highest number of sex-change operations on minors, with the Children’s Hospital of Philadelphia leading the list. This hospital saw 122 minor patients, five of whom underwent surgical procedures. The majority of these facilities are located in states where such procedures are fully legal and where gender-transition activism has political support from local officials.

The financial aspect of these interventions is also notable. Over the reporting period, nearly $120 million in charges were submitted to insurers, though the database does not include figures on reimbursements. This financial data underscores the growing scale of gender-transition interventions and the costs associated with them.