Background: Despite documented benefits of gender-affirming surgery (GAS), disparities in national and international access to care remain. Many factors may preclude access, including the legality of gender-affirming care (GAC) in a patient’s place of residence, legality of gender transition, and a lack of local surgeons performing GAS. Given a growing number of trans and gender-non-binary individuals globally, this study aims to explore the national and international gender care landscape, by reviewing presence of gender affirming (GA)-surgeons and laws surrounding gender transition in the United States (US) and in the world. Methods: The TransHealth Care database was queried to examine global GA-surgeon presence. The number of surgeons was collected and stratified according to location and surgery offered. The Equaldex website was utilized to collect data regarding the legality of gender transition. To assess associations between legality and GA-surgeon availability, chi-square tests were performed. Results: Out of 196 countries, 49 had at least one GA-surgeon, with 2,595 providers worldwide. In the US, all 50 states had providers offering GAS. Of global GA surgeons, most practiced in the US (n=1771, 68.3%), with Canada (n=100, 3.8%) second highest. Top surgery was most offered (844 providers), followed by facial feminization surgery (526 providers). Countries where GAC was legal were significantly associated with GA-surgeon presence (p < 0.001). There was no significant association found among US states (p = 0.962). Conclusion: Access to GA-surgical care is complex and largely influenced by legislature and provider presence. Rapidly changing legal landscapes may affect surgeon presence and restrict access to care, leading to increased financial burden of care, higher rates of unregulated care, and dispersion of qualified medical providers.
Friedman et al. (2026) studied this question.