NHS masculinising chest operations rose by 52 per cent between 2022-23 and 2024-25 before falling in 2025-26, figures obtained under freedom of information laws show, amid scrutiny of patient safety and inadequate monitoring of treatment outcomes.

There were 734 procedures in 2022-23, 904 in 2023-24, 1,115 in 2024-25 and 933 in 2025-26. At NHS England’s estimated £5,800 per operation, the annual cost reached approximately £6.5 million at its peak. None of the procedures covered by the figures involved under-18s.

The figures establish activity levels, not whether treatment benefited patients or caused harm. That distinction matters following Dr David Levy’s review of adult gender clinics, which found an “unacceptable” lack of safety monitoring in December last year. Failures to track benefits and harms made it “impossible to properly understand patient outcomes and the safety of these services”. The review also identified waiting-list problems.

The review found that most patients using adult services were aged 18 to 25, many with autism or mental health problems. Several people who have detransitioned have publicly described regret over irreversible surgery, pain and, in some cases, being unable to breastfeed their children. Those accounts document individual experiences; the supplied figures do not establish how common such outcomes are.

Helen Joyce, advocacy director at Sex Matters, called for the NHS to stop the operations. She argued that young adults could underestimate future regret and that genital surgery could bring serious complications without reproducing the other sex’s bodily functions. Her wider claim that treatment does no good is not established by these activity figures.

Bayswater Support Group, run by parents of trans-identified children, accused the NHS of exposing vulnerable adults to life-changing harms without robust evidence of benefit or adequate follow-up.

NHS England said surgeries fell by 16 per cent last year, while the broader five-year increase reflected a global rise in people seeking gender dysphoria care. Chest surgery was available only to adults through specialist clinics under guidance developed with medical royal colleges, clinical bodies and regulators.

Masculinising genital operations numbered 270, 357, 241 and 322 across the same four years; feminising genital operations numbered 420, 414, 380 and 364. Estimated respective costs of £32,000 and £10,000 per patient bring spending on all three categories to up to £21 million annually, analysis suggests.

Referral patterns have also shifted: since 2017, about 70 per cent of referrals to the youth Gender Identity Development Service were for people born female, mostly teenage girls. The service closed in 2024 following the Cass review.

Amid existing legal threats over trans patients’ treatment, including at the former Tavistock clinic, NHS England plans consultation next year on updated adult surgical specifications.