Trump’s Pants on Fire claim that schools are performing trans surgeries

Any parents who have filled out forms granting school nurses permission to give their children Benadryl for ant bites might have been puzzled to hear former President Donald Trump's recent claim about surgery in schools. 

"The transgender thing is incredible," Trump told Moms of Liberty co-founder Tiffany Justice during the group’s Aug. 30 gathering in Washington, D.C. "Think of it, your kid goes to school and comes home a few days later with an operation. The school decides what’s going to happen with your child."

If a surgical procedure at school sounds far-fetched, that’s because it is. Schools generally do not provide students with medical care without parental consent, let alone offer surgery. Parents, guardians and doctors, not schools, are the decision makers for health decisions involving minors. 

When we contacted Trump’s campaign for evidence to support his claim, spokesperson Karoline Leavitt pointed to examples of school policies that affect whether a child’s parents are notified when a child identifies as transgender at school. 

State policies vary on whether parents are notified if a child identifies as transgender at school. Some states prioritize student privacy by advising teachers to not inform parents without the student’s consent. Other states have laws requiring or encouraging schools to notify parents if  children express changes in their gender identity. But these policies have no bearing on whether a school is allowed to provide medical care. 

We asked National Association of School Nurses President Kate King what kind of medical care school nurses may give.

"School nurses," she said, "provide care for acute episodic injury and illness that arise during the school day which includes emergency care, health screenings like vision and hearing tests per state law or district policy, chronic disease management and treatment with health care provider orders and related parent/guardian consent." 

Not on the list: gender affirming surgery — or any surgery.

"Not ever," King said. PolitiFact could find no evidence of a situation like Trump described ever happening. CNN fact-checkers also contacted several conservative groups concerned with parental rights in school who were similarly unable to cite evidence of a school providing surgery to a student.

Pediatric care requires guardian or parent consent, said Dr. Michelle Forcier, a professor of pediatrics at the Warren Alpert Medical School of Brown University. "Excepting some public health areas of care: HIV, STIs, and pregnancy contraception issues in some states — kids and their parents make decisions about how to proceed if they pursue gender care. Kids cannot get medical care, hormones or surgeries, in the school setting."    

Gender-affirming surgical procedures are rarely provided to minors. Until children reach puberty, gender-affirming care generally amounts to using the name and pronouns that align with a child’s gender identity. At older ages, it can include evidence-based medical treatments such as puberty blockers or hormone therapies. 

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Professional standards of care from the American Academy of Pediatrics, World Professional Association for Transgender Health and the Endocrine Society all require parental consent and involvement for all kinds of gender-affirming care. 

"There are no instances of children receiving surgeries or access to surgeries from their schools," said Landon Hughes, a postdoctoral fellow at the Harvard T.H. Chan School of Public Health. "No provider in the U.S. would perform surgery on a minor under the direction of a school, let alone without parental consent." Hughes was a co-author on a peer-reviewed study on the prevalence of gender-affirming surgeries in the U.S. The study, which reviewed 2019 insurance claims data for 22,827,194 minors, found only 85 gender-affirming surgeries nationwide, 82 of which were breast reductions.

Dr. Marci Bowers, president of the World Professional Association for Transgender Health, previously told PolitiFact that if gender-affirming surgery is performed on minors, it is "only under the most severe conditions of gender dysphoria" — that’s the feeling of distress people can experience when their body doesn’t align with their gender identity.

In rare cases in which surgery is performed on a minor, it's a slow, careful process involving parental consent, not something that could happen in "a few days," as Trump said.

"Decisions around gender-affirming care are thoughtful and careful. They're an iterative process that typically involves minors and parents or guardians and providers," said Lindsey Dawson, director of LGBTQ+ Health Policy at KFF, a nonpartisan health policy research center.

"There's just not a scenario that I can envision where it would be plausible to have a school involved in any kind of decision like this," Dawson said. 

Trump said, "The transgender thing is incredible ... your kid goes to school and comes home a few days later with an operation. The school decides what’s going to happen with your child."

The premise is absurd. Schools do not provide medical care without parental consent, let alone surgery. More generally, surgical procedures on transgender minors are rare, and involve the consent of parents, medical providers and the patient. When it does happen, the process of getting a surgical procedure for a minor is typically slow and deliberative.

Trump’s campaign cited school policies that do not require teachers to notify parents if a student is transgender, but these policies do not mean a child can be given medical care or surgical care without parental consent.

We rate this claim Pants on Fire!