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As specialized psychotherapists, sex therapists must undergo plenty of schooling and training to practice sex therapy, according to Murray, Capalbo, Heidegger and Kaylee Rose Friedman, a licensed professional counselor and sex and couples therapist based in Princeton, New Jersey.

Sex therapists must initially obtain a master’s or doctorate degree in psychology, counseling or social work. “Once your degree is completed, the next step is to become a licensed associate (which is a person who is in the process of completing their professional license under direct supervision),” says Murray.

After receiving a state or national therapy license, a therapist must then become certified in sex therapy, a process which may take about a year to complete, according to Friedman.

“There is no national board of sex therapy, but there are certifying bodies,” says Heidegger. Just as you should in any other type of therapy, it’s always a good idea to ensure your therapist has the proper credentials, and in this case, is certified by one of these organizations, she adds.

Sex therapy certification organizations include:

• American Association of Sexuality Educators, Counselors and Therapists (AASECT)
• Sexual Health Alliance
• Select university programs, such as the Sex Therapy track at the University of Michigan

Sex therapy certification programs typically require several hours each of academic coursework, in-person training and clinical experience, as well as adherence to a code of ethics.

In addition to formal schooling, Capalbo adds that sex therapists must also:

• Thoroughly understand human sexuality, including sexual disorders, variances and anatomy
• Employ strong counseling and communication abilities, such as active listening and empathy
• Be attentive to and respectful of cultural differences and varied backgrounds and values

Sleep Number is a premium mattress brand that comprises some of the smartest, most feature-rich beds on the market. Many of its mattresses offer the luxury of adjusting a bed's firmness and even its temperature. The Sleep Number Climate360 mattress is one of the brand's latest models; it's a sleep tracker, temperature regulator, adjustable bed frame and a comfortable mattress all in one. I've truly never tested anything like it. 

Hot sleepers, disagreeing couples and anyone looking to make a serious investment in their sleep quality may want to consider the Sleep Number Climate360 mattress. This Sleep Number mattress review will cover the brand's latest addition to its bed catalog, and whether or not I think it's worth the money. 

First impressions 

I had high expectations for a mattress as expensive as the Sleep Number Climate360 smart bed. With so many technological features, I was curious to know what this mattress was going to look like when it arrived, how well it would work, and if there was going to be bulky tech equipment bulging out from underneath the frame. 

To my surprise, it looked like a normal bed once the Sleep Number technicians put it together; clean and simple. You'd almost never know by looking at it that it was a smart mattress with thousands of dollars worth of tech equipment under the frame. 

After pairing the mattress with your phone, all its features are controlled via Sleep Number's easy-to-navigate Sleep IQ app. I have been wary about smart beds and their ability to live up to their hype, but the Sleep Number Climate360 mattress is hands down the most advanced, functional bed I've ever tested. 

The bed's bread and butter is its advanced temperature system that allows you to adjust it to your liking, but its customization abilities are what make it such an accommodating, impressive bed. 

See more: Best mattress of 2023

Sleep Number Climate360 mattress feel and firmness

When it comes down to it, fancy tech aside, everyone just wants their mattress to be comfortable. 

The Sleep Number Climate 360 mattress has a poly foam feel, meaning it's a pleasant and neutral sensation that's soft and supportive without making you feel like you're sinking (like some memory foam beds). It's comfortable, cradles your pressure points and quickly bounces back to its normal shape once pressure is removed. 

How firm is the Sleep Number Climate360 mattress?

The beauty of the Sleep Number Climate360 smart bed is that its firmness level is whatever you or your partner want it to be. You can independently customize the left and right side's firmness profile by pressing the Sleep Number setting button in the SleepIQ app. This feature is especially appealing for couples with different sleeping positions. 

The firmness scale starts at 100 and goes down to zero, with zero being the softest and 100 being the firmest. I like keeping my Sleep Number setting around 50 to 55. It's a good middle ground that's firm and supports my back when I'm on my stomach but soft enough for when I sleep on my side. 

If you're manually changing your bed's firmness level, especially a large jump (from 80 to 20), it won't register the change immediately. supply the mattress a minute or two to complete the change from one firmness level to another. I also noticed more of a time lag when I was experiencing slow internet connection. 

Sleep Number Climate360 mattress construction and features

Mattress

The Sleep Number Climate360 mattress has seven layers of foam, pocketed coils and proprietary materials that stack up to 13 inches thick. However, many added features you won't find in most other beds make the Sleep Number Climate360 a smart mattress and one that's worth its very high price tag. 

Features 

• Dual adjustability: Customize the firmness and temperature for each side of the bed. 
• Timer: Avoid running the heat or cooling system all night by setting a timer in your temperature setting. 
  
• Responsive air technology: Responsive Air automatically turns on when you activate the cooling or heating system, and it adjusts the bed's firmness levels throughout the night according to your and your partner's sleeping positions and needs. 
  
• Sleep tracking: Tiny sensors are lined all across the mattress to measure things like movement, heart rate, breathing rate and sleep cycles to offer insights on your sleep quality and curate a personalized sleep score. The higher your score, the better you're sleeping. Since you don't have to wear anything around your wrist or on a finger, it's more convenient and comfortable than a wearable sleep tracker. 
  
• Foot warming: Separate from the bed's thermoregulatory system are warmers at the foot of the bed. If you run your hands across the bottom of your mattress you'll notice a crispy feel where the warmers are, but you don't notice once you're lying down and have your bed covered with sheets. 
  

FlexFit Base

Every Sleep Number Climate360 mattress has a feature-rich smart adjustable bed frame called the FlexFit Base. While the bed is still expensive, this inclusion helps justify the bed's expensive price tag. 

Unlike other beds, Your Sleep Number mattress physically connects to the bed frame. You can't move the mattress freely without bringing the bed frame along. Not only that, it's heavy. You essentially won't be able to move the bed once it's all put together, so make sure the technicians complete the setup where you expect to keep your bed.

Features

• Adjust head and foot: Raise the head and foot of your mattress to elevate your head, feet or both. There are five settings available, and you can even save your head-foot preference as a favorite setting. 
• Partner snore: Is your partner sawing logs? You can go into the SleepIQ app and raise your partner's head to an anti-snore position without disturbing them. 
  
• Automatic under-bed lighting: A subtle yet effective light will automatically switch on from under the frame when you hop out of bed for a middle-of-the-night run to the kitchen or bathroom. 
  
• Timer: You can set a timer for the under-bed light, or it'll automatically turn off when you return to bed. 
  

Sleep Number mattress performance

Temperature

The Sleep Number Climate360 mattress gets our seal of approval on its cooling (and heating) functionality, and each side of the bed has its own temperature control. 

Between heat from your body, pajamas and blankets, the space underneath your covers becomes like its own mini microclimate, causing people to feel hot while they sleep. When you toggle to the cool setting within your SleepIQ app, rather than blow cool air, the cooling system draws away the warm air and leaves you with a noticeable cooling sensation. 

If you're someone who sleeps cool, toggle the temp setting to warm and you'll feel a gentle, active stream of warm air blow upwards through the mattress. You can also activate foot warmers on the bottom of the bed to ensure you're cozy from head to toe. You can feel a subtle fan running when the temperature system is running, but it's not noisy or distracting enough to hamper sleep by any means. 

Motion isolation

While the mattress is bouncy, it does a good job at limiting motion transfer from one side of the bed to the other. While you might be an exception if you're a light sleeper, I didn't notice when my partner got up in the middle of the night because my side of the bed stayed still. 

Edge support

I'm a little disappointed with the edge support. While it's not bad enough to be a deal-breaker, my standards for this bed are extremely high. To me, the edge support feels like that of an average foam bed. However, I don't think you'll get the sensation you're going to roll off the edge, especially if you share a larger queen, king or California king mattress with a partner. 

Off-gassing

This term refers to the chemical-like smell that emits from bed-in-a-box mattresses when you unwrap them from their packaging and supply them time to inflate. However, the Sleep Number Climate360 mattress is hand-delivered and fully inflated, meaning there is no plastic-y smell during or after the setup process. 

Who is the Sleep Number Climate360 mattress best for? 

Sleeping position

The Sleep Number Climate360 mattress can be set to soft, firm and everything in between. This makes it an incredibly accommodating mattress that's fit for all sleeping positions.

Side sleepers should stay within the zero to 50 range, with zero being very pressure-relieving and 50 offering a nice balance of support and pressure relief. Unless you're extra petite, most will probably find the 30-to-50 range most comfortable. 

Back and stomach sleepers want a firmer profile to keep their back and spine in a straight alignment and avoid back pain. I was most comfy in the 55 setting, but I'm a stomach sleeper who sometimes switches to my side. If you're strictly a back or stomach sleeper, the 60-to-70 range is a good sweet spot. 

See more: Best mattress for stomach sleepers

Combination sleepers should stay around the 50 Sleep Number setting. Think of it like the Goldilocks of mattress firmness levels – not too soft, not too firm. It's just right. 

Body type

The Sleep Number Climate360 mattress should accommodate all body types, from petite to heavy. It has a thick 13-inch construction, comes with a strong and solid bed frame, and is constructed with supportive mattress materials. 

Price

If there are any downsides to this mattress, it's the price. It's the single most expensive bed I've ever tested and certainly caters to a specific audience. 

If you can't justify buying a bed that costs the same as you might pay for a used car, there are plenty of beds out there that cost a lot less than $8K. But if you have the discretionary income and want to make a smart investment in your sleep quality and, in turn, your overall health, it's a great bed. 

Prices shown above are full list prices. 

Trial, warranty and shipping

• 100-night free trial
• 15-year limited warranty
  
• Free white glove delivery 
  
• Free old mattress removal
  

Final thoughts

After everything is said and done, would I spend the money on a Sleep Number Climate360 mattress? Personally, no; I don't have any pain ailments, I don't have trouble with sleeping too hot, and my partner and I generally agree on our desired firmness level. That said, my parents would be the ideal sleepers for it.

Who will like the Sleep Number Climate360 mattress:

• Sleepers with body pain or discomfort: My father had shoulder surgery a few years back and tested the Sleep Number while he was pet-sitting in my home. He said the Sleep Number significantly improved pain in his shoulder while sleeping -- especially when it adjusted firmness levels to his movements. 
• Hot or cold sleepers: If temperature seriously hinders your ability to sleep fully throughout the night, whether it be heat or cold, the Sleep Number Climate360 is specifically designed to address these needs. And the cooling/heating feature seriously works. 
  
• Couples who can't agree on a firmness level: If you and your partner have two different sleeping preferences, you may require different firmness levels. With the Sleep Number Climate360 you can adjust the firmness level on each side of the bed for a perfectly customized fit. 
  

Who won't like the Sleep Number Climate360:

• People who want an average bed: If you have no temperature issues that need to be addressed, little to no pain and you sleep with your partner without issues, there are other Sleep Number mattresses that are still high quality, more affordable and better suited to what you need. 
• Frequent movers: Once your Sleep Number Climate360 mattress is set up, you will need help to move it. Attached to its bed frame, this bed setup is the heaviest I've ever tested. I physically cannot move it myself, even with a partner. If you're frequently on the move, this bed may be a hassle because you'll have to contact a Sleep Number tech each time you relocate. 
  
• People without reliable Wi-Fi: The Sleep Number Climate360 mattress is controlled via an app on your smartphone. If you don't have a reliable internet connection or you don't like tech in general, the Sleep Number Climate360 mattress will be more trouble than it's worth. 
  

How does Sleep Number compare to other mattresses?

Sleep Number vs. Tempur-Pedic

Tempur-Pedic is comparable to Sleep Number as one of the top brands in the mattress industry at delivering premium beds. When you compare the Sleep Number Climate360 mattress to top-tier Tempur-Pedic models, they're much different from each other.

• Tempur-Pedic has a strong memory foam feel.
• Tempur-Pedic mattresses don't have adjustable firmness levels and are typically on the firm end of the spectrum.
  
• Tempur-Pedic mattresses will sleep warmer than the Climate360 mattress.
  
• The Climate360 mattress is more expensive than beds from Tempur-Pedic.
  

Sleep Number Climate360 FAQ's

Healthcare

Hackensack Meridian Health announced that its academic flagship Hackensack University Medical Center is the first hospital in the nation to earn a Health Care Equity Certification from The Joint Commission. The certification indicates Hackensack Meridian Health‘s extensive efforts to address and Excellerate healthcare equity across its network.

“Our team members at Hackensack Meridian Health are dedicated to providing safe, equitable care to all of our communities. Achieving health equity is one of our network’s top priorities,” said Robert C. Garrett, FACHE, CEO, Hackensack Meridian Health. “We are honored to have Hackensack University Medical Center be recognized as the first site in the nation to complete this important certification from The Joint Commission, and we look forward to continuing to advance health equity for our patients.”

To become certified, The Joint Commission requires health systems to have formalized structures in place to Excellerate health equity across their facilities and serve as community collaborators to address areas of need. Organizations seeking this designation must collect, analyze, and act on data points relating to patient care, patient communication, socioeconomic information, staff education, and policies on various topics, including recruitment and retention.

“The Joint Commission’s Health Care Equity Certification is a testament to our team members’ dedicated commitment each and every day to providing outstanding, compassionate care to all of our patients,” said Mark D. Sparta, FACHE, president & chief hospital executive, Hackensack University Medical Center and president, Hackensack Meridian Health‘s North Region. “New Jersey is one of the nation’s most diverse states, and this certification validates our long-standing efforts to eliminate health disparities and elevate the standard of care. We look forward to building upon this recognition to continue enhancing patient care for all.”

“Our commitment to fostering an environment rooted in equity is at the forefront of what we do at Hackensack Meridian Health,” said Avonia Richardson-Miller, EdD, MA, CDE, senior vice president and Chief Diversity Officer at Hackensack Meridian Health. “We are incredibly proud of the work we’ve done to make our hospitals more inclusive for our patients and team members, and we will continue to build initiatives that support and represent all communities we serve.”

Hackensack University Medical Center underwent a rigorous onsite review to receive the certification. During the visit, a team of Joint Commission surveyors evaluated over 40 program-specific standards and a range of data points, including the following:

• Three quality and/or safety measures for priority clinical conditions by sociodemographic characteristics (e.g., cardiovascular outcomes, cesarean birth rates for nulliparous women with term, singleton baby in vertex position [NTSV], hospital-acquired conditions, pressure injury rates, etc.)
• Comparison of the race, ethnicity, and languages spoken by staff and leaders to the race, ethnicity, and languages spoken by the community
• Employee opinion survey/culture of safety survey results stratified by race, ethnicity, and language information
  Health Care Equity performance improvement plan

Hackensack Meridian Health invited members of its senior leadership team, administrative teams, and clinical care leaders to participate in the certification review.

Hackensack University Medical Center holds 30 other Joint Commission certifications, which is the most of any hospital in the country.

To access more business news, visit NJB News Now.

In today’s day and age, we learn a lot from TikTok. While some subjects are unique to the platform, others have been around for a while and are just now being discovered by the app’s largely Gen Z userbase. Case in point: Cryotherapy, the practice of applying ice-cold temperatures to the face and body to reduce inflammation and — according to TikTok — enjoy a bevy of internal and external health benefits.

As millennials may remember, cryotherapy was a budding trend several years back. As "cryospas" started cropping up around the country, Allure published a feature in 2015 on the various potential benefits of intense cold therapy. (Though, like many “new trends,” the wellness modality had first emerged decades earlier — this time in Japan in 1978 as a remedy for rheumatoid arthritis.) Considering TikTok didn’t start to snowball until around 2020, it’s not surprising that the Topic is only now flooding the app, prompting mass interest in the ultra-cold therapeutic approach. (The hashtag #cryofacial has garnered over 2 million views, while cryotherapy as a Topic has amassed over 174 million views on the app.)

So if you’ve been curious about the icy facials and full-body freezes filling your feed, you’re in the right place. Keep reading to learn everything you need to know about cryofacials and cryotherapy as a whole.

Meet the experts

• Dendy Engelman, MD, a board-certified dermatologist in New York City.

• Isabelle Soh, MD, MPH, an adjunct clinical assistant professor of medicine at Cedars Sinai Medical Center in New York City.

• Joshua Zeichner, MD, director of clinical and cosmetic research in dermatology at Mount Sinai Hospital in New York City.

• Hadley King, MD, a board-certified dermatologist in New York City.

• Edwin Kornoelje, DO in sports medicine at University of Michigan Health-West.

In this story:

What is cryotherapy?

According to the U.S. Food & Drug Administration, “cryotherapy is [the] ‘super-cooling’ of the body for therapeutic purposes.” Things as simple as ice packs and cooling beauty products (like the Boscia Cryosea Firming Icy-Cold Cleanser and Charlotte Tilbury Cryo-Recovery Face Mask and Eye Serum) and tools (such as the TikTok-beloved facial ice roller) could be considered cryotherapy — as can treatments as immersive as ice baths (like those at Remedy Place, a celebrity-frequented “social wellness club” in LA and NYC).

Charlotte Tilbury Cryo-Recovery Facial Duo

$118.00, Charlotte Tilbury

Boscia Cryosea Firming Icy-Cold Cleanser

$34.00, Ulta

In a dermatologist’s office or medispa setting, though, cryotherapy involves the application of freezing-cold vapors anywhere you would normally use an ice pack or ice roller. It’s often done locally on injuries to soothe inflammation — some orthopedic doctors will use it as part of rehabilitation programs. When applied on the face, New York City-based board-certified dermatologist Dendy Engelman says that in addition to reducing inflammation, cryotherapy can promote collagen production and even offer migraine and sinus relief. (One 2013 study found that the application of a frozen neck wrap at the onset of a migraine headache “significantly” reduced migraine pain among participants.)

While you might think that exposing yourself to ultra-cold air could pose a risk for hypothermia, think again. “Cryotherapy involves exposing the body to external cold temperatures around -270°F for only two to three minutes, which in turn cools the skin surface temperature to approximately 32°F,” explains Isabelle Soh, MD, MPH, an adjunct clinical assistant professor of medicine at Cedars Sinai Medical Center in New York City. “During this process, the body constricts its peripheral blood vessels in order to protect core internal organs and thus the core temperature does not decrease significantly, so there is no risk of hypothermia.”

Cryotherapy benefits: How does cryotherapy Excellerate skin?

When applied to targeted areas, such as during a cryofacial or to treat skin conditions like warts, cryotherapy can "enhance exfoliation of dead cells on the surface of the skin and strengthen the skin as a whole,” Joshua Zeichner, director of clinical and cosmetic research in dermatology at Mount Sinai Hospital in New York City, previously told Allure.

While exfoliation is a common denominator, the type of cryotherapy used for facials is different from what’s used for removing warts. “An in-office cryofacial is a cryotherapy treatment in which vaporized nitrogen is used to cool the skin of the face, scalp and neck area,” says New York City-based board-certified dermatologist Hadley King. “Liquid nitrogen (around -200 degrees celsius) vaporizes — making it no longer as cold — and is pumped out of a hose and onto your skin.” Meanwhile, the type of cryotherapy used on warts is liquid nitrogen, which is colder and can be more uncomfortable than the vaporized variety, Dr. King says. While OTC liquid nitrogen kits exist for wart removal, Dr. King advises against them. “Liquid nitrogen should not be used at home because of possible risks of burns, frostbite, and nerve damage,” she warns.

Now, a few years back, when cryotherapy was first becoming popular for everyday folks (as opposed to just professional athletes accustomed to submerging themselves in tubs of ice), no skin-care devices harnessing the technology were FDA-approved, or even cleared. (FDA-cleared products and treatments are those that have undergone a 510(k) submission that’s been reviewed and accepted with the conclusion that it won’t cause harm, while FDA-approved products and treatments have been rigorously tested for effectiveness.) That’s still true for whole-body cryotherapy, but now there’s one FDA-cleared treatment for the face: GlacialRx.

“GlacialRx uses precision cooling technology [in the form of ice-cold air blown onto the skin] to reduce inflammation and redness, brighten skin, and accelerate exfoliation,” says Dr. Engelman. On its own, it can be used to treat redness and inflammation (as well as benign lesions and dark spots), but it can also provide cooling relief following other aesthetic treatments.

How does whole-body cryotherapy work?

Whole-body cryotherapy treats the entire body at once in an effort to reduce inflammation throughout, and it can include the ice baths we mentioned earlier or specialized chambers. “The whole-body cryotherapy chamber is a full, walk-in [closet] that the guest spends roughly three minutes inside of at around -150F,” says Kyle Jones, cofounder and chief innovation and branding officer of iCRYO, which has over 250 locations nationwide.

“Unlike ice or an ice bath, the dry cold provides a cold but comfortable feeling during the session,” says Jones. Personally, I’ve tried a cryotherapy facial as well as a cryotherapy treatment on my foot after a sprain and at no point was I in pain from either treatment. But a full-body experience can feel anything from slightly-strange to downright unbearable, depending on who you ask — at a accurate industry event, one beauty editor had to step out before the full three minutes.

As with an ice plunge, participants are expected to wear bathing suits or underwear — specifically those without metal, as the cool vapors can react negatively with the material. Because of this, jewelry and watches are not to be worn during the session.

While there are no studies that establish what number of sessions will provide maximum benefits in the long run, Dr. Soh says that utilizing cryotherapy during moments of physical and mental stress can help to soothe the body and mind immediately. “The cold temperature stimulates the vagus nerve which in turn triggers the body to switch from sympathetic ‘fight or flight’ to the parasympathetic, which reduces inflammation and stress, and improves mood,” she explains.

Is this why athletes turn to ice baths after a long practice or big game? “While there is no scientific evidence that ice baths or cryotherapy help athletes, many feel there is some benefit in reduction of pain, inflammation, muscle soreness and swelling, with improvement in circulation,” explains Edwin Kornoelje, DO in sports medicine at University of Michigan Health-West. He points out that, at the very least, cryotherapy could be beneficial because of how it’s perceived. “Like many routines athletes follow, if they think it helps them, it will, both mentally and physically.”

Who should try cryotherapy?

Considering cryotherapy’s potential benefits and the relatively low risk involved, it’s a therapeutic modality that can be utilized by all, whether you’ve been experiencing chronic pain, recovering from an injury, or just feeling overwhelmed and burnt out. As Dr. Soh points out, other anecdotal benefits of cryotherapy include clearer thinking, more energy, and less anxiousness overall.

A 2017 review published by Frontiers in Physiology found that whole-body cryotherapy is an effective treatment “in relieving symptomatology of the whole set of inflammatory conditions that could affect an athlete.” Meanwhile, a 2021 review in the European Journal of Applied Physiology reports that cryotherapy is the key to rapid recovery post-exercise (which contradicted previous findings that it may just be a placebo effect). Another 2021 study published in Pain and Therapy found that “local and non-local cryotherapy can be low-risk and easy treatment options to add in the management of chronic pain.” (Though, they did point out that the patient’s underlying ailments play a role, and that further research is necessary to provide a concrete assessment of the modality.)

All this to say, if you’re looking for a way to boost your mood, reduce pain, and accelerate muscle recovery, signing up for a cryotherapy treatment might just be worthwhile. Of course, you could always start off by taking the coldest shower possible to see if you’d even be able to tolerate taking a plunge. (Keep in mind, localized cryotherapy tends to be much more tolerable, as it’s not a full submersion.) Or, consider investing in an at-home ice roller for your face, which can help treat the inflammation associated with inflammatory skin conditions like acne when used over time. (Though not as instantly or dramatically as super-cool liquid nitrogen.)

The cost of cryotherapy

As with any beauty, health, or wellness offering, cryotherapy prices vary depending on your location and the specific areas you want to treat. At Restore Hyper Wellness, with 200 locations throughout the country, whole-body cryotherapy (AKA a session in their chambers) ranges from $27-$41 for members and $42-$63 for non-members. A ten-minute cryofacial runs $175 for members and $245 for non-members. iCRYO offers their services at a comparable price range and operates on a similar model, offering clients passes that allow them to book multiple services at a lower price. Meanwhile, dermatologist-administered cryofacials with devices such as Glacial Rx can cost between $500 and $1,500 depending on location.

Is cryotherapy worth it?

It’s subjective. While more and more studies and reviews are coming out supporting cryotherapy, along with word-of-mouth commentary from people undergoing cryofacials and entering into cryotherapy chambers, there’s still not enough conclusive scientific research on the subject. One downside of cryotherapy is that it can be potentially dangerous without proper supervision. "Unmonitored exposure to extremely cold temperatures can lead to damage to the skin, which, in some cases, could result in permanent scars," Dr. Zeichner previously told Allure. "We still need [more] studies to fully evaluate its true benefit."

That said, there’s no harm in trying it for yourself so long as you go to a licensed aesthetician or dermatologist well-versed in cryotherapy, and make sure not to endure more than a few minutes of exposure.

Read about more treatments:

Now, watch 100 years of sun care:

Originally Appeared on Allure

The number of gender-affirming surgeries done in the United States nearly tripled between 2016 and 2019, a new study shows.The increase is probably due in part to changes in state and federal laws that require insurance to cover such care, in addition to some growing social acceptance of the trans community, according to the authors of the paper, published Wednesday in the journal JAMA Network Open.In the video player above: A accurate study shows how Americans feel about gender and sexual orientationEarlier studies have detected an increasing trend in earlier time periods, but they typically captured only inpatient procedures. Many gender-affirming surgeries are outpatient, study co-author Dr. Jason Wright said."There has been a general feeling that there are more patients who are seeking these procedures and looking for expertise, and there really wasn't a lot of great data to quantify the numbers," said Wright, who is the Sol Goldman Associate Professor of Obstetrics and Gynecology and chief of the Division of Gynecologic Oncology in the Columbia University College of Physicians and Surgeons.Gender-affirming surgery, also called gender confirmation or sex reassignment surgery, is a procedure or series of procedures that can help shape the body of a transgender or nonbinary person to more closely align with the gender with which they identify.Not every person who identifies as transgender or nonbinary will choose surgery. It's usually done as one of the later steps in gender-affirming care, the medically necessary, evidence-based care that uses a multidisciplinary approach to help a person transition from their assigned gender – the one the person was designated at birth – to their affirmed gender – the gender by which one wants to be known.For the new study, the researchers looked at records from 2016 to 2020 from the Nationwide Ambulatory Surgery Sample, the largest all-payer surgery database in the US that tracks people who have had procedures that don't require an overnight hospital stay, and the National Inpatient Sample, the largest publicly available all-payer database of people who have had to stay in the hospital when they have surgery.The researchers looked for patients whose records had a diagnosis code for "gender identity disorder," a personal history of sex reassignment, or the word "transsexualism." Though now considered outdated or offensive, that term is sometimes used in medical records.The study found that more than 48,000 people had at least one gender-affirming surgery during this time period. They included breast or chest procedures, often called "top surgery," which made up more than 56% of the surgeries. People who had genital reconstructive procedures, often called "bottom surgeries," made up more than 35% of the procedures. Facial and other cosmetic procedures were also included in this research.The number of gender-affirming surgeries rose from 4,552 in 2016 to 13,011 in 2019, declining only slightly to 12,818 during the first year of the Covid-19 pandemic, when many hospitals cut back on all surgeries. The number of medical appointments related to gender identity disorder rose from 13,855 in 2016 to 38,740 in 2020, the study found.Video below: What really is gender-affirming care?The majority of the patients were 19 to 30 years old, making up more than 52% of the surgeries. Breast and chest procedures were twice as common as genital procedures among that age group.More than 21% of the people who had surgery were 31 to 40. Genital surgeries were more common among those older than 40.The study found that a fraction of gender-affirming surgeries – about 7% – were done on patients ages 12 to 18, but some experts think that number sounds high. Wright said the majority of these surgeries tended to be among 17- and 18-year-olds and were the less-invasive procedures like breast or chest procedures.Surgery is not typically recommended until adulthood, and in some states, surgeries on teens are illegal.Dr. Devin Coon, a board-certified plastic surgeon in the Division of Plastic Surgery at Brigham and Women's Hospital and an associate professor of surgery at Harvard, was not involved with the new research but says it captures trends he sees in the operating room.He says, however, that because there's no one procedure code for gender-affirming surgery like there is with more common surgeries like knee replacements, the numbers in the new study can't be as specific. He thinks they're probably undercounted instead."It's very easy to say who had a knee replacement. It is not like that for gender-affirming surgeries," Coon said. "It is reasonable to look at the study, though, and say the trends in here are probably reflective of the overall trends."Study co-author Wright said the data sources they used were the best of what is available, but he acknowledges their limitations. For instance, these databases don't capture surgeries done in every state."I would say that the true number of surgeries are probably even a little bit higher than this," he said.Research has supported the positive effects of gender-affirming care.For trans and nonbinary adults, accurate studies show, surgeries are highly successful and offer significant physical and mental health benefits, including better mental health, a reduction in suicidal thoughts, a better quality of life and a higher rate of general life satisfaction. Surgeries even have indirect health benefits, studies show, such as reducing the number of people who smoke.Major medical associations – including the American Medical Association, the American Psychiatric Association, the American Academy of Pediatrics and the American Academy of Child & Adolescent Psychiatry – agree that gender-affirming care that can include surgery for adults is clinically appropriate and sometimes even life-saving.Studies also show consistently that people who have surgeries to help their body match their gender are extremely satisfied and generally do not change their minds later, as some critics have suggested.One review of studies published in 2021 found that of those who underwent transfeminine and transmasculine procedures, only 1% regretted it.Wright and Coon say the new research demonstrates that there is an increased need for surgeons specifically trained to work with trans and nonbinary patients. Demand for gender-affirming surgeries continues to rise. One study found that the number of inpatient procedures nearly doubled between 2000 to 2005 and from 2006 to 2011, yet the number of specifically trained surgeons has not kept pace."No procedure is obviously uncomplicated, but I think particularly with some of the facial procedures and some of the genital reconstructive procedures, can be quite specific and fairly significant operations for patients to undergo. So I think making sure that expertise is available to patients, I think it's definitely a take-home from this study from a policy standpoint," Wright said.Coon started a fellowship at Harvard to provide specific gender-affirming surgical training."A lot of these surgeries are just so complicated, so it's important to produce a group of people who are skilled at doing this," he said. "We see a lot of patients who got not great surgery because the person doing it wasn't super well-trained, so we would certainly like a dedicated workforce and supervised education to expand patients' options."