Whether to circumcise is among the first decisions that parents of baby boys have to make.

Michael Miller of Ramsey chose to have the procedure done on his newborn son because he wanted him to "look like me and like the other boys in the locker room. It had nothing to do with religion and certainly nothing to do with any phony medical reason. Those first few showers in middle school are hard enough without being the different one."

Another new father, Troy Tepley of Minneapolis, said his wife ultimately left it up to him, as the other male in the family.

"I did a lot of research and decided it was unnecessary," he said. "We don't live in an era where cleanliness is really an issue, and conformity wasn't enough for me to change him from the natural way he was born."

The number of boys getting circumcisions has been falling nationwide for many years, from about 80 percent in the 1970s to below 60 percent at the start of this decade. But a sharp drop indicated by a recent study -- from 56 to 32.5 percent between 2006 and 2009 -- is being challenged by doctors. The numbers were presented by a researcher for the Centers for Disease Control, but CDC officials have not endorsed them, saying they aren't definitive.

Circumcision rates vary considerably by region, with the Midwest and Northeast having the highest rates. Doctors in the Twin Cities say most parents in this region still opt to circumcise their baby boys, based on cultural mores.

"Social norm is the only thing that matters to most parents I see," said Dr. Karl Chun of Fairview Children's Clinic. "People walk in and say, 'I want it done,' or 'I don't want it done.' Rarely does anyone change their mind based on anything medically related I tell them."

The decision to circumcise can even vary by neighborhood, he said. "In some areas almost everyone does it, and in others almost everyone doesn't. It's more universally done in suburbs and rural areas."

In keeping with other organic movements of the past few decades, anti-circumcision groups such as New York-based Intact America and Minnesota NICE (Newborn Infant Circumcision Education) call the procedure not only unnecessary, but cruel and unnatural.

The study at the center of the debate, conducted by the data-analyzing company SDI Health, was seen as a victory by the anti-circumcision movement. But pediatricians say the data collected left out an important trend -- a major shift in the number of circumcisions being performed outside hospitals.

Dr. Sheldon Berkowitz, medical director of Children's Hospitals and Clinics of Minnesota, called the figures "suspect," because many more circumcisions are now being performed in clinics. The reason? Money.

Hospitals charge facility fees, which cover equipment and assisting personnel, of $1,000 or more, atop a $300 to $400 doctor's fee. While many private insurers still cover circumcision at least partially, they may not cover every fee, and copays also have gone up.

Recent changes in insurance coverage may also play a role. Medicaid stopped paying for the procedure in 2006, and some private insurers have reduced coverage, which is likely to have contributed to the decrease in families opting for the hospital procedure.

"Before the rules changed for insurance, we might have done 20 to 25 a year in our clinic," said Berkowitz. "Now it's 125."

A pediatrician for 26 years, he observed a "big shift" in attitudes toward circumcision during the 1990s, he said. "There was an effort to explain to parents that it wasn't necessary, and the overall percentage of people doing it for medical reasons dropped. But I don't think in this area it's gone below 70 percent."

Dr. William Nersesian, pediatrician and chief medical officer for Fairview Physicians Associates, has performed about 800 circumcisions in his career, the last 25 years of which he's worked in the southwest suburbs. He agrees that it's still "the majority choice" but notes that changing demographics play some role in the decrease.

In his experience, "not as many Hispanic boys are circumcised, and among African-Americans it goes 50-50," he said.

While there is a slightly higher risk that uncircumcised men will develop cancer of the penis and contract urinary tract infections and STDs including HIV, many doctors and health organizations -- including the American Academy of Pediatrics and the CDC -- are holding off on recommending circumcision for medical reasons.

Ryan and Emily Boog of White Bear Lake chose to have 7-month-old Matthew circumcised. Because Emily had an emergency C-section, they wound up bringing their infant back as a 1-month-old for a $400 outpatient clinic procedure covered by insurance (minus a $40 copay).

"We just always thought we would do it; it seems the norm to us," Emily said. "It did cause me a lot of anxiety when they explained what they would do, and I couldn't be in the same room. But it took no more than 10 minutes, and he didn't even cry."

Kristin Tillotson • 612-673-7046