Cross-sex hormones, including testosterone, are part of gender-affirming treatments that have been banned in half the states.
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Rory Doyle for The Washington Post//Getty Images
How many transgender adolescents in the United States receive medical care related to gender transitions? According to a peer-reviewed research letter published Monday in JAMA Pediatricsthe answer is very, very few.
It’s a key data point as Republican lawmakers in Congress and across the country continue to focus on transgender youth in settings ranging from sports to bathrooms to doctors’ offices. In a legislative sprint over the past few years, half of U.S. states have banned gender-affirming care. Some of these laws have been blocked in court, and one such case was just argued before the U.S. Supreme Court in December.
The care in question includes puberty blockers and cross-sex hormone therapy — medications that help transgender teens develop characteristics that match their gender identity. The use of these treatments is supported by major American medical groups including the American Academy of Pediatrics.
“It’s important to quantify the ongoing debates,” says Landon Hughes, a postdoctoral researcher at the Harvard School of Public Health. “There were no peer-reviewed studies that looked at the rate of use of hormones and puberty blockers among youth in the United States, and so we wanted to fill that gap.”
Hughes and colleagues from Harvard and Folx Health, a virtual LGBTQ health care company, used a dataset of private insurance claims from 2018 to 2022 that included more than 5 million adolescents.
“The total number of young people diagnosed with gender dysphoria was less than 18,000,” says Hughes. “Of these people, fewer than 1,000 (young people) have had access to puberty blockers and fewer than 2,000 have ever had access to hormones.”
In other words, the study found that less than 0.1% of adolescents with private insurance in the United States are transgender and receive gender-specific medications.
A recent CDC mental health survey found a much higher percentage: 3% of high school students identify as transgender. Not all transgender people seek medical diagnosis or treatments related to their identity, notes Lindsey Dawson, director of LGBTQ health policy at the research organization KFF. “It’s much more common to change your hairstyle, your clothing style, using a different name,” she says, referring to KFF’s research.
Dawson, who was not involved in the research, said the study was notable for its large sample size. “This echoes previous work that has shown that gender-affirming medical care, including puberty blockers and hormone treatments, is relatively rare among all trans and non-binary people, but particularly among adolescents,” says -She.
Hughes says the study puts the political attention paid to this group into perspective. In recent elections, Republicans spent more than $222 million on anti-LGBTQ ads, according to an AdImpact report shared with NPR.
“It’s a very, very small number of people who have managed to consume all the oxygen in our political discourse over the last few months,” Hughes observes.
The American Principles Project, a conservative political advocacy group that has opposed transgender policy for years, is likely to push for a ban on gender-affirming care for minors under the Trump administration, a said Jon Schweppe, political director of the organization. told NPR in November.
“We have tested this by polling and we are confident that the American people agree,” Schweppe said.
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