As policymakers around the world debate whether minors should have access to transition-related medications, a study published Monday in the nation’s premier pediatric medical journal found that these medications are rarely prescribed to young people.
Fewer than 0.1% of adolescents with private insurance in the United States are transgender or gender diverse and are prescribed puberty blockers or gender-affirming hormones, according to findings published in JAMA Pediatrics.
The research note, which analyzed private insurance claims for more than 5.1 million young patients aged 8 to 17 from 2018 to 2022, also found that no transgender patients under the age of 12 was seen prescribed gender-affirming hormones. Private insurers covered 65% of the country in 2023, according to the Census Bureau.
“It’s really important that the public understands that not everyone has access to gender-affirming care when they see a doctor,” said the report’s lead author, Landon Hughes, a researcher at TH Chan School of Public Health at Harvard University. “It’s not as ubiquitous as some would have us believe, especially among young people. »
“There’s not a massive surge of people accessing care,” Hughes added. “It’s certainly a tiny group of people who have access to this care, and that has certainly absorbed a lot of the public discourse in the recent political and legal climate.”
The study found that the use of puberty blockers and hormones was more common among trans minors who were assigned female at birth compared to those who were assigned male at birth . The authors noted that this may occur because the onset of puberty occurs earlier in people assigned female at birth.
Puberty blockers are used to delay the start of puberty or pause it while it occurs. The medication is designed to give children with gender dysphoria more time to decide whether they want to take more permanent steps to change their gender. Puberty resumes when the medication is no longer taken. Gender-affirming hormones are typically prescribed to replace hormones that a person’s body produces naturally but do not match their gender identity.
Most major medical organizations in the United States support gender-affirming care for minors. The American Medical Association, which publishes JAMA, has called such care “medically necessary.”
Dr. Alex S. Keuroghlian, director of education and training at the LGBTQ health care organization Fenway Health and is not affiliated with the study, said he was “not surprised” by outcomes, as access to transition-related care is limited.
“This particular type of care, there is such a bias against providing it, that I suspect that not all transgender or gender diverse youth who would have benefited from it in this data set necessarily received it,” a he declared. “I see this in practice in the communities we work with, even in privileged communities with private insurance. There may be many barriers at the family level and practice level for this child to receive gender-affirming care.
In December, the Supreme Court heard oral arguments in a case involving the state’s ban on anti-puberty medications and other forms of transition-related care for minors. The court is weighing the constitutionality of a Tennessee state law that prohibits gender-affirming care for minors, and the justices appear to be leaning in favor of upholding the law. Tennessee is one of more than two dozen states that restrict this care in the United States.
Last month, the United Kingdom indefinitely banned new prescriptions of puberty blockers to treat minors suffering from gender dysphoria. The indefinite ban came several months after an independent review commissioned by England’s National Health Service concluded that medical evidence regarding transition-related care for minors was “remarkably weak.”
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