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| A person holds a vial of testosterone cypionate injection, which is commonly prescribed in gender-affirming care. |
As policymakers globally debate whether minors should have access to transition-related medications, a recent study published in the nation's leading pediatric medical journal reveals that these drugs are seldom prescribed to youth.
The study, published Monday in JAMA Pediatrics, found that fewer than 0.1% of transgender or gender-diverse adolescents with private insurance in the U.S. are prescribed puberty blockers or gender-affirming hormones. The research, which analyzed private insurance claims for over 5.1 million young patients aged 8 to 17 between 2018 and 2022, also found that no transgender minors under 12 received gender-affirming hormones. According to the Census Bureau, private insurers covered 65% of the U.S. population as of 2023.
“It’s crucial for the public to understand that not everyone has access to gender-affirming care during doctor visits,” said Landon Hughes, the study’s lead author and a fellow at Harvard University’s T.H. Chan School of Public Health. “It’s not as widespread as some may believe, particularly among youth.”
Hughes emphasized, “There’s no massive surge in people seeking care. It’s a very small group of individuals accessing these services, despite the heightened public discourse in the current political and legal environment.”
The study also noted that the use of puberty blockers and hormones was more prevalent among trans minors assigned female at birth, as puberty typically begins earlier in those individuals. Puberty blockers are used to delay or pause puberty, allowing children experiencing gender dysphoria time to make decisions about transitioning. Once the medication is stopped, puberty resumes. Gender-affirming hormones are prescribed to align a person's physical traits with their gender identity.
While major medical organizations, such as the American Medical Association (which publishes JAMA), support gender-affirming care for minors, calling it “medically necessary,” access to such care remains limited. Dr. Alex S. Keuroghlian, director of education and training at Fenway Health, an LGBTQ health organization, noted that he is "not surprised" by the findings, as transition-related care is difficult to access.
"This type of care faces significant bias, and I suspect not every transgender or gender-diverse youth who could benefit from it received care," said Keuroghlian. "In practice, even in affluent communities with private insurance, there are numerous barriers to accessing gender-affirming care."
In December, the U.S. Supreme Court heard arguments in a case concerning state bans on puberty blockers and other transition-related treatments for minors. The court is evaluating the constitutionality of a Tennessee law that prohibits gender-affirming care for minors, and early signals suggest the justices may uphold the law. Tennessee is one of over two dozen states that have enacted restrictions on such care.
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