Among the many political wedge issues raised by president-elect Donald Trump have been those concerning health-care for transgender Americans—particularly trans youth, who have already been the target of gender-affirming care bans in 26 states.
“With the stroke of my pen on day one,” Trump said at a rally just before Christmas, “we’re going to stop the transgender lunacy.”
Transgender adolescents are frequently cited as a huge and growing population by anti-LGBTQ legislators, despite only comprising 300,000 youths 13-17 in the U.S. And a new study published today in JAMA Pediatrics finds that despite fears of their over-medicalization, transgender adolescents are very rarely prescribed hormones and puberty blockers.
“The politicization of gender-affirming care for transgender youth has been driven by a narrative that millions of children are using hormones and that this type of care is too freely given. Our findings reveal that is not the case,” said lead author Landon Hughes, a fellow in Harvard Chan School’s Department of Epidemiology, in a news release.
Further, he told Fortune, “We don’t have any peer reviewed estimates of the rate of accessing hormones or puberty blockers among youth, and so it was really important for us to get a handle on that—certainly given the political discourse…but also in terms of thinking through how care is being delivered.”
The study looked at private insurance claims representing 5.1 million patients ages 8 to 17. It found that less than 0.1% of U.S. transgender and gender diverse (TGD) adolescents were prescribed puberty blockers or gender-affirming hormones—and that not a single patient under age 12 received hormones.
Puberty blockers—technically called gonadotropin-releasing hormone analogues (GnRHas) and approved mainly for use in precocious (early) puberty—work by temporarily pausing development in children who have entered puberty, allowing more time to think about their gender. They were just banned in the U.K., despite a 2020 study which found the use of puberty blockers was associated with decreased thoughts of suicide.
They can be part of what’s known as gender-affirming care—a range of services that can “affirm gender or treat gender dysphoria,” which is the psychological distress resulting from an incongruence between one’s sex assigned at birth and one’s gender identity.
Other gender-affirming care services may include hormone replacement therapy (HRT), mental health counseling, and gender-affirming surgeries (exceedingly rare for minors), which can range from facial feminization surgery and voice surgery to feminizing vaginoplasty or masculinizing chest or “top” surgery (a double mastectomy).
The new study is from researchers at Harvard T.H. Chan School of Public Health, Harvard Pilgrim Health Care Institute, and FOLX Health, and it counters a growing concern among policymakers that gender-affirming care is frequently over-prescribed to children. Along with finding the low percentage of those who use these treatments, it found that the timing in which it’s used aligns with the standards outlined by the World Professional Association for Transgender Health, the Endocrine Society, and the American Academy of Pediatrics.
The researchers faced some limitations, Hughes explained, because of the nature of the claims data—which don’t specify if patients are using the drugs for other indications, and which don’t take misdiagnoses into account. Further, they are only paid claims. “These folks have been at least billing these to insurance,” he said. “So we’re missing those that are just fully out of pocket.”
But the already low 0.1% figure is “likely even an high-end estimate,” said Hughes, as they are private-insurance claims—meaning these patients are likely to have the most access to gender-affirming care.
Hughes says he and the other researchers were not all that surprised by the findings, despite the narrative put forth by “a lot of bad actors that are trying to score political points using trans youth.”
That’s because of the many barriers that exist to accessing such care.
“You have to imagine what it’s like to be a trans youth,” he said. “You need to come to terms with your own identity, then reach out to a parent or caregiver. They need to be accepting of you. You need to want care. Then you need to find a provider who will provide it. You need to have insurance that’ll cover it—and you need to live in a state where it’s allowed. So, tons of barriers to care already exist for youth. And we expected the rates to be small because of that very reason.”
More on transgender health care:
- Fleeing the country and rationing testosterone: Transgender Americans’ new reality under a Trump presidency
- How Trump’s Agenda 47, plus Project 2025, offer clues into possible health-care policy changes
- Trump pledged to roll back protections for transgender students. They’re flooding crisis hotlines
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