Pro-transgender activists are recycling an old, ineffectual argument against laws protecting minors from gender transition procedures through a rose-colored media blast. In a research letter published Monday in the Journal of the American Medical Association (JAMA) Pediatrics, transgender activist group FOLX Health and Harvard University researchers claimed the percentage of trans-identifying minor teens who accessed puberty blockers and cross-sex hormones from 2018-2022 was miniscule.

This low percentage is “a key data point as Republican lawmakers in Congress and around the country continue to focus on transgender youth in contexts ranging from sports to bathrooms to doctors’ offices,” claimed National Public Radio (NPR), a reliable source of taxpayer-funded, left-wing propaganda, which reported on the journal article the same day it was published.

“It’s important to put numbers to the debates that are currently happening,” declared article lead author Dr. Landon Hughes, a postdoctoral research fellow at the Harvard School of Public Health. “It’s a very, very small number of people that has managed to eat up all of the oxygen in our political discourse over the last few months.”

But are these data, and this characterization, correct?

Research Letter Findings

The research letter analyzed private health insurance claims covering 5.1 million minors aged 8-17. Of this number, “the total number of youth who had any diagnosis of gender dysphoria was less than 18,000,” Hughes summarized. “Among those folks, there were less than 1,000 [youth] that accessed puberty blockers and less than 2,000 that ever had access to hormones.”

Based on these numbers, the study concluded that less than 0.1% of U.S. teens with private insurance both identify as transgender and have access to hormones. This number is “surprisingly low,” reacted Jae Corman, head of analytics and research at FOLX Health, given a recent CDC study showing that 3% of high schoolers identify as transgender.

The article received praise from other pro-transgender activists working in health policy. For instance, NPR quoted Lindsey Dawson, director of LGBTQ health policy at the Kaiser Family Foundation, praising the study for its large sample size and echoing the narrative that such treatments are rare. “It echoes past work that has found that gender-affirming medical care, including puberty blockers and hormone treatment, is relatively rare among all trans and nonbinary people, but especially so among adolescents,” she said.

Research Limitations

Before analyzing the numbers themselves, it’s useful to recognize the limitations of the research article, things the authors themselves would likely acknowledge.

First, the survey size (5.1 million minors) is large, but not the largest study examining the rate at which minors receive gender transition procedures. In fact, one of the article’s coauthors, Brittany Charlton, also coauthored a study published in June 2024 with a sample size of 22.8 million minors (that study looked at the prevalence of gender transition surgeries only). In 2022, health technology company Komodo Health also studied the prevalence of gender transition procedures among minors — likewise using insurance claims as their dataset — but had a sample size of 40 million patients, aged 6 to 17. Thus, while the sample is large, it is possible that it may not capture the full picture.

Second, this survey only considered private health insurance claims, thereby omitting any gender transition procedures that were self-paid or covered by public health insurance. In a 2022 study published in JAMA Pediatrics, researchers from Vanderbilt University found that, from 2016-2019, only 61.1% of gender transition surgeries on minors were covered by private insurance, compared to 16.5% covered by public insurance and 15.8% self-paid (with 6.6% unspecified). According to the U.S. Census Bureau, 65.6% of Americans had private health insurance in 2022, while 36.1% had public health insurance. These numbers suggest that gender transition procedures among minors are slightly underrepresented among private insurance claims, an implication that could only be proven or disproven through further research.

Third, the data used in this article ranges in time from 2018-2022. This means that it is working with numbers that are two to six years old. This is likely the most recent data available, and, for many subjects, the age of this data would not prove to be an issue. However, research has shown that the number of gender transition procedures provided to minors is rapidly growing every year.

This is evident in the 2022 Komodo study, which recorded that 15,172 minors were diagnosed with gender dysphoria in 2017, 18,321 minors in 2018, 21,375 minors in 2019, 24,847 minors in 2020, and 42,167 minors in 2021. In keeping with this trend, over the same period, the number of minors receiving gender transition procedure also increased significantly. From 2017 to 2021, the annual number of minors initiating puberty blockers increased by 219%, and the number initiating cross-sex hormones increased by 222%. These signify the numbers of new patients, most of whom will remain on transgender hormones for their entire lives.

This rapid acceleration in the number of minors taking gender transition hormones signals that something is causing rapid societal change. Without a compelling explanation for why the rapid increase in minor gender dysphoria abruptly stalled after the period covered in this study, it is unconvincing to argue, based in part on data from 2018, that gender transition procedures for minors are still vanishingly uncommon.

Analyzing the Results

An obvious place to begin analyzing a report like this is with a “gut check”: do the results feel accurate, or does something seem off? (Not that a gut check can replace true analysis, but it may point in a helpful direction that provokes more probing questions.)

The article’s conclusion — that less than 0.1% of U.S. teens both have a gender dysphoria diagnosis and receive gender transition procedures — was “surprisingly low” to FOLX Health’s head of analytics and research, quoted above. If combined with the CDC’s estimate that 3% of U.S. high schoolers identify as transgender, then less than one in 30 trans-identifying teens take gender transition hormones. Given how widely available these drugs are, and how liberally practitioners are willing to prescribe them to minors, that would be a surprising result.

But this may not be an apples-to-apples comparison. The study’s own abstract cited a significantly lower estimate (1.4%) trans-identifying adolescents (or 300,000). It then reviewed insurance claims for 5.1 million minors and only found less than 18,000 minors diagnosed with gender dysphoria (0.35% of the sample). In other words, their data showed a percentage of gender dysphoric youth amounting to only one-tenth of that estimated by the CDC. Anyone without a diagnosis of gender dysphoria was automatically excluded from their tabulation of the number of minors receiving gender transition procedures.

What explains the tenfold difference? It could be that some people with gender dysphoria are never diagnosed. It could also be that some people self-identify as transgender on a survey but don’t meet the criteria for a gender dysphoria diagnosis. In fact, the category often used in academic writings like the one at issue here is “transgender and gender diverse (TGD),” which would also cover people who identify as non-binary. This category could pad the numbers of those identifying as “trans” without translating into medical results.

Thus far, we have considered the JAMA article on its own terms. But it’s also important to compare it to other studies.

The Komodo Health study conducted in 2022 covered roughly the same time frame (2017-2021) and age range (six through 17), although it began and ended one year sooner (which, given the increasing incidence of gender dysphoria, should result in slightly lower numbers). The primary difference is that Komodo Health analyzed insurance claims from 40 million patients, eight times the size of the dataset for the Harvard/FOLX Health article.

Komodo Health found 121,882 children diagnosed with gender dysphoria over that period (equivalent to 15,200 in Harvard/FOLX Health’s smaller dataset). They found 4,780 minors who began puberty blockers (equivalent to 600 in the smaller dataset) and 14,726 minors who began cross-sex hormones (equivalent to 1,800 in the smaller dataset). This roughly tracks with the final numbers reported by Harvard/FOLX Health, which is to be expected since both derived from the same source, insurance claims.

However, even the Komodo Health study represents only a partial picture. Some states do not report Medicaid data for children under a certain age, and a review of insurance claims would entirely overlook any gender transition procedures paid for out of pocket. This means that the total number could be higher than reported in these studies, but not lower.

In 2023, Do No Harm compiled a more comprehensive accounting of gender transition procedures provided to minors. They found “62,682 hormone and puberty blockers prescriptions [were] written for 8,579 pediatric patients” from 2019 to 2023, as well as 5,747 “sex change” operations carried out on minors. These procedures totaled nearly $120 million.

Having considered the details, let’s step back to consider what impact, if any, the new Harvard/FOLX Health article should have on public policy debates.

The argument made by NPR and other apologists for the transgender health care agenda is that these procedures are carried out on so few individuals that they do not deserve such prime billing in public discourse — with the insinuation that Republicans should stop trying to pass such bills altogether. This argument relies on the tenuous proposition that issues that affect a small fraction of the community are not appropriate topics for public policy or public discourse. Data scientist and tech entrepreneur Derek Park points out that “the gun death rate among adolescents was 0.0035%,” but no one disputed its relevance as a topic for public discourse.

In fact, the assumption that laws should not be written that address small fractions of society undercuts the transgender lobby’s own case. (I use the neutral term “address” to include laws that would impact them in any way, including, say, statutory civil rights protections.) If laws should not address the 0.1% of U.S. teens receiving gender transition hormones or the 0.35% of teens with a gender dysphoria diagnosis, then why should they address the 3% of trans-identifying high schoolers?

The Harvard/FOLX Health data simply serves to reinforce the picture that was already developing. A small but growing number of American minors (perhaps ranking in the thousands or tens of thousands) suffer from gender dysphoria and receive gender transition procedures as a treatment. Every healthy body marred by these procedures is a tragedy, and protecting minors from these treatments — not to mention protecting sane medicine in civic life — can and should remain an important public policy priority. It’s a good thing that approximately half of state legislatures have seen fit to nip this unethical trend in the bud before it proceeded any further.