Embargoed for release: Monday, Jan. 6, 2025, 11:00 AM ET
Key points:
Less than 0.1% of U.S. adolescents were transgender and gender diverse (TGD) and prescribed puberty blockers or gender-affirming hormones in a study of private insurance claims representing 5.1 million patients ages eight to 17.
No TGD patients under age 12 received hormones.
According to the researchers, the findings counter a growing concern among policymakers that gender-affirming care is frequently over-prescribed to children.
Boston, MA—Puberty blockers and gender-affirming hormones are rarely prescribed to U.S. transgender and gender diverse (TGD) adolescents, according to a new study from researchers at Harvard T.H. Chan School of Public Health, Harvard Pilgrim Health Care Institute, and FOLX Health.
The study will be published Jan. 6 in JAMA Pediatrics.
“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, Yerby Fellow in Harvard Chan School’s Department of Epidemiology and postdoctoral fellow at Harvard Chan School and Harvard Pilgrim Health Care Institute’s LGBTQ Health Center of Excellence.
A 2024 study led by researchers at Harvard Chan School and Harvard Pilgrim Health Care Institute documented the rarity of gender-affirming surgeries among adolescents. But little is known about hormone use among transgender and gender diverse adolescents. The researchers analyzed private insurance claims data from 2018 to 2022, representing more than 5.1 million young patients ages eight to 17. They identified transgender or gender-diverse patients based on a gender-related diagnosis and then checked if they received puberty blockers or gender-affirming hormones. They then calculated the rate of adolescents who are TGD and receiving this care per 100,000 privately insured adolescents according to age and sex assigned at birth.
The study found that less than 0.1% of minors with private insurance are TGD and received puberty blockers or gender-affirming hormone treatment. No TGD patients under age 12 were prescribed gender-affirming hormones. Use of puberty blockers and gender-affirming hormones was more common among TGD adolescents assigned female sex at birth than those assigned male sex at birth.
The researchers noted that higher rates of puberty blocker and hormone prescriptions for TGD patients assigned female sex at birth aligned with an earlier onset of puberty for people who are female vs. male sex assigned at birth.
“Our study found that, overall, very few TGD youth access gender-affirming care, which was surprisingly low, given that over 3% of high school youth identify as transgender .” said senior author Jae Corman, head of analytics and research at FOLX Health. “Among those that do, the timing of care aligns with the standards outlined by the World Professional Association for Transgender Health, the Endocrine Society, and the American Academy of Pediatrics.”
The researchers also noted that the study likely reflects the highest rates of puberty blocker and hormone use by adolescents, given the study used private insurance data, likely reflecting greater access to gender-affirming care. Lower rates would be expected among the uninsured, Medicaid recipients, and those with less comprehensive private insurance.
Isa Berzansky, research analyst at Harvard Pilgrim Health Care Institute, and Brittany Charlton, associate professor in the Department of Epidemiology at Harvard Chan School and founding director of the LGBTQ Health Center of Excellence, were co-authors.
“Gender-Affirming Medications Among Transgender Adolescents in the US, 2018-2022,” Landon D. Hughes, Brittany M. Charlton, Isa Berzansky, Jae D. Corman, JAMA Pediatrics, January 6, 2025, doi: 10.1001/jamapediatrics.2024.6081
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Harvard T.H. Chan School of Public Health is a community of innovative scientists, practitioners, educators, and students dedicated to improving health and advancing equity so all people can thrive. We research the many factors influencing health and collaborate widely to translate those insights into policies, programs, and practices that prevent disease and promote well-being for people around the world. We also educate thousands of public health leaders a year through our degree programs, postdoctoral training, fellowships, and continuing education courses. Founded in 1913 as America’s first professional training program in public health, the School continues to have an extraordinary impact in fields ranging from infectious disease to environmental justice to health systems and beyond.
The Harvard Pilgrim Health Care Institute's Department of Population Medicine is a unique collaboration between Harvard Pilgrim Health Care and Harvard Medical School. Created in 1992, it is the first appointing medical school department in the United States based in a health plan. The Institute focuses on improving health care delivery and population health through innovative research and education, in partnership with health plans, delivery systems, and public health agencies. Follow us on Bluesky, X, and LinkedIn.
The LGBTQ Health Center of Excellence was founded in 2024 through a first-of-its-kind partnership between the Harvard Chan School and the Harvard Pilgrim Health Care Institute. The Center aims to improve the health of a growing and diverse LGBTQ population, with a specific focus on reducing and preventing health inequities that impact LGBTQ communities. To do this, the Center embraces a multi-pronged approach, including training LGBTQ health leaders, catalyzing new research, and disseminating information about LGBTQ health to policy makers, healthcare providers, and the public.
Launched in December 2020, FOLX Health is an LGBTQIA+ healthcare service provider built to serve the community's specific needs. The company delivers a new standard of healthcare that's built to serve LGBTQIA+ people, rather than treat them as problems to be solved. FOLX Health provides end-to-end virtual primary care, HRT, PrEP, care navigation, content and community through a diverse network of queer and trans specialized providers. In January 2021, FOLX Health established the FOLX HRT Care Fund which redistributes financial resources from allies inside and outside of the LGBTQIA+ community to support trans, nonbinary, and intersex folks to access hormone replacement therapy care through FOLX.
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