A recent study has sparked significant attention, shedding light on the limited access U.S. minors have to gender-affirming medications. According to findings published in JAMA Pediatrics on January 8, less than 0.1% of adolescents with private insurance in the United States receive prescriptions for puberty blockers or gender-affirming hormones. This revelation comes amid an ongoing global debate on whether minors should be allowed to pursue transition-related treatments, including medical interventions aimed at aligning their physical characteristics with their gender identity.
The study, which analyzed the private insurance claims of over 5.1 million minors between the ages of 8 and 17 from 2018 to 2022, provides a comprehensive view of the reality surrounding gender-affirming care. Of these minors, the number who were prescribed such treatments was strikingly small. Notably, the research found that no transgender minors under the age of 12 were prescribed gender-affirming hormones, a stark contrast to the growing political and legal discussions around the accessibility of such treatments for youth.
Landon Hughes, the lead author of the study and a fellow at the Harvard T.H. Chan School of Public Health, emphasized the importance of public awareness regarding this issue. He pointed out that contrary to the narratives that have been heavily debated in the media, the actual number of minors receiving gender-affirming care is extremely small. “It’s really important for the public to understand that not everyone is getting access to gender-affirming care when they go to the doctor,” Hughes said. He added that the number of youths undergoing treatment for gender dysphoria is “minuscule” compared to the intensity of the public discourse.
The study further examined differences in treatment based on sex assigned at birth. It found that gender-affirming care, including the use of puberty blockers and hormones, was more common among transgender minors assigned female at birth. This could be due to the fact that puberty typically begins earlier for individuals assigned female, which may prompt earlier intervention. Puberty blockers, which are used to delay or pause the onset of puberty, allow transgender youth more time to explore their gender identity before making irreversible decisions.
Gender-affirming hormones, which are used to align a person’s physical characteristics with their gender identity, are another key aspect of care for transgender minors. Medical organizations such as the American Medical Association have consistently supported gender-affirming care as “medically necessary,” citing the benefits it offers in alleviating gender dysphoria and improving overall mental health.
However, despite the support of major medical organizations, the actual availability of such care remains limited. Dr. Alex S. Keuroghlian, a recognized expert in LGBTQ+ healthcare, commented on the study’s findings, noting that he was “not surprised” by the low numbers. He highlighted that, despite private insurance coverage, there are often significant barriers to accessing gender-affirming care. These barriers can include family reluctance, social stigma, and even medical professionals’ biases against providing such treatments.
This study also coincides with a broader legal landscape in the United States. In December 2024, the U.S. Supreme Court heard arguments regarding state bans on puberty blockers and other transition-related treatments for minors. The justices appeared to favor upholding such laws, particularly one in Tennessee that bans gender-affirming care for minors. Currently, more than two dozen states have enacted laws restricting access to these treatments.
Internationally, other countries are following similar paths. Just last month, the United Kingdom imposed an indefinite ban on prescribing puberty blockers to minors, following an independent review that found medical evidence supporting such treatments for young people was weak.
This ongoing global debate highlights the challenges transgender and gender-diverse youth face in accessing medical care that supports their gender identity. While the numbers of minors receiving gender-affirming care may be small, the legal, medical, and societal questions surrounding this issue continue to evolve. As these discussions unfold, understanding the complexities of access to gender-affirming treatments remains crucial in shaping fair and informed policies for the future.
