No children aged 12 years or younger received hormones or gender-affirming surgery.
Less than 0.1% of adolescents in the United States identified as transgender or gender diverse and received puberty blockers or gender-affirming hormones, according to study findings published this week in JAMA Pediatrics.
"We have heard misinformation over the past few years about the number of youths accessing this care, and our data suggest the number is much smaller than has been discussed in public discourse," Landon D. Hughes, PhD, a Yerby Fellow at the Harvard T.H. Chan School of Public Health and postdoctoral research fellow at Harvard Medical School, told Healio.
According to KFF, 26 U.S. states have passed bans on gender-affirming health care such as puberty blockers, hormones and surgical procedures for children aged 17 years or younger. Two studies published in the last year have shown that this type of care is rare and that pediatricians are following current standards of care.
Hughes and colleagues analyzed private insurance claims from all 50 states between 2018 and 2022 for puberty blocker and hormone prescriptions among children and adolescents aged 8 to 17 years who identified as transgender or gender diverse. They calculated the rate of prescriptions per 100,000 total adolescents enrolled in private health insurance.
Among 5,155,282 patients enrolled in private insurance, 20.81 (95% CI, 19.04-22.59) per 100,000 assigned female at birth (AFAB) received puberty blockers and 49.9 (95% CI, 47.14-52.65) per 100,000 received testosterone. The rates among patients assigned male at birth (AMAB) were lower, with 15.22 (95% CI, 13.73-16.71) per 100,000 receiving puberty blockers and 25.34 (95% CI, 23.42-27.27) per 100,000 receiving estrogen.
Among patients younger than age 14 years, more AFAB adolescents received puberty blockers compared with AMAB adolescents. Hormone prescription rates increased among patients aged 14 years or older, the researchers reported. The highest rates were among 17-year-olds: 140.16 (95% CI, 128.01-152.32) per 100,000 AFAB teens and 82.42 (95% CI, 73.25-91.59) per 100,000 AMAB teens.
No patients younger than age 12 years were prescribed hormones, and higher puberty blocker rates among AFAB youth vs. AMAB youth aligned with earlier puberty onset, Hughes and colleagues noted.
"The study includes only those who had private insurance, meaning this estimate is likely high," Hughes told Healio. "Using our rates applied to the number of youths in the United States, we estimate that less than 8,000 youths accessed puberty blockers and roughly 16,000 accessed hormones over the 5-year study period."
"Put another way, on average, eight youths a day initiated hormones and four initiated puberty blockers during the period across the U.S.," he said.
A similar study published in June 2024 reported that gender-affirming surgery among transgender and gender diverse minors was also rare.
Dannie Dai, a research data analyst in the department of health policy and management at the Harvard T.H. Chan School of Public Health, and colleagues -- including Hughes -- investigated patient demographics for all gender-affirming surgeries performed in the U.S. in 2019. They excluded procedures for patients with differences in sex development, as well as people who received amputations due to cancer or injury.
Their study included 47,437,919 adults and 22,827,194 children and adolescents aged 17 years or younger with insurance.
There were 2,664 gender-affirming surgical procedures among adults, which equates to a rate of 5.3 per 100,000 total adults, according to Dai and colleagues. Among children and adolescents, 85 received gender-affirming surgeries, nearly all of which were for patients aged 15 to 17 years (2.1 per 100,000 total). No children aged 12 or younger received gender-affirming surgery.
A majority of surgeries among adults (59.7%) and almost all surgeries among adolescents (96.4%) were related to the chest, the researchers reported. Four in five breast reductions among adults and 97% among adolescents were performed on cisgender men and boys.
"These findings suggest that concerns around high rates of gender-affirming surgery use, specifically among minors, may be unwarranted," Dai and colleagues wrote.