How many transgender teens in the U.S. are receiving medical care related to gender transitions? According to a peer-reviewed research letter published Monday in JAMA Pediatrics, the answer is very, very few.
It's 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. In a legislative sprint over the last few years, half of U.S. states have enacted bans on gender-affirming care. Some of those laws have been blocked in court, and one such legal case was just argued in the U.S. Supreme Court in December.
The care at issue includes puberty blockers and cross-sex hormone therapy — medications that help transgender teens develop characteristics that align with their gender identity. Use of these treatments is supported by major American medical groups including the American Academy of Pediatrics.
"It's important to put numbers to the debates that are currently happening," says Landon Hughes, a postdoctoral research fellow at the Harvard School of Public Health. "There weren't any peer reviewed studies that were looking at the rate of hormone use and puberty blocker use among youth in the U.S., and so we wanted to fill that void."
Hughes and colleagues at Harvard and Folx Health, a virtual LGBTQ health care company, used a data set of private insurance claims from 2018-2022 that included more than 5 million adolescents.
"The total number of youth who had any diagnosis of gender dysphoria was less than 18,000," Hughes explains. "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."
In other words, the study found that less than 0.1% of teenagers with private insurance in the U.S. are transgender and receive gender-related medicines.
A recent mental health survey from the CDC found a much higher percentage — 3% of high school students — self-identified as transgender. Not all transgender people seek a medical diagnosis or treatments related to their identity, notes Lindsey Dawson, director of LGBTQ health policy at the research organization KFF. "Much more common is to change hair grooming, style of clothing, using a different name," she says, pointing to KFF research.
Dawson, who was not involved with the research, said the study was notable for the large sample size. "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 says.
Hughes says the study puts the political attention on this group into perspective. In the recent election, Republicans spent more than $222 million on anti-LGBTQ advertisements, according to a report by AdImpact shared with NPR.
"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," Hughes observes.
The American Principles Project, a conservative political advocacy group that has opposed transgender policy for years, is likely to push for a ban on gender-affirming care for minors under the Trump administration, Jon Schweppe, policy director at the organization told NPR in November.
"We've poll tested that, and we're pretty confident that the American people agree," Schweppe says.
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