A new study by researchers at the Harvard T.H. Chan School of Public Health shows gender-affirming hormone treatment is rarely prescribed to transgender and gender diverse adolescents in the United States.
The study published Monday in JAMA Pediatrics found that out of more than 5 million young patients included in the study, only 0.1% of those were transgender or gender diverse and prescribed puberty blockers or hormone therapy. Researchers found no cases of patients under the age of 12 who received hormones.
“What we’re finding is that this is just a very, very, very rare form of care,” 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.
The findings counter the narrative that gender-affirming care is over-prescribed to children. That concern has increased in recent years, and 26 states have passed legislation to limit access.
Hughes said misinformation around gender-affirming care has spread, including during the most recent election.
“There were some folks on the political trail who were saying that kids are getting access to these in schools and are getting access to this wherever they want. And we’re not seeing that. It’s very rare,” he said.
For the study, researchers reviewed five years’ worth of private health insurance claims for patients between the ages of 8 and 17, looking for those with a gender-related diagnosis and prescription for puberty blockers or hormone treatment.
Puberty blockers halt the body’s production of sex hormones that lead to puberty, while gender-affirming hormone therapy alters the body’s hormone levels to prompt physical changes.
Hughes said less than 2,000 of the 5.1 million patients included in the study received hormone therapy, and less than 1,000 accessed puberty blockers.
“And this is over a five-year period. So, in our study sample, about one kid a day is accessing this care,” Hughes said.
Senior author Jae Corman, head of analytics and research at FOLX Health, said that’s “surprisingly low” because more than 3% of high school youth are transgender.
“Our study found that, overall, very few [transgender and gender diverse] youth access gender-affirming care,“ Corman said. “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.”
Alex Keuroghlian, associate professor of psychiatry at Harvard Medical School and director of the National LGBTQIA+ Health Education Center, said he was not surprised by the findings, in part because of the barriers to receiving care.
“Gender diverse identities among youth are typically highly underreported. And among those youth ... very few are going to be able to access gender-affirming medical care due to practitioners not being knowledgeable or comfortable or willing to provide this, due to families being confused and not getting good counseling from care teams about how to support youth,” he said. “And all this happening in the context of widespread, coordinated disinformation.”
Keuroghlian said previous studies have not stopped the political hostility toward transgender and gender diverse youth.
“It’s going to take more than, you know, research publications to shift the culture and to shift policy,” he said.
