How many patients under the age of 18 received medication therapy as gender affirming care
Executive summary
Two different, widely cited analyses offer very different counts: a 2018–2022 private‑insurance study found 926 adolescents received puberty blockers and 1,927 received gender‑affirming hormones, while a broader 2017–2021 analysis that included public plans reported at least 14,726 minors began hormone therapy and 4,780 started puberty‑blocking medications — the gap reflects different data sets and methods, not a contradiction in raw care trends [1] [2] [3].
1. The low‑count, private‑insurance picture: 926 blockers and 1,927 hormones (2018–2022)
A JAMA Pediatrics analysis drawing on more than 5 million privately insured adolescents found that from 2018 through 2022 just 926 adolescents with a gender‑related diagnosis received puberty blockers and 1,927 received gender‑affirming hormones, leading researchers to conclude that fewer than 0.1% of youth in that database received such medications and that no patients under age 12 were prescribed hormones in that sample [1] [4] [5].
2. The higher, population‑level tally: at least 14,726 started hormones (2017–2021)
A separate Komodo Health analysis reported to Reuters and summarized by other research outlets counted at least 14,726 minors who started hormone therapy between 2017 and 2021 and 4,780 who began puberty blockers in that period, a figure based on a larger mix of private and public insurance claims covering roughly 330 million U.S. patients — the broader inclusion of Medicaid and other plans accounts for the much higher totals compared with the private‑only study [2] [3].
3. Why the numbers diverge: scope, definitions and access matter
The discrepancy is not simple error but stems from differences in data coverage and methodology: the Harvard/Chan study used a large private‑insurance cohort and identified transgender or gender‑diverse patients by diagnostic codes and prescriptions, likely capturing youth with better access to specialty clinics, whereas the Komodo/Reuters work included Medicaid and a wider claims universe and therefore detected far more treatment starts across the system; researchers and reporting outlets explicitly note these coverage and identification limits as drivers of divergent counts [4] [2] [6].
4. What the data do — and don’t — tell about minors receiving medical transition care
Both studies repeatedly underline rarity: the private‑insurance analysis emphasized that fewer than 0.1% of adolescents received these medications and that hormone prescriptions to very young children were absent in that sample, while commentators caution these figures exclude uninsured youth, out‑of‑pocket care, and states where Medicaid does not cover such treatments and that waiting lists and access barriers may further suppress counts in claims data [1] [7] [6].
5. Context, politics and potential agendas in interpretation
The numbers have become political flashpoints: some advocates use the lower private‑insurance rates to argue that access is limited and uncommon [5], while opponents of youth gender‑affirming care cite higher systemwide counts to argue treatments are more widespread [2]; news outlets and think tanks reporting these figures often have explicit frames and those frames can shape which data set is amplified, so readers should weigh scope and source when interpreting head‑line counts [1] [2] [3].
6. Caveats, consensus and next steps for clearer counting
Neither data source fully captures the universe of care — researchers note private‑insurance samples may overrepresent access, Reuters‑level claims may better reflect systemwide starts but still miss uninsured or privately paid care, and both depend on diagnostic coding and prescription capture; clinical literature and professional guidance emphasize individualized care pathways, and ongoing monitoring will matter as state laws and federal actions change access [4] [2] [8].