How many minors received puberty blockers or cross‑sex hormones in the U.S. by year?

1. What the two headline numbers say and why they differ

The smaller counts—926 puberty‑blocker starts and 1,927 hormone starts from 2018–2022—come from a JAMA Pediatrics study that analyzed private commercial insurance claims and identified adolescents with a gender‑related diagnosis who then received blockers or hormones ^{[1] [5]}. The larger Reuters/Komodo totals come from a broader Komodo Health data set used by Reuters that included a mix of private and public plans and reported a five‑year total of roughly 17,683 children who initiated blockers or hormones (with reporting that 4,780 began blockers and 14,726 began hormones in 2017–2021) and a rise in annual initiations from 2,394 in 2017 to 5,063 in 2021 ^{[2] [4] [3]}.

2. What can be stated year‑by‑year from available reporting

The only explicit year‑by‑year numbers in the provided reporting are from the Reuters/Komodo analysis: combined starts of puberty blockers or hormones rose from about 2,394 in 2017 to about 5,063 in 2021, producing a five‑year total (2017–2021) of about 17,683 patients ages 6–17 who initiated either therapy ^{[3] [2]}. The JAMA Pediatrics/private‑insurance study gives aggregated counts for 2018–2022 (926 blockers; 1,927 hormones) but the provided summaries do not include a published per‑calendar‑year breakdown in the excerpts supplied here ^{[1] [5]}.

3. How rates and prevalence were framed by those studies

The JAMA Pediatrics analysis emphasized rarity within its sample: fewer than 0.1% of privately insured adolescents received blockers or hormones during 2018–2022, and authors noted their figures likely represent higher access compared with Medicaid‑insured or uninsured youth ^{[1] [5] [6]}. Reporting translated that to practical terms—on average across the U.S. roughly eight youths a day initiated hormones and four initiated puberty blockers during the study window, per one news account summarizing the research ^[7]. Other writeups highlighted per‑age rates (for example, by age 17 about 1 in 1,000 privately insured minors were receiving hormones in 2018–2022) drawn from that private‑claims analysis ^[8].

4. Methodological caveats that matter to interpreting “by year”

Differences in numerator and denominator definitions, the insurance populations covered, diagnostic coding rules, and the study periods drive the divergent totals: JAMA Pediatrics used large‑group private plans and counted adolescents with a gender‑related diagnosis who filled prescriptions ^[5], while the Reuters/Komodo work used broader claims across private and public plans and reported higher absolute counts and an explicit year‑to‑year increase ^{[2] [4]}. Neither set of summaries provided a full public spreadsheet here; therefore exact, audited year‑by‑year national totals across all payers and settings cannot be reconstructed from the excerpts supplied ^{[1] [2]}.

5. What the debate often misses—and what the sources show

Both data sets undermine hyperbolic claims that large numbers of minors were broadly medicated: even the higher Komodo totals amount to thousands over five years, not hundreds of thousands, and the private‑claims study places use under 0.1% of adolescents in its sample ^{[2] [1]}. At the same time, policy arguments differ over significance—advocates point to small absolute numbers and clinical protocols that limit treatment, while critics emphasize rising trends and unresolved long‑term safety questions—positions reflected across reporting and academic commentaries ^{[7] [9] [10]}. The available evidence here supports a cautious numeric conclusion: exact calendar‑year counts depend on which dataset and payer mix are used; the two prominent analyses reported thousands of starts across multi‑year windows, with Reuters/Komodo showing a clear upward trend by year through 2021 and JAMA Pediatrics reporting lower totals when restricted to private plans across 2018–2022 ^{[3] [2] [1]}.