Fewer than 50 per 100,000 transgender adolescents in the U.S. received gender-affirming hormones, with even lower rates for puberty blockers, according to a recent study.

The prevalence of gender-affirming medications among transgender and gender-diverse (TGD) adolescents in the U.S. from 2018 to 2022 were examined. The study, published in JAMA Pediatrics, utilized data from the Merative MarketScan Research Database, encompassing private insurance claims from all 50 states. The aim was to quantify the use of puberty blockers (gonadotropin-releasing hormone agonists) and gender-affirming hormones, stratified by age and sex assigned at birth.

The researchers analyzed 5,155,282 adolescents aged 8 to 17 years, corresponding to 11,879,766 person-years of data. (Note: A person-year is a unit representing one person followed for one year, accounting for variations in individual follow-up durations.) TGD adolescents were identified using diagnostic, procedural, and pharmaceutical codes related to gender-affirming care, such as histrelin implants and exogenous hormone prescriptions. The rates of puberty blocker and hormone use per 100,000 insured adolescents were calculated by age and sex assigned at birth, with 95% confidence intervals (CIs) determined using the Wald method.

The results demonstrated that the receipt of puberty blockers was rare, with rates of 20.81 (95% CI, 19.04-22.59) per 100,000 among adolescents assigned female at birth (AFAB) and 15.22 (95% CI, 13.73-16.71) per 100,000 among adolescents assigned male at birth (AMAB). Among those younger than 14 years, AFAB adolescents had slightly higher rates of puberty blocker use compared with AMAB adolescents. The use of gender-affirming hormones was also uncommon, with rates of 49.9 (95% CI, 47.14-52.65) per 100,000 for AFAB and 25.34 (95% CI, 23.42-27.27) per 100,000 for AMAB adolescents. Hormone use increased after age 14 years, peaking at age 17 at 140.16 (95% CI, 128.01-152.32) per 100,000 for AFAB and 82.42 (95% CI, 73.25-91.59) per 100,000 for AMAB adolescents. Adolescents under the age of 12 did not receive hormone prescriptions.

Limitations were noted, including reliance on claims data that may misclassify care and the exclusion of other gender-affirming medications. The findings suggest that gender-affirming medical care is rare among TGD adolescents and is more common among those with private insurance through large group plans, reflecting better access to care in this population. These disparities highlight the potential challenges faced by uninsured adolescents or those with less comprehensive insurance coverage.

Full disclosures can be found in the published study.