Gender-Affirming Care For Adolescents Extremely Rare, Says Harvard Study

Only 0.1 percent of American adolescents receive gender-affirming care, says a new study from Harvard.

The study was published in the Journal of the American Medical Association (JAMA) and led by Dr. Landon D. Hughes of the Harvard T.H. Chan School of Public Health Department of Epidemiology. The medical records of more than five million patients aged between 8 and 17 were surveyed between 2018 and 2022 using the Merative MarketScan Research Database. The result yielded around 300,000 adolescents who identified as trans or gender diverse.

Of those, only 0.1 percent ever received puberty blockers or hormone therapy. The use of puberty blockers was slightly higher for adolescents assigned female at birth (AFAB) than adolescents assigned male at birth (AMAB), but both were less than 21 adolescents per 100,000. Hormone therapy increases as patients reach 17, but still only account for between 82 and 140 adolescents per 100,000.

The study comes at a time when Texas Republicans are seeking to ban gender-affirming care for minors. In June, the Texas Supreme Court upheld a law banning gender-affirming care in an 8-1 vote. The court said that the plaintiffs failed to prove that the law violated the Texas Constitution, and said they were not ruling on the validity of the practice.

Gender-affirming care is used to treat trans and gender-diverse individuals for gender dysphoria, an acute mental health condition characterized by distress and depression when patients are forced to adhere to their community’s preferred gender presentation, usually their birth gender. Evidence-based practice shows that it reduces self-harm, suicidal ideation, and mental suffering when employed for adults and adolescents.

“Despite its safety and effectiveness, gender-affirming medical care for adolescents who identify as TGD is a polarizing topic, with nearly half of US states enacting laws to limit access,” the study reads. “Advocates of these restrictive laws argue that rates of gender-affirming care are too high.”

Contrary to popular belief, gender-affirming care for adolescents almost never involves surgical alteration. Another JAMA-published study from Dr. Jose F. Figueroa of Harvard showed that only 2 out of 100,000 TGD adolescents receive any kind of surgical care, and almost all of it was related to breast reduction (96 percent). There is no record of any children under 12 receiving hormone or surgical treatment.

Despite this, the Texas Legislature is gearing up to put further restrictions on gender-affirming care and trans identity in 2025. Bills already filed include assertions on government documents that there are only two genders, laws requiring individuals to identify as their birth gender, prohibitions on changing gender markers on government documents, bans on trans people using bathrooms not associated with their birth gender, and stripping public funding for gender-affirming care. At least some of these are likely to meet constitutional challenges in the U.S. Supreme Court, where there is currently a conservative supermajority of 6-3.

In the meantime, Texas law is likely to make the already rare practice of medical intervention to support TGD youths even rarer than it already is.