Genspect Explainer: Latest data on gender affirmative care from USA

On October 6th 2022, Reuters published a ground-breaking article highlighting the drastic increase in children identifying as transgender and seeking gender ‘affirmative care’ between 2017 and 2021. Reuters worked with health technology company Komodo Health Inc to determine how many youths have sought and received ‘gender affirming’ care during that period in the US.

This first graph shows that the number of children receiving a gender dysphoria diagnosis has nearly tripled from 15,172 in 2017 to a staggering 42,167 in 2021. According to Reuters, this data is backed up by state-level data obtained via Medicaid, which showed similar trends in the number of children now claiming a transgender identity. These numbers do not include children who have not sought a social or medical transition or treatment; therefore, the number of children in the US influenced by trans discourse is likely much higher than the 42,167 reported here.

A small but increasing number of these children are choosing to begin medical interventions at the onset of puberty, at around age 10-11. Puberty blockers, also known as GnRH agonists, suppress the release of the sex hormones testosterone and estrogen. Puberty blockers and cross-sex hormones do not have U.S. Food and Drug Administration (FDA) approval for children’s gender care. No clinical trials have established their safety for such off-label use. The drugs’ long-term effects on fertility and sexual function remain unclear. In 2016, the FDA ordered makers of puberty blockers to add a warning about psychiatric problems to the drugs’ label after the agency received several reports of suicidal thoughts in children who were taking them.

More broadly, no large-scale studies have tracked people who received gender-related medical care as children to determine how many remained satisfied with their treatment as they aged or eventually regretted transitioning. Yet, between 2017 – 2021, the number of children prescribed puberty blockers increased from 633 to 1,390. Reuters notes that these numbers are likely an undercount as the data does not include private treatment carried out without insurance or treatment given without a prior diagnosis of gender dysphoria. Reuters remarks that ‘Practitioners may not log this diagnosis when prescribing treatment,’ which is highly questionable when research has found that 98% of children who take puberty blockers go on to take cross-sex hormones. Surely a diagnosis of gender dysphoria should be required before beginning irreversible medical treatments. 

With or without prior treatment with puberty blockers, teens may choose to start cross-sex hormone treatment. This involves giving them hormones that align with their perceived gender identity. As the data shows, in 2017, there were 1,905 children receiving hormone treatment, but by 2021 that number had increased to 4,231. Again, this number is likely to be an undercount as the data set does not include treatment carried out without insurance. The long-term effects of hormone therapy are poorly studied and understood, and their use may lead to infertility, especially if taken after puberty-blocking medications. As stated in the Reuters article, Dr Annelou de Vries, a specialist in child and adolescent psychiatry and one of the Dutch researchers whose early work established the importance of rigorous patient assessments before starting medical treatment; ‘said that while she worries about the growing number of children awaiting treatment, the graver sin is to move too fast when puberty blockers and hormones may not be appropriate.’ This is especially true with the recent explosion in the number of desisters and detransitioners who regret the permanent lifelong changes caused by ‘affirmative care’ treatments.

Top surgery, which involves the removal of breast tissue to create a flat chest, is uncommon among minors; however, it is still carried out. See the recent Boston Children’s Hospital case, where the hospital was caught advertising irreversible ‘gender affirmative’ surgeries to minors. As the data shows, since 2017, 776 double mastectomies have been carried out on girls aged between 13-17. Reuters also notes that 56’ bottom surgeries’ have been carried out in the same period. Like all the other data sets, these numbers are likely to be much higher. It is still unclear how many children are impacted by these irreversible medical interventions, but we can be sure that the number has exploded and is rising in the US over the last five years according to the Reuters data; a total of 17,683 patients, ages 6 through 17, with a prior gender dysphoria diagnosis initiated either puberty blockers or hormones or both.