More Than One in 250 Biological Girls in Oregon Between 2016 and 2023 Were on Testosterone by Age 17, New Study Finds

The use of gender-transition drugs by adolescents in Oregon skyrocketed between 2016 and 2023, according to a new analysis of health-insurance data on youth in the state. The study authors found that during this period, prescriptions for cross-sex hormones increased by nearly an order of magnitude among biological girls and charted a 14-fold increase in natal boys.By age 17, about one in 240 insured natal girls in Oregon were taking testosterone and about one in 625 of their natal-male counterparts were taking estrogen. These figures are three-fold higher for natal girls and nearly twice as high for natal boys compared with statistics from a study published last year that analyzed nationwide data on commercially insured youth in the same age range, covering 2018 to 2022. About one in 100 insured youth ages eight to 17 in Oregon were diagnosed with gender dysphoria, a psychiatric condition involving distress stemming from a conflict between an individual’s sex and their gender identity. The diagnosis is typically required to secure insurance coverage for treatment of youth identifying as transgender with puberty blockers and cross-sex hormones. Hormones, in particular, cause permanent alterations to secondary sex characteristics, such as by deepening the voice among natal girls or causing breast tissue to grow among natal boys.The authors of the new study, most of whom are researchers at the health consulting firm Comagine Health at Portland, concluded that the findings indicate that gender-transition treatment rates among minors in the Pacific Northwest state are suboptimal. They wrote that “access remained limited” to this population and that pediatric gender-transition treatment is “rare in Oregon.”Amid a fierce and ongoing political battle over the care and treatment of gender dysphoric youth, authors of the national study sought upon its publication to combat what they characterized as politically motivated hyperbole and exaggerations about the prevalence of these prescriptions. They intimated that too few adolescents were accessing these medical interventions. The national study’s senior author, Jae Corman, who at the time was head of analytics and research at the transgender-medicine telehealth provider FOLX Health, said in a press release last year that the national pediatric treatment rate the team identified was “surprisingly low, given that more than three percent of high school youth identify as transgender.” Jae Corman via LinkedIn.Dr. Corman was also a coauthor on the new paper. Neither of the corresponding authors of the two papers returned a request for comment. A child psychologist who helped establish the field of pediatric gender medicine in the United States two decades ago, Laura Edwards-Leeper, has emerged in recent years as a prominent critic of what she has characterized as the field’s flagging observation of important safety guardrails. She recently relocated to the Midwest after spending about a decade practicing in Oregon. In an interview with The New York Sun, Dr. Edwards-Leeper conjectured that two main factors were likely driving what she characterized — in contrast to the papers’ authors — as notably high rates of gender-transition medication uptake among minors in her former home state. First, she said, “Oregon is arguably the most trans-affirming state in the nation.” This includes in school curricula, which, she said, “encourage students of all ages to contemplate their gender identity.” Dr. Laura Edwards Leeper via her website.Second, Oregon health care providers are also “extremely supportive of trans people,” Dr. Edwards-Leeper added. Many pediatric providers “value their patients’ bodily autonomy regardless of age” and are concerned that denying youths prompt receipt of gender-transition drugs will harm their mental health. Advocates of pediatric gender medicine point to research that has found an association between receiving puberty blockers and hormones as an adolescent with better metrics of mental health. But a slew of systematic literature reviews — the gold standard of scientific evidence — have found the supporting evidence wanting and inconclusive. Transgender advocates have in turn criticized those who leverage review papers to undermine pediatric gender medicine as setting the evidentiary bar so high that no study of these medical interventions could ever hope to reach it. Publishing their findings in Research Connections on May 7, the new study’s authors analyzed an insurance database of publicly and commercially insured Oregon residents aged eight to 17 between 2016 and 2023. The database covers about 80 percent of all insured Oregonians.Oregon’s Medicaid program started covering gender treatments for patients of all ages in 2014. In 2023, the state passed a so-called shield law to protect youths’ access to gender-transition treatment as Republican legislatures banned such medical practices in what today is just over a majority of U.S. states. An Oregon Health and Science University plastic surgeon, Blair Peters, second from right, shared this photo on Instagram of his surgical team celebrating Pride Month by promoting phalloplasty. The new study’s authors noted that the gender dysphoria diagnosis rate in Oregon was lower than the estimates of youth identifying as transgender in the state, which ranged between 1.2 percent and 3.2 percent at the time.Of the group diagnosed with gender dysphoria in Oregon, less than 25 percent were prescribed gender-transition drugs. Eight percent received puberty blockers and 20 percent received cross-sex hormones. Natal boys were much more likely to get puberty blockers, including 17 percent of those with gender dysphoria, compared with 5.5 percent of natal girls diagnosed. But their rates of cross-sex hormone prescriptions were similar, at 22 percent and 19 percent, respectively.Youth with gender dysphoria had a higher rate of prescriptions of puberty blockers if they had commercial insurance. According to the report, the median age when minors were diagnosed with gender dysphoria was 14. Commercial insurance began covering treatment about eight months after diagnosis while for publicly insured youth, this interval was just under 11 months.The youngest age at which any natal girl received puberty blockers was eight years old while the youngest corresponding age for the natal boys was nine. Puberty blocker prescriptions remained low in Oregon, but peaked in youths’ mid-teens, at which point around 75 per 100,000—or one in 1,333—youths were receiving the drugs.The youngest age of children receiving cross-sex hormones was 10 for natal boys and 11 for natal girls. Cross-sex hormone prescriptions began increasing for kids of both sexes at age 13, before dramatically shooting up in the mid-teen years, for natal girls in particular. By age 17, about 415 in 100,000 natal girls were taking testosterone, or one in 240; while about 160 in 100,000, or one in 625 natal boys were on estrogen.Although the prescribing rates in Oregon were much higher than the national figures found in the previous study, the general prescribing patterns broken down by age were strikingly similar. A senior fellow studying pediatric gender medicine at the Manhattan Institute, Leor Sapir, said that the new study provides stark evidence of a remarkable and unprecedented explosion of gender dysphoria cases, particularly among adolescent girls. He noted that several European nations, after examining the systematic reviews of this field, have conducted an about-face on pediatric gender medicine and have begun sharply restricting access to gender-transition interventions for minors. “It was in response to such sharp and dramatic epidemiological changes that European health authorities decided to re-examine in earnest the evidence for pediatric medical transition — something most American medical groups have so far refused to do,” Dr. Sapir said.Overall, gender dysphoria diagnoses have been swiftly skewing younger nationwide. According to a study of medical claims data of patients of all ages published in 2023, the average age at which Americans were first diagnosed with the condition decreased to age 26 in 2021 from age 31 in 2017.Some evidence suggests that trans identification has declined among youths nationally in more recent years. The actual number of youths who have received gender-transition interventions nationwide in recent years is hazy, even amid fierce political interest in the issue.According to a recent Congressional Budget Office analysis, Medicaid spent more than $100 million nationally on gender treatments and surgeries for minors between 2019 and 2023. The particulars of this study suggested that a recent analysis by the nonprofit Do No Harm, which opposes pediatric gender medicine, likely produced a considerable underestimate when it concluded that some 14,000 youths received gender-related interventions over a recent five-year period.Across the eight years covered by the Oregon study, the annual rate of testosterone prescriptions for all natal girls increased steadily from 28 per 100,000 girls in 2016 to 252 per 100,000 in 2023—a nine-fold increase. The rate of natal boys taking estrogen increased from seven to 97 per 100,000—a 14-fold increase. Given this stark rise in prescriptions and the fact that the rates the paper provided that were broken down by age represented an average over time, it is likely that by 2023, the rates of youths receiving cross-sex hormone prescriptions by age 17 was even higher than the figures reported in this paper. The study authors did not publish such granular data, however.The study authors did suggest that what they observed as a constant proportion of youth diagnosed with dysphoria receiving gender-transition treatment over time likely reflected “a combination of factors, including persistent structural and systemic barriers” such as youths’ overall access to health care, insurance issues, health care provider availability, and requirements for consenting to such treatment, among others. The study did not include data on uninsured youth or those insured by health plans that are not covered by the data set. This may limit the generalizability of the study findings, the authors cautioned. However, just three percent of Oregon’s minors lack health insurance, the fourth-lowest rate in the nation, according to U.S. Census data analyzed by United Health Foundation. Gender transition treatment for minors has often been sold as “lifesaving” by advocates, given studies have found it is associated with lower suicidality. Numerous parents of children with gender dysphoria have reported that doctors have responded to their concern about consenting to such treatment by suggesting that there was an extremely high likelihood their child would commit suicide absent medically transitioning. An expert in evidence-based medicine who teaches at McMaster University in Hamilton, Ontario, Yuan Zhang, however, noted on social media that despite the surge in gender-transition treatments among minors, the state’s rates of suicide as well as suicidality related emergency room visits remained stable during the study period. These findings, he said, suggest that “from an ecological level, access to ‘lifesaving’ gender affirming care has no impact on suicide.”Dr. Edwards-Leeper said that the pediatric gender medicine field has undergone a sea change over the past decade in providers’ attitudes about conducting comprehensive psychological assessments of minors as a condition of approving them for blockers or hormones. Her own vocal advocacy for such assessments, which she sees as vital, has largely fallen on deaf ears in Oregon. Many of her former colleagues there, she said, have come to see such assessments as unnecessary and egregiously burdensome to vulnerable young patients.“Unfortunately,” Dr. Edwards-Leeper said, “this shift occurred as the mental health complexity of this young patient population was increasing. In other words, thorough assessments to help determine whether medical interventions would be beneficial were removed when they were needed most.”

More Than One in 250 Biological Girls in Oregon Between 2016 and 2023 Were on Testosterone by Age 17, New Study Finds

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