Over 1 in 250 Natal Girls Were Taking Testosterone By Age 17 in Oregon, From 2016 to 2023
This rate, from a study of data about insured adolescents in Oregon, represents an average over this period. Given swift increases in hormone uptake over time, the rate was likely much higher by 2023.
The use of gender-transition drugs among insured adolescents in Oregon soared between 2016 and 2023, charting a nearly 10-fold increase among biological girls and a 14-fold increase in natal boys. Across this period, about 1 in 100 insured youth ages 8 to 17 in the Pacific Northwest state were diagnosed with gender dysphoria, a psychiatric condition involving distress stemming from a conflict between an individual’s natal sex and their gender identity.
By age 17, about 1 in 240 insured natal girls were taking testosterone and about 1 in 630 natal boys were taking estrogen in Oregon. These figures are nearly three-fold higher for natal girls and nearly twice as high for natal boys as figures from a study published last year that analyzed national data on commercially insured youth from 2018 to 2022.
Oregon is among the most famously liberal states and is home to the notably progressive Oregon Health and Science University. Consequently, it is perhaps unsurprising that the state should have what appear to be disproportionately high rates of prescribing of gender-transition treatment to minors.
The new details about pediatric gender medicine in Oregon come from a study published in Research Connections on May 7. The study authors analyzed data on both publicly and commercially insured Oregon residents age 8 to 17 between 2016 and 2023. (They chose the age 8 for the lower end, because that is the earliest that puberty can begin and not be considered precocious puberty. ) The insurance database the authors relied upon covers about 80 percent of all insured Oregonians.
The investigators were keen to examine the rates of prescribing of puberty blockers and cross-sex hormones to treat pediatric gender dysphoria in a state that has a policy environment that is particularly supportive of pediatric gender medicine. Oregon’s Medicaid program started covering these treatments for minors in 2014. In 2023, the state passed a so-called shield law to protect youths’ access to gender-transition treatment.
Out of 868,740 insured Oregonian youth in the data set, 0.98 percent were diagnosed with gender dysphoria, including 1.5 percent of natal girls and 0.5 percent of natal boys. This lopsided sex ratio is quite common across the Western world these days; whereas before the 2010s, the sex ratio of youth presenting at gender clinics was heavily slanted toward natal males. Few of the ardent supporters of pediatric gender medicine have expressed interest in thoroughly exploring the reasons for this dramatic flip in the sex ratio.
The new study’s authors noted that the gender dysphoria diagnosis rate in Oregon was lower than estimates of the population of youth identifying as transgender in the state, which range between 1.2 percent and 3.2 percent.
Of the group diagnosed with gender dysphoria in Oregon, 23 percent were ever prescribed gender-transition drugs, including 8 percent who received puberty blockers and 20 percent who received cross-sex hormones. Natal boys were much more likely to get puberty blockers (including 17 percent of those with gender dysphoria) compared with natal girls (including 5.5 percent). 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, at 10 percent, compared with their publicly insured peers, at 7 percent. But the respective rates of cross-sex hormone prescriptions were about the same, at 20 percent and 19 percent.
Here are prescription patterns broken down by age and year and by type of insurance:
The median age at which youth were first diagnosed with gender dysphoria was 14 for both those with both commercial and public insurance. The median age at which youth received their first gender-transition treatment prescription was 15 for commercial insurance and 16 for public insurance. The median number of days between a gender dysphoria diagnosis and a first prescription of gender-transition treatment of any kind was 250 days for commercial insurance and 325 days for public insurance.
The earliest age at which any youth, natal boy or girl, received puberty blockers was 9. The earliest age at which any natal boy received estrogen was 10. And the earliest age at which any natal girl received testosterone was 12.
Puberty blocker prescriptions were never particularly common in Oregon during the study period. They peaked at about age 14 for natal girls and at age 15 for natal boys—in both cases at a rate of about 75 prescriptions per 100,000 such youths, or 1 in 1,333 youths.
Cross-sex hormone prescriptions, on the other hand, began to inch up at age 13 for both natal sexes and then shot up dramatically through the mid-teen years for natal girls in particular. By age 17, about 414 in 100,000 natal girls were taking testosterone, or 1 in 242; while about 158 in 100,000 natal boys were on estrogen, or 1 in 632.
Note how similar the findings broken down by age from new study from Oregon (the first graph) are compared with the recent study looking at national data on commercially insured youth (the second graph). The rates of usage are much higher in Oregon, mind you. But the rates of increase of hormones and the overall pattern of the use of blockers broken down by age are very similar, lending confidence that these patterns represent a real-world phenomenon across the country, regardless of insurance type.
I recently reported in The New York Sun that from 2019 to 2023, Medicaid spent more than $100 million nationally on gender treatments and surgeries for minors. This was according to a recent government analysis. The particulars of the analysis suggested that a recent analysis by the nonprofit Do No Harm, which opposes pediatric gender medicine, finding that some 14,000 youths received gender-related treatments over a recent five-year period, was likely a considerable underestimate.
Across the eight-year study period in the Oregon study, the rate of testosterone prescriptions for all natal girls age 8 to 17 increased steadily from 28 per 100,000 girls in this age range in 2016 to 252 per 100,000 in 2023—a nine-fold increase. The rate of natal boys taking estrogen increased from 7 to 97 per 100,000 during this period—a 14-fold increase. The rate of increase for girls was particularly steep between 2022 and 2023.
Given this steady rate of increase in the use of gender-transition drugs over the study period, and given the fact that the prescription rates broken down by age represented an average over time, it is likely that by 2023, the rates of youth receiving cross-sex hormone prescriptions by age 17 was even higher than the 1 in 242 natal girls and 1 in 632 natal boys found in this paper. The study did not provide such granularity in its figures, however, including in the supplementary tables.
Over time, the proportion of youth diagnosed with gender dysphoria who received gender-transition drugs remained constant in Oregon, the study authors found. They suggested that this likely reflected “a combination of factors, including persistent structural and systemic barriers (e.g. access, insurance, provider availability, and consent requirements), variation in adolescents’ readiness for interventions, and the fact that not all [transgender] adolescents seek or require treatment.”
The interval between diagnosis and treatment, the study authors theorized, “may reflect a combination of factors, including guideline-concordant assessment, the variable timing of gender identity development, readiness for medical interventions, and, in some cases, barriers or delays in accessing care.”
Cross-sex hormone use, the authors wrote, “increased steadily across adolescence, reflecting guideline-recommended individualized initiation based on readiness and clinical judgement. These patterns reinforce that [gender-affirming care, or GAC] provision emphasizes ongoing assessment and individualized care rather than uniform uptake across adolescents.” I cannot see how they can know any of this based on simply looking at these data, however.
As for the reasons for higher use of gender-transition treatment among commercially-insured youth, the investigators wrote that “families with commercial insurance may, on average, have advantages in navigating complex care systems, reflecting differences in socioeconomic resources, caregiver advocacy capacity, geographic access, and provider availability. In contrast, publicly insured youth may encounter structural barriers—including limited availability of trans-affirming providers, clinicians with less experience in GAC, transportation challenges, or financial constraints—that could limit access.”
The study is limited, in part, the authors wrote, by the fact that it does not cover uninsured youth and those insured by health plans that are not covered by the data set. This may limit the generalizability of the study findings, the authors stated.
I am an independent journalist, specializing in science and health care coverage. I contribute to The New York Times, The Guardian, NBC News, The Free Press and The New York Sun. I have also written for the Washington Post, The Atlantic and The Nation, among many others. Follow me on X: @benryanwriter. Visit my website: benryan.net
I’m not the first to point this out but as a child of the 80’s and 90’s the large psychosocial issue of the day for girls was eating disorders and cutting. To the extent there was heavy social pressure abetting these disorders it remains remarkable that health care providers who lived and grew up through the same period completely forget this phenomenon and the cohort that was most representative when diving head first into, what I call, genderology.
How many are on SSRI’s?