At Least 14,000 U.S. Minors Have Received Gender-Transition Treatment or Surgeries In 5 Years, With Docs Billing $120 Million
The findings of a comprehensive analysis of insurance-claims data by the advocacy nonprofit Do No Harm.
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This article was originally published on Benjamin Ryan’s Substack.
About the Author
Benjamin Ryan is an independent journalist, specializing in science and health care coverage. He has contributed to The New York Times, The Guardian, NBC News and The New York Sun. Ryan has also written for the Washington Post, The Atlantic, The Nation, Thomson Reuters Foundation, New York, The Marshall Project, PBS, The Village Voice, The New York Observer, the New York Post, Money, Men’s Journal, City & State, Quartz, Out and The Advocate.
Learn more about Ryan’s work on his website, follow him on X @benryanwriter, and subscribe to his Substack.
Medicalized gender transitions for minors were rapidly becoming more common in the United States until state bans of such medical interventions started to go into effect. Even in blue states where these medical practices remain legal, quite a few states saw a downturn in 2023, including in California and New York.
At least 14,000 minors underwent gender-transition treatment, surgeries, or both between 2019 and last year. This five-year tally is a conservative estimate, meaning that the true figure is likely higher, if not quite a bit higher. The figure is the product of a new analysis of national insurance-claims data that was released on Tuesday by Do No Harm.
This medical advocacy nonprofit is fervently opposed to minors accessing puberty blockers, cross-sex hormones, and gender-transition surgeries to treat gender dysphoria. Consequently, Do Not Harm’s word choice when describing these medical practices may strike some people as incendiary and even offensive.
“We feel very strongly that the science behind using these treatments in children is extraordinarily flawed and suggests that children are being harmed,” said the chair of Do No Harm’s board, Dr. Stanley Goldfarb, in a press briefing on Monday.
Do No Harm has published the findings of their medical-claims-data analysis in a comprehensive website—DoesMyHospitalTransitionKids.com—that allows users to investigate pediatric gender-transition and surgery data by state and by individual institutions within each state.
Main Findings in the 2019 to 2023 Medical-Claims Data:
13,994 unique minors received gender-transition surgeries, treatment, or both.
5,747 minors received gender-transition surgeries.
8,579 minors received puberty blockers, cross-sex hormones, or both (the analysis did not disaggregate to show how many minors received each type of medication). Between them, these minors were written 62,682 prescriptions.
Health care providers billed $119,791,202 for all these patients. The analysis did not reveal the dollar figure of how much these providers were actually reimbursed, mind you; that figure could be at least somewhat smaller.
The Williams Institute at UCLA estimates that 300,000 Americans age 13 to 17 identity as transgender. In April, the World Professional Association of Transgender Health (WPATH) argued that the majority of such minors would do best to undergo a medicalized gender transition. Consequently, from WPATH’s perspective, 14,000 minors receiving such a medical intervention over a five-year period is equivalent to only about 10 percent of the target population. However, on Tuesday, the Centers for Disease Control reported that 3.3 percent of high school students identified as transgender, compared with 1.4 percent according to the Williams Institute. It is difficult to discern whether this difference is a result of differences in survey methods, a rapid increase in youth trans identification, or both.
The math-minded among you may notice that there appears to be little overlap between the group that received surgeries and the group that received medication treatment, given that the sum of the two groups is 14,326; that is only 332 greater than the total number of minors who received either type of intervention. This defies logic, since presumably the vast majority of minors who undergo such surgeries are already taking cross-sex hormones.
This apparent lack of overlap between the two groups is a product of the analysis’ conservative methodology. The authors of the report only counted a cross-sex hormone prescription if it was written a maximum of 90 days following the entry into a patient’s medical file of a gender-dysphoria-related diagnosis code. Consequently, there may have been any number of cross-sex hormone prescriptions that the analysis did not include in its tally because too much time passed between the recording of a gender dysphoria-related diagnosis and the prescription of hormones.
“We have a very high level of confidence that what you are seeing here is directly related to sex-change treatments,” Michelle Havrilla, director of Do No Harm’s program to shield children from gender-transition treatment, said during Monday’s press briefing.
The Do No Harm analysis is also limited by the fact that its authors could not access medical-claims data regarding minor patients who either saw their care processed through internal Veterans Affairs claims, paid out of pocket, received charity care, or were cared for by Kaiser Permanente (which cares for a wide swath of patients across the West Coast in particular).
“What we’re really showing you today is a floor or a very conservative estimate of what’s happening throughout the country,” said Ms. Havrilla.
The Picture of Pediatric Gender-Transition Treatment Comes Into Sharper Focus
Do Not Harm’s surgery figures are in the general ballpark of estimates put out by Leor Sapir of the Manhattan Institute in August. Dr. Sapir conducted a similar analysis of insurance-claims data and found that between 2017 and 2023, 5,288 to 6,294 minor natal girls underwent double mastectomies for gender dysphoria.
In an email to me regarding the Do Not Harm analysis, Dr. Sapir said: “The data on surgery align with our findings, though we looked at a broader range of years (2017-2023) and exclusively at mastectomy. In both cases, the analyses were deliberately based on conservative assumptions; with a field as contentious as this, it’s better to underestimate than to overestimate.”
“The practice of sex ‘change’ surgery in minors is not nearly as rare as its advocates have said,” Dr. Sapir told me. Indeed, the Do No Harm analysis re-affirms my previous reporting about how Harvard recently falsely claimed that gender-transition surgeries are rare among minors.
Dr. Sapir argued that at least for surgeries, the Do No Harm analysis has superseded an analysis conducted by the data analytics firm Komodo Health Inc. on behalf of Reuters, which was published in Oct. 2022. Komodo’s data for medication-based transition treatment was in the general ballpark of Do Not Harm’s. They found that between 2017 and 2021, 4,780 minors with gender dysphoria received puberty blockers and 14,726 received cross-sex hormones. But that analysis identified only 776 gender-transition surgeries.
Also, a study published in Sept. 2023 in the journal Cureus analyzed data from the American College of Surgeons National Surgical Quality Improvement Program Pediatric database. From 2018 to 2021, it identified just 108 minors who received such surgeries. But it did identify a swift increase in the number of surgeries with each passing year, similar to the growth in all types of gender-transition interventions identified by Komodo.
Top 12 Children’s Hospitals Providing Gender-Transition Treatment and Surgeries to Minors
Do No Harm assembled a list it derisively referred to as the “dirty dozen” of the “worst-offending children’s hospitals promoting sex change treatments for minors.”
Their criteria included:
The number of gender-transition patients under age 18
Whether the institution had a dedicated pediatric gender clinic that advertised gender-transition treatment
Which treatments and procedures were offered (surgeries put a clinic higher on the list)
The number of gender-transition treatment prescriptions written
The dollar amount of related medical claims
The promotion of gender-transition treatment within the community
Activism and public support by an institution and its leaders of what Do No Harm referred to as “gender ideology”
The top dozen hospitals includes:
The Children’s Hospital of Philadelphia, with 122 minor patients receiving gender-transition treatment, 5 of whom received surgery. They submitted $230,784 in bills over the five-year period.
Connecticut Children’s Medical Center in Hartford
Children’s Minnesota in Minneapolis
Seattle Children’s
Children’s Hospital Los Angeles
Boston Children’s Hospital (which in 2007 set up the nation’s first pediatric gender clinic, importing a treatment model pioneered by Dutch researchers)
Rady Children’s Hospital in San Diego
Children’s National Medical Center in Washington, DC
UCSF Benoff Children’s Hospital Oakland
Children’s Hospital Colorado in Aurora
UPMC Children’s Hospital of Pittsburgh
Cincinnati Children’s Hospital Medical Center
For a rather famous—or, according to gender-medicine skeptics, infamous—example of how Boston Children’s has advertised gender-transition surgeries for minors, check out the video below. It was first published in Aug. 2022, but was later taken down amid a firestorm of criticism over the OB/GYN, Dr. Frances Grimstad, effervescently describing what she calls “gender-affirming hysterectomies” for minors with gender dysphoria. But the video is still available via the internet archive.
Many of the doctors at these top children’s hospitals, such as UCSF’s Dr. Jack Turban, may have established themselves as the face of the pediatric gender medicine field. But only about 10 percent of claims for pediatric gender-transition treatment and surgeries are coming from children’s hospitals, Do Not Harm found. The vast majority of care is provided by non-pediatric clinics or hospitals.
Data Broken Down By State
“There are lots of ideas that this is a rare event, lots of ideas that this is localized to just a few places,” Dr. Goldfarb said of pediatric gender-transition treatment at the Monday press briefing. “We thought it was really crucial that we develop an approach that allows you all, as representatives of the people, to be able to inform people in their local hospitals and locales exactly what’s happening.”
Accordingly, users of the Do Not Harm website can zoom in to individual states to analyze data on local health care practices and billing histories. For example, over the five-year period of the analysis, California health care providers treated at least 2024 minors with gender-transition treatments, billing nearly $29 million for 1359 surgeries and prescribing puberty blockers and cross-sex hormones to 725 children.
Zooming in a little closer, here is a segment of the roster of California care providers and their respective shares of the tally:
Here is share of those cases from Children’s Hospital Los Angeles:
The Top Doctors and Medical Institutions By Billing
Gender-transition treatment is a substantial source of revenue for a number of large hospitals. Keep in mind, however, that even if Mount Sinai brought in all $8.2 million they billed for such medial care over five years, this would only have amounted to 0.05 percent of the hospital system’s total revenues during that period, of about $17 billion.
The following figures suggest that there is a small club of individual doctors who billed in excess of $2 million over a five-year period for gender-transition treatment for minors. A single doctor at Boston Children’s billed in excess of $5 million.
Overall trends
Interestingly, even in states where gender-transition treatment and surgeries for minors has remained legal, there was a sharp downturn in prescriptions and operations in 2023 in some but not all states—including California, Colorado, Illinois, New York, Pennsylvania and Washington. Do No Harm told me this was not because the data from 2023 is incomplete.
My recent reporting suggests that it is possible that in the face of backlash against pediatric gender medicine and waves of bad publicity—including the publication of Britain’s Cass Review, the release of the WPATH Files and the unsealing of damaging documents about WPATH in the federal lawsuit in Alabama—physicians in this field have started to become more conservative in their prescribing practices. Also, it is possible that parents have become more reticent about consenting to such treatment in the face of waves of news that might lead them to question the related evidence base.
Also, in the wake of gender-affirming surgeon Dr. Blair Peters’ recent conversation on Instagram Live with the American Society of Plastic Surgeon’s president, many wondered how many minors Dr. Peters has operated on. Dr. Peters works at Oregon Health and Science University. OHSU Portland had at least 19 minor patients who received gender-transition surgeries over the past five years.
Learn more about Ryan’s work on his website, follow him on X @benryanwriter, and subscribe to his Substack.
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Thanks to all for reading my report about the Do No Harm analysis on the numbers of youth who have received pediatric gender-transition treatment and surgeries. Give me a follow if you're so inclined. I report often and in-depth about this controversial medical field.
This is madness. We knew the number was likely very high for puberty blockers & hormones, but radical trans activists have been saying “nobody is doing surgery on minors” for years. Oh, except for the 5,700+ times they did.