How Many Girls on Testosterone Is Too Many?
A new Oregon study shows that pediatric gender transitions aren’t as rare as advocates of the “affirming” model assured us.
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About the Author
Dr. Colin Wright is an evolutionary biology PhD, Manhattan Institute Fellow, and CEO/Editor-in-Chief of Reality’s Last Stand. His writing has appeared in The Wall Street Journal, The Times, the New York Post, Newsweek, City Journal, Quillette, The Washington Examiner, and other major news outlets and scientific journals.
For years, we were told not to worry about pediatric gender medicine because it was vanishingly rare. Puberty blockers and cross-sex hormones, we were assured, were reserved for a tiny number of carefully assessed children with severe and persistent distress.
But when new data show that these treatments aren’t so rare, the same defenders suddenly change their tune: the numbers are no longer reassuring because they are small; now they are reassuring because they are large. More children receiving medical transition means that a previously hidden population finally feels safe enough to pursue the care it has always needed. Higher cross-sex identity persistence after social transition or administering puberty blockers means the interventions were obviously appropriate.
Any outcome, it seems, can be interpreted as proof that “gender-affirming care” is successful. But this is not how evidence-based medicine is supposed to work. This is how an ideology protects itself from falsification.
The latest example comes from Oregon. As Benjamin Ryan first reported, a new study in Research Connections analyzed insurance claims for 868,740 insured Oregon adolescents ages 8 to 17 from 2016 to 2023. The data cover roughly 80 percent of insured Oregonians. The figures were shocking.
By age 17, roughly one in 240 insured Oregon girls was taking testosterone, and about one in 630 boys was taking estrogen. Across all ages in the study, about 1 percent of insured Oregon youth had a gender-related diagnosis. For girls, the figure was 1.5 percent.
These aren’t nationwide numbers. Oregon is an unusually progressive state with an unusually supportive legal and insurance environment for pediatric gender medicine. But they give us a glimpse of what happens when supporters of child transition receive little to no pushback.
The study’s authors don’t view the numbers as alarming. They still describe medical transition as “rare” and emphasize that access remains “limited” even in Oregon. They suggest that the state’s supportive policy environment likely contributed to greater access, while “structural and systemic barriers” may still be holding treatment rates down.
Whatever the data, they support the affirmative model. If the rates are low, that proves the panic is overblown. If the rates are high, that’s evidence that access is improving. If the rates rise, that means stigma is declining. If they don’t rise enough, that means barriers remain. Heads they win, tails you’re a bigot.
This pattern shows up again and again. Years ago, when critics warned that puberty blockers appeared to function less as a “pause button” and more as the first step on a nearly automatic pathway to cross-sex hormones, defenders insisted that persistence meant the children had been properly selected. But if administering puberty blockers changes the likelihood that a child will persist in rejecting their sex from about 15–20 percent to more than 97 percent, then persistence isn’t proof that the child’s transgender identity was fixed all along—it’s evidence that the intervention made permanent what would have been ephemeral.
Kenneth Zucker, one of the world’s leading experts on childhood gender dysphoria, has warned that even social transition is not a neutral act. Changing a child’s name, pronouns, clothing, and social identity is a psychosocial intervention. It may reduce distress in the short term, but it also seems to increase the likelihood that a child’s cross-sex identity persists into adolescence, when puberty blockers and hormones are put on the table.
That possibility should haunt the field. Instead, it is dismissed.
Consider a new Canadian study, published in the Journal of Adolescent Health and shared by pediatric psychiatrist and gender medicine proponent Jack Turban on social media. Researchers examined 445 adolescents referred to gender clinics. After a median follow-up of 2.4 years, 97.1 percent still identified as transgender or nonbinary, and only 1.1 percent of those who started cross-sex hormones stopped taking them. The study presents this as reassuring evidence that adolescent transgender identity is extremely stable, and that concerns about regret and potential detransition are overblown.
The same logic appeared in response to the Oregon data. Trans activist Ari Drennen said on X that it “should not be shocking” that 0.4 percent of 17-year-old girls in Oregon are chemically transitioning. But it is shocking. If one in 240 girls aged 17 in a state were receiving any other powerful intervention for a new psychiatric diagnosis that permanently deepened their voice, caused them to grow beards, altered their sexual function, and affected their fertility, no serious person would shrug and say, “Sounds about right.”
At some point, defenders of pediatric gender medicine must answer several simple questions: What result would make you reconsider? Would it be one in 100 girls on testosterone? What about one in 50? What rate of regret or detransition is too high? Would you accept that as evidence that suicidality and mental health don’t improve after treatment? How many systematic evidence reviews must conclude that the evidence of benefit is extremely weak while the risk of serious harm is significant?
We should have insisted on answers long ago, before we ever started performing this medical experiment on children—not after the results come in, when activists have had ample time to devise post hoc explanations about why the latest horrific finding is actually wonderful news.
Falsifiability is a basic principle of science. No claim that can be supported by every possible outcome has any business being called scientific or “evidence-based.”
This essay was originally published in City Journal.
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From my perspective as a neuroscientist, let me make explicit some simple facts that those reading this essay understand intuitively: For all sexually reproducing organisms, sexual maturation is a central, overriding set of developmental processes. These processes involve all physiological systems, including, I might add, the central nervous system — that is, the brain. All drugs administered will have side effects, or unintended consequences. Some are minor; some can be fatal. The consequences of these side effects may not be evident for decades, as the organism ages. You cannot reach into a system pharmacologically and simply tweak a discrete process in which you are interested. Systemically administered hormones, for instance, have body-wide effects. To think otherwise is both willful ignorance and profound arrogance. Put simply, anyone with even the most rudimentary understanding of physiology is aware of the real and unavoidable consequences of hormone administration, especially to children. As a scientist, it is unclear to me why this issue remains debatable. As a biological psychologist, I do not understand why it is assumed that hormones will solve what is, in many cases, a set of psychological and cognitive challenges faced by young people. Unfortunately, the history of psychology is rife with such tragic misunderstandings. My heart goes out to those affected.
I am in Ontario Canada and I have a 22 yo daughter on testosterone. She injects herself once a week. She was given a prescription by a nurse practitioner in a gender clinic. They test her blood every quarter to “monitor” her testosterone levels.
Everything about this is a tragedy. And every medical professional who goes along with this is criminally incompetent.