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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.
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 apparently 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: saw their care processed through internal Veterans Affairs claims, paid out of pocket, received charity care, or were cared for by Kaiser Permanente (which covers a substantial swath of West Coast patients 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.
Sapir added these caveats: “2023 data are incomplete, making it premature to conclude that a dip occurred that year, relative to previous years. Second, even the liberal estimates are an undercount, as the data are limited by two constraints: the procedures had to be covered by insurance, and patients had to have a preexisting diagnosis of 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.
Their criteria included:
Dr. Frances Grimstad, touts hysterectomies for gender dysphoric minors. Source: Boston Children’s You Tube: https://web.archive.org/web/20220810102144/
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.
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, Pennsylvania health care providers treated at least 822 minors with gender-transition treatments, billing some $6 million for 316 surgeries and prescribing puberty blockers and cross-sex hormones to 518 children.
Zooming in a little closer, here is a segment of the roster of Pennsylvania care providers and their respective shares of the tally:
Here is the Children’s Hospital of Philadelphia’s share of those cases:
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.
I wrote about the downturn in a separate Substack:
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.
(shoutouts to this post and the featured article in it)
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.
The top-line findings about 2019 to 2023 medical-claims data include:
- 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 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 apparently 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: saw their care processed through internal Veterans Affairs claims, paid out of pocket, received charity care, or were cared for by Kaiser Permanente (which covers a substantial swath of West Coast patients 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.
Sapir added these caveats: “2023 data are incomplete, making it premature to conclude that a dip occurred that year, relative to previous years. Second, even the liberal estimates are an undercount, as the data are limited by two constraints: the procedures had to be covered by insurance, and patients had to have a preexisting diagnosis of 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.
The 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 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’sMinnesota 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
Dr. Frances Grimstad, touts hysterectomies for gender dysphoric minors. Source: Boston Children’s You Tube: https://web.archive.org/web/20220810102144/
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, Pennsylvania health care providers treated at least 822 minors with gender-transition treatments, billing some $6 million for 316 surgeries and prescribing puberty blockers and cross-sex hormones to 518 children.
Zooming in a little closer, here is a segment of the roster of Pennsylvania care providers and their respective shares of the tally:
Here is the Children’s Hospital of Philadelphia’s share of those cases:
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. See this selection of large liberal states:
I wrote about the downturn in a separate Substack:
Gender Doctors In Blue States Pulled Back On Prescribing Transition Medications to Minors in 2023
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. I also spoke with an academic who suggested that all the bad publicity has made parents more reticent to consent to gender-transition treatment for their children.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.
(shoutouts to this post and the featured article in it)
