The Facts About Transgender Youth: Why Puberty Blockers, Hormones, and Surgeries Matter — And Why They Don’t Burden Taxpayers

There is a lot of misinformation about transgender youth and medical care in the United States. Some claim that thousands of minors undergo surgeries or receive medications without regulation. The truth is very different. Recent data from JAMA Pediatrics and other reputable sources show that these procedures are extremely rare, medically necessary, and not a financial burden on taxpayers.

Why Do Transgender Youth Need Puberty Blockers?

Puberty blockers are not cosmetic. They are prescribed to help transgender youth who experience gender dysphoria, a severe psychological distress caused by the mismatch between their gender identity and physical development. Here are the main reasons for using them:

• Reduce Gender Dysphoria: Puberty brings permanent changes (voice deepening, breasts, facial hair). For transgender youth, these changes can cause extreme anxiety and depression.
• Give Time for Informed Decisions: Puberty blockers are reversible and provide time for the child and family to decide about future steps.
• Prevent Permanent Physical Changes: For trans girls, they prevent facial hair and deep voice. For trans boys, they stop breast development and hip widening.
• Mental Health Benefits: Research shows lower depression and suicide risk among youth who receive blockers when needed.

Why Hormone Therapy and Surgery Are Sometimes Necessary

For some transgender individuals, puberty blockers alone are not enough. As they grow older, many choose gender-affirming hormone therapy and, in rare cases, surgery. These treatments are not about preference or “cosmetic changes”; they are medical interventions for a condition recognized by all major health organizations: gender dysphoria.

• Hormone Therapy: Aligns physical traits with gender identity, reducing severe psychological distress.
• Surgery: For a small percentage, surgery becomes necessary for complete alignment, significantly lowering depression and suicide rates.

What Happens If They Don’t Get These Treatments?

• Higher Suicide Risk: Trans individuals denied care have up to a 40% suicide attempt rate.
• Severe Mental Health Decline: Untreated gender dysphoria leads to depression, anxiety, and self-harm.
• Economic and Social Harm: Lack of care often results in job loss, school dropout, and poverty.

Does Gender-Affirming Care Burden Taxpayers?

No. The financial impact is almost zero compared to overall healthcare spending. Here is why:

• Extremely Few Patients: Fewer than 200 minors per year receive puberty blockers; fewer than 300 receive surgery.
• Mostly Covered by Insurance: Private insurance or Medicaid usually pays. Medicaid costs are negligible compared to the total budget.
• Cheaper Than Many Treatments: Puberty blockers cost $8,000–$12,000 per year, while diabetes care costs $16,000 annually per patient. Erectile dysfunction drugs cost U.S. men over $14 billion yearly—100x more than transgender care.
• Prevents Future Costs: Denying care leads to hospitalizations for mental health crises, which cost far more than treatment.

According to Health Affairs, gender-affirming care for youth accounts for less than 0.0005% of healthcare spending in the U.S.

How Many Trans Youth Receive These Treatments?

• Puberty Blockers: 926 over five years (~185/year).
• Hormones: 1,927 over five years (~385/year).
• Top Surgeries: 776 over three years (~259/year).
• Bottom Surgeries: 56 over three years (~19/year).

Summary Table

Huge Taxpayer Burden is a MYTH

Gender-affirming care for minors is rare, carefully regulated, and medically necessary. The idea that it is widespread or a huge taxpayer burden is a myth. These treatments save lives, reduce suffering, and cost far less than many common healthcare expenses.

Sources: JAMA Pediatrics, AP News, Health Affairs, Washington Post, AMA, Endocrine Society