Abstract Background Despite increasing attention, population-level evidence on medical gender-affirming care (GAC) is used among transgender and gender diverse (TGD) adolescents remains limited, and little is known about use in supportive policy environments. Aims To describe population-level patterns and trends in medical GAC utilization among insured TGD adolescents in Oregon (2016-2023), overall and by age, sex assigned at birth (SAAB), and insurance type. Methods Using a multi-payer claims database operated by Comagine Health, we identified TGD adolescents, ages 8-17, using diagnostic codes of gender dysphoria and assessed receipt of puberty blockers and gender affirming hormone therapies using procedural codes. We calculated GAC utilization rates per 100,000 insured adolescents and 95% confidence intervals estimated using the Wald method. Results Among 868,740 insured adolescents, 8,480 (0.98%) had a TGD-related diagnosis. GAC use increased over the study period. The median age at diagnosis was 14 years and initiation was 15 years (10-month interval). Overall, 23% of adolescents with a TGD-diagnosis received medical GAC (8% puberty blockers; 20% hormone therapies). Utilization was slightly higher among commercially insured youth. Puberty blocker use peaked in early to mid-adolescence, while hormone therapy use increased steadily with age. Conclusions Medical GAC utilization increased in Oregon but remained limited to a minority of adolescents with a TGD-related diagnosis. Even within a supportive policy and insurance environment, access remained limited, with variation by age and insurance type. These findings highlight the need for ongoing monitoring to inform clinical practice, health system capacity, and policy planning.
Gray et al. (Tue,) studied this question.