National Institutes of Health Funding for Research About Transgender and Nonbinary Youths

Importance Research is needed to improve health and well-being for transgender and nonbinary (TGNB) youths (<18 years), including access to gender-affirming medical care (GAMC) and associated clinical outcomes. Investment in TGNB youth research at the National Institutes of Health (NIH) has not been well-characterized even though it has been the source of considerable public debate and recent policy changes to restrict funding. Objective To examine patterns of funding for TGNB youth research at NIH, including trends over time, demographic subgroups, GAMC and other health topics, and geographic distribution. Design, Setting, and Participants This cross-sectional study examined NIH funding for research related to TGNB youths from 2012 to 2024, using the NIH Research Portfolio Online Reporting Tools (RePORTER) database. Awards were included if abstracts explicitly focused on TGNB youth health. This study took place at the University of Minnesota and used publicly available data regarding domestic and international grants administered by NIH. It did not include participants. Exposure NIH funding for TGNB youth research. Main Outcomes and Measures The amount of TGNB youth awards, both as a total and a proportion of the NIH portfolio was calculated. Award characteristics (eg, administering institute) were extracted from NIH RePORTER, and costs were inflation-adjusted to 2024 dollar values. Systematic coding of abstracts characterized demographic subgroups and health topics for each award. Results Between 2012 and 2024, 97 awards and 42 supplements totaling $158.3 million were issued for research about TGNB youths, representing 0.06% of the NIH portfolio. Funding increased over the study period and was concentrated among institutions in states with currently protective GAMC policies. To align funding with estimates of the population size of TGNB youths, investment would need to increase by a factor of 3.5 to 9.8. Nonbinary youths and racially and ethnically minoritized TGNB youths were minimally funded. Common research topics included HIV or AIDS ($68.8 million; 43.5%) and mental health ($78.0 million; 49.3%), with the latter associated with increases in total funding from 2021 onward. GAMC funding ($38.3 million; 24.2%) increased moderately over time. Conclusions and Relevance In this cross-sectional study of NIH awards, research about TGNB youths increased from 2012 to 2024, but it was substantially below population-proportional levels, reflecting historical underfunding and structural barriers in research prioritization.