Research and morality aren’t on their side, but can hospital executives really say no to so much money?
Research and morality aren’t on their side, but can hospital executives really say no to so much money?
B efore his debate with Governor Tim Walz, Republican vice-presidential nominee Senator J. D. Vance slammed his Democratic counterpart for making Minnesota a “trans refuge” for children. Vance is right to highlight the medical and moral monstrosity of an establishment that encourages young boys and girls who feel that they must change their gender. But it’s also true that massive amounts of money are at stake. Medical providers stand to earn a windfall from children’s gender-transition procedures, which helps explain why the industry has endorsed the most aggressive treatments for gender dysphoria.
That’s our conclusion after looking at transgender medical interventions — puberty blockers, cross-sex hormones, and surgeries — performed on minors at children’s hospitals and affiliated health systems between 2019 and 2023. The facilities for which there are publicly available data provided nearly 14,000 treatments (including 5,700 surgeries) at a total cost to insurance companies and taxpayers of nearly $120 million. The real numbers are almost certainly higher, since major health systems such as Kaiser Permanente don’t disclose data, nor do patients who pay out of pocket.
At first glance, these numbers may look small, especially for an industry that makes billions of dollars a year. But they reflect a massive business opportunity, one that involves not only far more transgender treatments but also a lifetime of additional medical care for those subjected to those treatments. Despite barely existing before 2018, gender transitions for children will likely soon be a billion-dollar industry, if they aren’t already.
Our analysis shows that the average intervention makes more than $8,500 for medical providers. That’s significantly more than the cost of the typical hospital stay, which, according to provider MDC Healthcare, is on average $2,600 per day in the U.S. All told, the cost of the average transgender treatment for a child is equivalent to 62 percent of annual health-care spending per person, based on federal data. In other words, hospitals and health systems can bill most of a patient’s annual medical expenses in a single day.
But transgender treatments almost never end after just one day. When a child receives puberty blockers, which some hospitals provide to children as young as age nine, there’s a 98 percent chance that the child will go on to receive cross-sex hormones. One in three will eventually have surgery. Moreover, puberty blockers and cross-sex hormones often have permanent side effects — such as weight gain, blood clots, and sexual dysfunction — as do surgeries, which can also leave scars and recurring infections. These issues require physical and mental-health treatment throughout adulthood. This can be true also for the patients who come to regret their childhood decisions. The prominent detransitioner Chloe Cole, a 20-year-old woman who began transitioning at age twelve but at 16 tried to go back, frequently talks about her still-bandaged breasts, ongoing urinary-tract issues, and serious mental-health challenges that stem from her initial treatments.
Given the near certainty of ongoing income, children’s hospitals and health systems have a strong incentive to push children down the gender-treatment road, and many have recently opened dedicated centers, clinics, and initiatives. Children’s Minnesota opened its Gender Health program in 2019; Akron Children’s Hospital launched its Center for Gender-Affirming Medicine in 2019; the Children’s Hospital of Philadelphia expanded its gender program into New Jersey in 2020; and so on. They can perhaps look forward to raking in money, as did the Children’s Hospital of Los Angeles, which opened its transgender center in 2015 and has billed $1.5 million in surgeries alone over the last four years. Some estimates say transgender surgeries alone, across all age groups, will generate $5 billion by 2030.
Medical providers may respond by arguing that gender-transition treatments for children are no different than any other kind of medical care, which justifies the resulting revenue for clinics and hospitals. But unlike other widely used medical practices, the effectiveness of so-called gender-affirming care for children is not supported by the evidence. A growing number of European countries have acknowledged this fact after reviewing the research, concluding that the risks to children’s health outweigh any ostensible benefits. In no other area of American medicine do patients — let alone children, whose minds and bodies are still developing — face so much risk with so little evidence of benefit.
No doubt, many providers truly believe that they’re helping children. But many others have grave concerns, as we can attest from our conversations with medical professionals. Despite broad misgivings about transgender medicine for vulnerable young people, physicians often work for executives who see no issue providing invasive and irreversible treatments that could ruin a child’s body and mind. Medical research and morality aren’t on their side, but can they really say no to so much money?
Stanley Goldfarb is the chairman of Do No Harm, where Roy Eappen is a senior fellow.