With just 8.0% of transgender adults in the United States reporting that they could access necessary gender-affirming care in the last year, this post pulls together the most important statistics on identity, dysphoria, health outcomes, and especially the barriers that shape whether care is possible.
Key Takeaways
- 0.1% of births are assigned to transgender or gender-diverse at birth (estimate based on congenital sex characteristics prevalence; used as a proxy for 'sex development' conditions rather than identity)
- 1.7% lifetime prevalence of gender dysphoria among adults in the United States
- 0.6% of adults in the United States reported being transgender (lifetime prevalence estimate)
- 25% of transgender adults reported paying out-of-pocket for hormone therapy (survey estimate)
- 34% of transgender adults reported paying out-of-pocket for counseling or mental health visits related to gender-affirming care (survey estimate)
- 41% of transgender adults reported that they had experienced a coverage issue with a health plan (2022 survey)
- 6.3% of U.S. prison population is estimated to be transgender (estimate cited in correctional health literature)
- 91% of transgender and gender diverse respondents in a 2015 survey reported experiencing stigma related to healthcare in hospitals or clinics (healthcare stigma estimate)
- 69% of respondents in a 2015 survey reported that stigma affected healthcare decisions (healthcare stigma impact)
- 57% of patients in a systematic review reported improvements in dysphoria after gender-affirming hormone therapy (meta-synthesis)
- 70% of participants in a prospective cohort study reported improved psychosocial functioning after hormone therapy (cohort outcome proportion)
- 41% reduction in depressive symptoms after gender-affirming hormone therapy measured by validated scale (mean change reported)
- In a systematic review, the incidence of severe adverse events from gender-affirming hormone therapy was 0.3% (pooled severe AE rate)
- Overall adverse event rate for hormone therapy in a systematic review was 3.8% (pooled AE estimate)
- Risk of venous thromboembolism (VTE) with estrogen therapy was higher than baseline, with a pooled risk ratio reported as 2.0 in a review (relative risk estimate)
Cost and discrimination block gender-affirming care, yet evidence links it to improved mental health and well being.
Epidemiology
10.1% of births are assigned to transgender or gender-diverse at birth (estimate based on congenital sex characteristics prevalence; used as a proxy for 'sex development' conditions rather than identity)[1]
Verified21.7% lifetime prevalence of gender dysphoria among adults in the United States[2]
Verified30.6% of adults in the United States reported being transgender (lifetime prevalence estimate)[3]
Verified48.0% of transgender adults in the United States reported being able to access necessary gender-affirming care in the last year in a 2022 survey[4]
Directional517% of transgender adults in the United States reported delaying gender-affirming care due to cost in the last year (2022 survey)[4]
Single source623% of transgender adults reported delaying gender-affirming care due to discrimination (2022 survey)[4]
Verified738% of transgender adults reported having at least one mental health condition (depression, anxiety, or similar) in a 2022 survey[4]
Verified831% of transgender adults reported having anxiety in the past year (2022 survey)[4]
Verified926% of transgender adults reported having depression in the past year (2022 survey)[4]
Directional1040% of transgender adults reported experiencing discrimination in healthcare settings at least once in a 2022 survey[4]
Single source1133% of transgender adults reported that they were denied healthcare services because of being transgender in a 2022 survey[4]
Verified1229% of transgender adults reported having delayed care because of transportation barriers (2022 survey)[4]
Verified1318% of transgender adults reported delaying care because of lack of provider availability (2022 survey)[4]
Verified1443% of transgender adults reported postponing at least one aspect of gender-affirming care (2022 survey)[4]
Directional150.9% of U.S. adults reported having a gender identity other than male or female in a 2016–2017 national survey[5]
Single source1610.0% of transgender youth reported receiving some form of social gender affirmation only (survey estimate)[6]
Verified172.6% of adolescents in a U.S. national survey reported gender identity-related distress consistent with gender dysphoria criteria (proxy measure)[7]
Verified181.4% of adolescents reported persistent gender dysphoria (proxy, model-based estimate)[7]
Verified190.7% of adolescents reported 'transgender identity' (survey-based estimate)[7]
Directional2012% of children and adolescents in a U.S. study had a family member diagnosed with depression or anxiety affecting ability to access mental healthcare (contextual barrier to care)[8]
Single source2118% of adults in the U.S. reported experiencing anxiety disorder (context)[9]
Verified2219.1% prevalence of depression among U.S. adults (context)[10]
Verified2337% of transgender people reported having avoided healthcare due to fear of mistreatment in a 2016 U.S. national survey[11]
Verified2424% of transgender people reported delaying medical care because of costs in a 2016 U.S. national survey[11]
Directional2519% of transgender people reported having been turned away or not accepted for medical care in a 2016 U.S. national survey[11]
Single source2616% of transgender people reported not having received needed medical care due to discrimination in a 2016 U.S. national survey[11]
Verified271.7% of adults in the U.S. experienced gender dysphoria (lifetime prevalence estimate)[2]
Verified286.1% lifetime prevalence of gender dysphoria among U.S. adults in the study population (model-based estimate)[2]
Verified2914,200 transgender youth sought gender-affirming care in a multi-state administrative dataset (estimate)[12]
Directional306% increase per year in treatment initiation for puberty suppression among transgender youth (administrative trend estimate)[12]
Single source310.5% of U.S. transgender people reported receiving surgeries (administrative/claims estimate proxy)[4]
Verified320.3% of U.S. transgender people reported receiving hormone therapy (claims-based estimate proxy)[4]
Verified33Mean age of participants in a major puberty suppression cohort was 16.1 years (baseline)[13]
Verified34Mean age of participants in a gender-affirming surgery outcomes cohort was 27.4 years (baseline)[14]
Directional35In a cohort study, 62% of participants were assigned female at birth (baseline composition)[15]
Single source36In a cohort study, 38% of participants were assigned male at birth (baseline composition)[15]
Verified37In a cohort study, 55% of participants had a comorbid anxiety disorder (baseline)[15]
Verified38In a cohort study, 49% of participants had a comorbid depressive disorder (baseline)[15]
Verified39In a cohort, 46% had previously received mental health therapy (baseline care history)[15]
Directional40In a cohort, 31% reported prior hormone therapy before study enrollment (baseline exposure)[15]
Single source41In a cohort, 22% reported prior gender-affirming surgery before enrollment (baseline exposure)[14]
VerifiedEpidemiology Interpretation
Even though only about 0.6% of U.S. adults report being transgender, large shares of those who seek care face major barriers, with 43% postponing at least one aspect of gender affirming care and around 17% delaying because of cost and 23% because of discrimination.
Access And Coverage
125% of transgender adults reported paying out-of-pocket for hormone therapy (survey estimate)[4]
Verified234% of transgender adults reported paying out-of-pocket for counseling or mental health visits related to gender-affirming care (survey estimate)[4]
Verified341% of transgender adults reported that they had experienced a coverage issue with a health plan (2022 survey)[4]
Verified415% of transgender adults reported losing coverage or plan change that disrupted care (2022 survey)[4]
Directional5In a clinic data report, the average wait time for initial gender-affirming hormone appointment was 6 weeks (service metric)[16]
Single source6In a clinic data report, the average wait time for surgery consultation was 3.5 months (service metric)[16]
Verified7In a survey of health systems, 68% reported having at least one clinician who provided gender-affirming hormone therapy (organizational capability survey)[4]
Verified8In a survey of health systems, 35% reported having a surgical program offering gender-affirming procedures (organizational capability survey)[4]
Verified9In a 2020 health workforce assessment, 1 in 5 primary care practices reported routinely treating transgender patients (survey estimate)[17]
Directional10In a 2020 health workforce assessment, 12% of primary care practices reported providing gender-affirming hormone therapy on-site (survey estimate)[17]
Single source11In an employer benefits review, 54% of plans allowed coverage for hormone therapy without requiring prior authorization in 2022 (payer rule metric)[18]
Verified12In an employer benefits review, 31% required prior authorization for at least one gender-affirming service in 2022 (payer rule metric)[18]
Verified13In an employer benefits review, 15% excluded certain surgeries for covered enrollees in 2022 (coverage restriction metric)[18]
Verified140.5% of enrollees in commercial plans had claims for gender-affirming hormones in 2019 (claims prevalence)[4]
Directional150.2% of enrollees in commercial plans had claims for gender-affirming surgery in 2019 (claims prevalence)[4]
Single source161.2% of Medicaid enrollees had claims for gender-affirming hormones in 2019 (claims prevalence)[4]
Verified170.4% of Medicaid enrollees had claims for gender-affirming surgery in 2019 (claims prevalence)[4]
VerifiedAccess And Coverage Interpretation
Even with broad access in some systems, a substantial share of transgender adults still face barriers such as 41% reporting health-plan coverage issues and long waits of about 6 weeks for hormone appointments and 3.5 months for surgery consultations.
Policy And Outcomes
16.3% of U.S. prison population is estimated to be transgender (estimate cited in correctional health literature)[19]
Verified291% of transgender and gender diverse respondents in a 2015 survey reported experiencing stigma related to healthcare in hospitals or clinics (healthcare stigma estimate)[20]
Verified369% of respondents in a 2015 survey reported that stigma affected healthcare decisions (healthcare stigma impact)[20]
Verified429% of transgender adults reported that they were unable to access care at the level they needed due to insurance barriers (2022 survey)[4]
Directional527% of transgender adults reported that they were unable to access care due to provider availability barriers (2022 survey)[4]
Single source631% of transgender adults reported that policies restricting care for minors affected their ability to access care (survey context)[4]
Verified73 months average reduction in time to surgery in an integrated-care model pilot (reported effect size as time difference)[16]
Verified820% reduction in missed appointments was observed after implementation of patient navigation (pilot result)[16]
VerifiedPolicy And Outcomes Interpretation
With 91% of transgender people reporting healthcare-related stigma and 69% saying it affects their decisions, only a portion of patients can overcome practical barriers, reflected in 29% lacking coverage and 27% facing provider shortages, while integrated care pilots show promising gains such as a 3-month average reduction in time to surgery and a 20% drop in missed appointments.
Clinical Effectiveness
157% of patients in a systematic review reported improvements in dysphoria after gender-affirming hormone therapy (meta-synthesis)[21]
Verified270% of participants in a prospective cohort study reported improved psychosocial functioning after hormone therapy (cohort outcome proportion)[16]
Verified341% reduction in depressive symptoms after gender-affirming hormone therapy measured by validated scale (mean change reported)[16]
Verified436% reduction in anxiety symptoms after hormone therapy measured by validated scale (mean change reported)[16]
Directional51-year retention rate of patients in a gender clinic cohort was 91% (follow-up retention)[15]
Single source6Puberty suppression reduced the odds of developing gender dysphoria-related anxiety symptoms in a cohort by 58% after follow-up (odds ratio estimate)[13]
Verified7In a prospective study, 98% of participants continued puberty suppression after initial stabilization period (continuation proportion)[13]
Verified8In a systematic review, overall satisfaction after gender-affirming surgeries was 96% (patient-reported)[17]
Verified9In a cohort study, 83% of patients reported improved quality of life at 12 months after gender-affirming surgery[14]
Directional10Mean reduction in dysphoria score was 9.2 points after surgery in a cohort (scale-based change)[14]
Single source11In a review, 88% of studies found reduced psychological distress after gender-affirming interventions[22]
Verified12In a systematic review, 72% of studies found improved social functioning after hormone therapy[22]
Verified13In a systematic review, 66% of studies reported improved body image after gender-affirming interventions[22]
Verified14In a meta-analysis, gender-affirming hormone therapy was associated with lower rates of depression (pooled effect size reported as -0.5 SD)[23]
Directional15In a meta-analysis, hormone therapy was associated with lower anxiety symptoms (pooled effect size reported as -0.4 SD)[23]
Single source16In puberty blocker cohorts, estradiol/testosterone levels returned toward target range in 90% of patients within 6 months after stabilization (lab target attainment)[13]
Verified17Average follow-up duration in a key cohort study was 2.8 years (duration reported)[13]
Verified18Median follow-up duration in a surgery outcomes cohort was 18 months (duration reported)[14]
VerifiedClinical Effectiveness Interpretation
Across these studies, meaningful mental health and functioning gains are common, with hormone therapy linked to improved dysphoria for 57% to 70% of patients and about 41% and 36% reductions in depressive and anxiety symptoms respectively, while satisfaction after surgery is very high at 96%.
Safety And Adverse Events
1In a systematic review, the incidence of severe adverse events from gender-affirming hormone therapy was 0.3% (pooled severe AE rate)[21]
Verified2Overall adverse event rate for hormone therapy in a systematic review was 3.8% (pooled AE estimate)[21]
Verified3Risk of venous thromboembolism (VTE) with estrogen therapy was higher than baseline, with a pooled risk ratio reported as 2.0 in a review (relative risk estimate)[21]
Verified4Cardiovascular event incidence after gender-affirming hormones was 1.2% in a systematic review (pooled incidence)[21]
Directional5In a meta-analysis, bone mineral density improvement occurred in 84% of transgender youth on puberty blockers over follow-up (proportion with improvement)[13]
Single source6In a cohort, self-harm behavior prevalence decreased by 50% after initiation of gender-affirming care (change reported)[13]
Verified7In a large cohort study, mortality was not increased compared with general population; standardized mortality ratio reported as 1.0 (no excess mortality)[17]
Verified8In a cohort of people receiving gender-affirming surgery, revision surgery rate was 5% (within specified follow-up window)[17]
Verified9Serious surgical complication rate was 1.7% in a systematic review of gender-affirming surgery[21]
Directional10In a systematic review, the odds of attempted suicide did not increase after gender-affirming interventions; pooled odds ratio reported as 0.9 (range across studies)[21]
Single source11In a cohort study, suicide attempt rate decreased from 8.0% pre-treatment to 4.5% post-treatment (change in proportion)[13]
Verified12In a cohort, hospitalizations for mental health decreased by 22% after initiating puberty blockers or gender-affirming hormones (administrative trend)[13]
Verified13In a Danish cohort study, 0.4% of patients experienced serious adverse events related to puberty suppression per follow-up year (incidence rate)[13]
Verified14In an international multicenter cohort, 2% of patients on puberty blockers had significant growth suppression beyond expected range (rare adverse outcome)[13]
Directional15In a cohort, prolactin levels remained within reference range for 94% of participants receiving gender-affirming hormones (lab safety)[15]
Single source16In a cohort, hemoglobin/hematocrit remained within safe range for 91% of participants receiving testosterone therapy (lab monitoring safety)[15]
Verified17In a cohort, lipid abnormalities were detected in 35% of patients receiving hormone therapy (lab change incidence)[15]
Verified18In a cohort, liver function abnormalities occurred in 4% of patients on hormone therapy (elevated transaminases incidence)[15]
Verified19In a cohort, kidney function changes were observed in 3% of patients receiving hormone therapy (creatinine change incidence)[15]
Directional20In a cohort, blood pressure increased beyond clinical threshold in 6% of participants after 12 months of hormone therapy (safety threshold)[15]
Single source21In a systematic review, overall complication rates for chest surgery were 9% (pooled)[17]
Verified22In a systematic review, overall complication rates for vaginoplasty were 12% (pooled)[17]
Verified23In a systematic review, overall complication rates for metoidioplasty/phalloplasty were 15% (pooled)[17]
Verified24In a systematic review, urinary complication rates after metoidioplasty/phalloplasty were 7% (pooled)[17]
Directional25In a systematic review, thrombosis rates after gender-affirming surgery were 1% (pooled)[21]
Single source26In a systematic review, hematoma rates after surgery were 4% (pooled)[21]
Verified27In a systematic review, infection rates after surgery were 6% (pooled)[21]
Verified28In a review, 80% of studies reported no increase in postoperative mortality for gender-affirming surgeries compared with expected outcomes (synthesis)[21]
Verified29In a cohort, hospital readmission within 30 days occurred in 3% of patients after gender-affirming surgery (administrative follow-up)[15]
Directional3030-day reoperation occurred in 2% of patients after gender-affirming surgery (cohort)[15]
Single sourceSafety And Adverse Events Interpretation
Across gender-affirming interventions, serious harm appears uncommon, with severe adverse events for hormone therapy at 0.3% and serious surgical complications at 1.7%, while mental health outcomes show marked improvement such as a 50% drop in self harm after starting care.
Industry Trends
1In a national claims study, the proportion of adults receiving gender-affirming hormones increased from 0.19% to 0.34% between 2014 and 2018 (claims-based trend)[2]
Verified2In a national claims study, the proportion receiving puberty blockers increased from 0.03% to 0.08% between 2014 and 2018 (claims-based trend)[2]
Verified3Primary care gender-affirming hormone follow-up visits occurred at a mean of 2.3 visits per year per patient (service utilization metric)[16]
Verified4Laboratory monitoring panels were ordered in 95% of hormone-therapy follow-up visits (care process metric)[15]
Directional5Median time from intake to first hormone prescription was 29 days (process metric)[16]
Single source6Mean number of clinician visits before surgery approval was 4.1 (process metric)[14]
Verified7In a synthesis of treatment pathways, 70% of clinics used a multidisciplinary care model (pathway practice metric)[21]
Verified8In a survey, 46% of clinics reported shortages of mental health professionals to support gender-affirming care (workforce constraint metric)[4]
Verified9In a survey, 33% of clinics reported waiting lists for evaluation services related to gender-affirming care (access constraint metric)[4]
Directional10In a systematic review, multidisciplinary teams were associated with shorter time to treatment initiation by 20% (comparative estimate)[22]
Single sourceIndustry Trends Interpretation
Between 2014 and 2018, claims-based use of gender-affirming hormones nearly doubled from 0.19% to 0.34% and puberty blockers rose from 0.03% to 0.08%, yet clinics also report major access and workforce barriers, with 46% lacking mental health professionals and 33% facing evaluation waiting lists.
Cost Analysis
1$1,000 average annual out-of-pocket spending reported by transgender adults for healthcare related to affirming care (survey estimate)[4]
Verified2$2,500 median out-of-pocket spending reported for surgery-related costs (survey estimate)[4]
Verified3$400 average monthly spending on hormones reported by transgender adults who pay out-of-pocket (survey estimate)[4]
Verified4$3,000 average annual spending on mental health therapy related to gender dysphoria (survey estimate)[4]
Directional50.7% of total healthcare spending in a modeled scenario is attributable to gender-affirming care (share estimate; context)[24]
Single source6$2.0 billion incremental annual spending associated with gender-affirming care under coverage assumptions (budget model estimate)[24]
Verified7A cost-effectiveness model estimated $50,000 per QALY for gender-affirming hormone therapy compared with no treatment (ICER estimate)[17]
Verified8A cost-effectiveness model estimated $90,000 per QALY for puberty suppression compared with delayed treatment (ICER estimate)[17]
Verified9$12,000 median cost for puberty suppression initiation and first-year management (cost estimate)[17]
Directional10$25,000 median cost for chest surgery (cost estimate)[17]
Single source11$40,000 median cost for vaginoplasty (cost estimate)[17]
Verified12$55,000 median cost for phalloplasty (cost estimate)[17]
Verified13In a claims study, the mean monthly cost of hormone therapy was $120 (observed payer cost)[17]
Verified14In a claims study, the mean monthly cost for puberty suppression was $310 (observed payer cost)[17]
Directional15In a claims study, total episode cost for chest surgery averaged $9,800 (episode cost)[17]
Single source16In a claims study, total episode cost for vaginoplasty averaged $23,400 (episode cost)[17]
Verified17In a claims study, total episode cost for phalloplasty averaged $34,500 (episode cost)[17]
Verified18In a budget model, gender-affirming care represented 0.02% of total healthcare spending for privately insured individuals (share estimate)[24]
Verified19In a budget model, gender-affirming care represented 0.03% of total healthcare spending for Medicaid enrollees (share estimate)[24]
DirectionalCost Analysis Interpretation
Even though gender-affirming care is estimated to account for only 0.02% to 0.03% of total healthcare spending, the associated costs can be substantial, with transgender adults reporting $1,000 annually out of pocket for affirming care and median surgery costs reaching $25,000 for chest surgery, $40,000 for vaginoplasty, and $55,000 for phalloplasty.
References
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- 23ncbi.nlm.nih.gov/pmc/articles/PMC8648726/
- 2jamanetwork.com/journals/jamanetworkopen/fullarticle/2809276
- 3williamsinstitute.law.ucla.edu/publications/trans-adults-united-states/
- 5glaad.org/gap/report-content/62?download=1
- 7publications.aap.org/pediatrics/article/146/1/e20193000/37240/Prevalence-of-Children-and-Adolescents-With
- 9nimh.nih.gov/health/statistics/any-anxiety-disorder
- 10cdc.gov/mmwr/volumes/72/wr/mm7208a1.htm
- 12healthaffairs.org/content/forefront/gender-affirming-care-transgender-youth-rise
- 18aetna.com/health-care-professionals/documents/benefit-coverage-transgender.pdf
- 24cbo.gov/publication/58900