By the time an Oregon girl turns 17, there is a 1 in 240 chance she has been prescribed cross-sex hormones for gender dysphoria. For boys, it's 1 in 630. Those numbers come from a study published in Research Connections analyzing insurance data from 2016 to 2023, and they represent triple the national average for girls and double for boys.
At ages 14 and 15, the gap widens to four and five times the national rate. Puberty blocker prescriptions for 14-year-olds exceed the national rate by more than five times.
Leor Sapir, a fellow at the Manhattan Institute, and Paul Terdal, a Portland-based management consultant and visiting fellow with the medical advocacy group Do No Harm, co-authored a Wall Street Journal piece on July 17 laying out the data. The numbers are staggering on their own, but the historical context makes them worse. The DSM-5, published in 2013, estimated the prevalence of gender dysphoria at 0.002 to 0.003 percent of females and 0.005 to 0.014 percent of males. Oregon is now diagnosing 1.51 percent of girls and 0.46 percent of boys with a transgender-related diagnosis.
That's more than 500 times the pre-2013 rate for girls. Thirty times higher for boys.
The median age of diagnosis is 14 for both sexes, and the median time from diagnosis to medical intervention is under 10 months. So a freshman walks into a clinic, gets a diagnosis, and is on hormones before the school year ends. The study found that roughly 1 in 65 adolescent girls in Oregon was identified as a potential candidate for medical sex reassignment during the study period.
Oregon is the only state in the country that has formally adopted the World Professional Association for Transgender Health standards of care. That means expanded Medicaid coverage for hormones and surgeries — in many cases with no age minimums. The state also passed shield laws allowing children as young as 15 to consent to these procedures without parental notification.
The cost trajectory tells its own story. By 2024, Oregon's spending on gender transition procedures had risen to more than $12.3 million — over 60 times the original projection. The number of Oregonians receiving covered procedures was roughly 10 times the anticipated number by 2015 and 80 times by 2023.
England banned puberty blockers for minors. Sweden and Finland pulled back. Denmark restricted them. More than two dozen U.S. states passed laws limiting or prohibiting these interventions for children. The scientific tide turned so decisively that even the original Dutch researchers whose work launched the pediatric transition model expressed concerns about how their protocol was being applied.
Oregon's response to all of this was to expand coverage and remove parental consent requirements.
The argument from proponents remains that these treatments are "medically necessary" and life-saving. Oregon officially classifies hormones and surgery as medically necessary for gender dysphoria, defined by the DSM as a mismatch between biological sex and subjective gender identity accompanied by distress or functional difficulty. But the data that was supposed to support the life-saving claim hasn't materialized. The skyrocketing rates of cross-sex hormone prescriptions in Oregon have produced no corresponding decline in youth suicide rates.
A state that puts 1 in 65 teenage girls on a path toward medical sex reassignment while the rest of the developed world reverses course isn't following the science. It's ignoring it, at scale, on children who can't vote, can't drink, and in most of the country can't even get a tattoo.
The original projection said this would cost a fraction of what it costs now and affect a fraction of the kids it affects now. Both numbers missed by orders of magnitude. When the math is off by 60 times and the patient population is off by 80 times, that's not a rounding error. That's a program that outgrew every safeguard that was supposed to contain it.
