One in 240 — What Oregon’s Data Says About Girls on Testosterone.
A peer-reviewed study published in May 2026 put a hard number on a question that has been argued mostly in slogans: how common is medical gender transition among American teenagers? Analyzing insurance claims for 868,740 insured Oregon adolescents from 2016 to 2023, researchers found that by age 17, roughly one in 240 insured Oregon girls was taking testosterone, and about one in 630 boys was taking estrogen.
That figure — surfaced first by independent journalist Benjamin Ryan and amplified in a City Journal essay by biologist Colin Wright — is the spine of this story. It is also genuinely contested terrain. Oregon is one of the most permissive states in the country for pediatric gender medicine, so its rates run far above the national picture, where a separate study in JAMA Pediatrics put the share of U.S. adolescents on these medications at well under 0.1 percent.
This page lays out what the Oregon data actually shows, how it compares with the national numbers, why the underlying evidence is now disputed by major medical reviews on both sides of the Atlantic, and where the policy fight stands — sourced to the primary study and the documents, not the headlines.
- 1 in 240 — insured Oregon girls taking testosterone by age 17, per the Research Connections study of 868,740 adolescents (2016–2023) · Source: Gray et al., Research Connections (Oxford UP); City Journal
- 1 in 630 — insured Oregon boys taking estrogen by age 17 over the same period · Source: Gray et al., Research Connections
- 0.98% — of the 868,740 Oregon adolescents carried a transgender/gender-diverse diagnosis — 1.51% of natal girls vs. 0.46% of natal boys · Source: Gray et al., Research Connections
- 20% / 8% — of diagnosed Oregon youth received cross-sex hormone therapy / puberty blockers · Source: Gray et al., Research Connections
- Under 0.1% — of U.S. privately insured adolescents nationally were on these medications — 1,927 on hormones, 926 on blockers across 5M+ patients, 2018–2022 · Source: Hughes et al., JAMA Pediatrics, Jan. 2025
- ~4–5x — Oregon's cross-sex hormone rate for 14–15-year-olds versus the national rate; up to ~6x for puberty blockers · Source: RedState analysis of the Oregon data; Just the News
- Weak evidence — the Cass Review (NHS England, 2024) finding on puberty suppression; NHS ended routine prescribing and the UK ban was made indefinite Dec. 2024 · Source: Cass Review; GOV.UK; NHS England
The data come from a study titled “Gender-affirming care for transgender and gender-diverse youth in Oregon: trends over time,” by Mary Gray and colleagues, published May 7, 2026 in Research Connections, an Oxford University Press journal. The researchers analyzed administrative insurance claims covering roughly 80 percent of insured Oregonians — 868,740 adolescents ages 8 to 17 — using diagnostic and procedure codes to identify gender-related diagnoses and the medications prescribed.
Of that population, 8,480 youth — 0.98 percent — carried a transgender or gender-diverse (TGD) diagnosis. The breakdown by sex is itself a finding: about three-quarters of those diagnosed were assigned female at birth (1.51 percent of natal girls) versus roughly one-quarter assigned male (0.46 percent of natal boys). Among the diagnosed group, 20 percent received cross-sex hormone therapy and 8 percent received puberty blockers, with blocker use peaking at ages 13 to 15 and hormone use climbing steadily with age.
The “1 in 240” figure is a cumulative rate: by age 17, that share of insured Oregon girls had been prescribed testosterone at some point in the study window. Colin Wright’s City Journal essay frames why that lands as striking — testosterone is a powerful, partly irreversible intervention, and a rate that would be unremarkable for, say, acne treatment reads very differently when the diagnosis is psychiatric and the physical effects are permanent.
One honest caveat sits inside the number: it is an average across the full 2016–2023 window, and uptake rose sharply over those years, so the rate by 2023 was almost certainly higher than the headline average. Reporting on the data also noted that Oregon’s figures sit below the state’s own self-identification surveys — which run 1.2 to 3.2 percent — meaning the claims data, if anything, undercount how many Oregon youth identify as transgender, even as they document the share actually receiving medication.
A new Oregon study shows pediatric gender transition isn't the vanishingly rare event advocates promised. By 17, roughly 1 in 240 insured Oregon girls was on testosterone. That's a lot of kids on a powerful, partly irreversible drug.
The Oregon rate — about 1 in 240 natal girls on testosterone by 17 — is an average over 2016–2023. Uptake climbed steeply across those years, so the current figure is likely higher still.
Oregon is not the United States. A January 2025 study in JAMA Pediatrics by Harvard’s Landon Hughes and colleagues examined private-insurance claims for more than five million U.S. patients ages 8 to 17 from 2018 to 2022 and found that fewer than 0.1 percent received these medications: 1,927 adolescents started hormones and 926 started puberty blockers over the five years, with no patients under 12 prescribed hormones. Hughes argued the data refute the claim that the care is being handed out indiscriminately.
Both things are true, and the gap between them is the actual story. Analyses of the Oregon data put its cross-sex hormone rate for 14- and 15-year-olds at roughly four to five times the national average, and its puberty-blocker rate as high as six times national. In other words, the national number is small because most states are not Oregon — and the trajectory matters: Reuters’ 2022 investigation, using Komodo Health claims data, found gender-dysphoria diagnoses among children ages 6 to 17 nearly tripled nationally, from 15,172 in 2017 to 42,167 in 2021.
Oregon (Research Connections): 1 in 240 insured girls on testosterone by 17; 0.98% of all youth with a TGD diagnosis — a permissive state running well above the national rate.
National (JAMA Pediatrics): under 0.1% of privately insured adolescents on these medications — cited by supporters as proof the care is rare and carefully gated.
The trend (Reuters / Komodo): diagnoses among ages 6–17 nearly tripled from 2017 to 2021 — the direction both camps agree on.
What turns a prevalence statistic into a controversy is the strength of the evidence behind the treatment. In April 2024, England’s independent Cass Review — led by pediatrician Dr. Hilary Cass — concluded that the evidence for puberty suppression and its effects on gender dysphoria and mental health is weak. NHS England subsequently ended routine prescribing of puberty blockers for under-18s, and in December 2024 the UK made an emergency ban indefinite, citing an “unacceptable safety risk.”
In the United States, the picture is sharply polarized. A May 2025 HHS review, produced under a Trump executive order, similarly disputed the evidence base and promoted psychotherapy as a first-line approach. The American Academy of Pediatrics and more than 30 U.S. medical associations rejected that report as misrepresenting the consensus and continue to endorse gender-affirming care. Critics counter with a documented concern: testosterone’s effects in natal girls — voice deepening, facial hair, changes to fertility and sexual function — are substantially permanent, raising the stakes of any later regret.
“One in 240 girls in a single state receiving a powerful intervention for a new psychiatric diagnosis with permanent physical effects would be considered shocking for almost any other kind of medical treatment.”
Colin Wright, 'How Many Girls on Testosterone Is Too Many?' City Journal, June 2026 (paraphrased)
The data have landed in the middle of an active policy fight. More than 20 states have enacted restrictions on pediatric gender medicine, and in 2025 the U.S. Supreme Court upheld Tennessee’s ban on these treatments for minors. England has gone the furthest of the major Western systems, ending routine puberty blockers and restructuring its youth gender services around the Cass Review. The Oregon study cuts the other way on the map: it documents a state that has built an unusually supportive legal and insurance environment, and the numbers reflect it.
One data point fuels the skeptics’ case: coverage of the Oregon trend noted that as cross-sex hormone prescriptions to youth climbed steeply, the state recorded no corresponding decline in youth suicide — a pointed counter to the “lifesaving care” framing often used to justify the interventions. That is a correlation, not a controlled finding, and supporters note suicide is driven by many factors. But it is the kind of measurable outcome that the “weak evidence” reviews say is missing on both sides.
An honest account names the limits. The Oregon study is a claims analysis, with the inherent caveats its own authors flag: codes can misclassify, and the data cannot always distinguish a clinical decision from an access barrier. The 1-in-240 figure is real and peer-reviewed, but it describes Oregon, a deliberate outlier — not the country. Nationally, the share remains under 0.1 percent, and the “millions of kids on hormones” rhetoric is not supported by the data.
But the load-bearing facts stand. In one permissive state, a non-trivial share of adolescent girls are being prescribed a powerful, partly irreversible drug; the treatment skews heavily toward natal females; diagnoses are rising fast; and two government-commissioned evidence reviews — one in England, one in the United States — have judged the supporting evidence weak. Whatever one’s politics, a society prescribing testosterone to teenage girls at this scale should be able to point to strong evidence that it helps. That is the question the Oregon numbers force, and it is a fair one to ask.
A peer-reviewed Oregon study found that by age 17, about 1 in 240 insured girls had been prescribed testosterone and 1 in 630 boys estrogen — rates several times the national average in a state built to be permissive. Nationally the share stays under 0.1 percent, but diagnoses have tripled and the evidence base is now formally disputed by reviews in both England and the United States. The numbers are not a scandal in the criminal sense; they are a measurement — of how fast a contested medical practice has scaled, and of how little settled science underwrites it. We’ll track the follow-on data, the state bans, and whether the long-promised outcome evidence ever arrives.
- 1.City Journal — Colin Wright, 'How Many Girls on Testosterone Is Too Many?' June 25, 2026 (the framing and 1-in-240 read originate here)
- 2.Research Connections (Oxford University Press) — Gray, Blalock, Kappesser, Corman & Leichtling, 'Gender-affirming care for transgender and gender-diverse youth in Oregon: trends over time,' Vol. 1, Iss. 2, vmag049, May 7, 2026 (PRIMARY STUDY: 868,740 insured adolescents; 0.98% with a TGD diagnosis)
- 3.Benjamin Ryan — 'Hazard Ratio' (Substack), independent reporting that first surfaced the Oregon study and the 1-in-240 figure
- 4.JAMA Pediatrics — Hughes et al., 'Gender-Affirming Medications Among Transgender Adolescents in the US, 2018-2022,' Jan. 2025 (national context: 1,927 received hormones, 926 puberty blockers across 5M+ privately insured patients; fewer than 0.1%)
- 5.PBS NewsHour — 'Fewer than 0.1 percent of U.S. adolescents receive gender-affirming medications, report finds,' Jan. 2025 (coverage of the JAMA Pediatrics study; lead author Landon Hughes, Harvard)
- 6.NBC News — 'Less than 0.1% of U.S. minors take gender-affirming medication, study finds,' Jan. 2025
- 7.Reuters Investigates — 'As children line up at gender clinics, families confront many unknowns,' Oct. 2022 (Komodo Health analysis: gender-dysphoria diagnoses in ages 6-17 nearly tripled, 15,172 in 2017 to 42,167 in 2021)
- 8.The Cass Review (NHS England) — Final Report, April 2024 (independent review found 'weak evidence' for puberty suppression in youth)
- 9.NHS England — 'Children and young people's gender services: implementing the Cass Review recommendations' (puberty blockers ended as routine treatment, 2024)
- 10.GOV.UK — 'Ban on puberty blockers to be made indefinite on experts' advice,' Dec. 2024 (Commission on Human Medicines: 'unacceptable safety risk')
- 11.U.S. Dept. of Health & Human Services — 'Treatment for Pediatric Gender Dysphoria: Review of Evidence and Best Practices,' May 1, 2025 (HHS Office of Population Affairs)
- 12.American Academy of Pediatrics — response characterizing the HHS report as 'misrepresent[ing] the current medical consensus'; gender-affirming care endorsed by 30+ U.S. medical associations (via KFF)
- 13.Just the News — 'Kids on "lifesaving" cross-sex hormones skyrocket in Oregon, but no corresponding suicide decline' (coverage of the Oregon trend data)
- 14.RedState — Ward Clark, 'New Study: 1 in 250 Oregon Teen Girls on Testosterone,' June 11, 2026 (Oregon rates ~4-5x the national rate at 14-15; up to ~6x for puberty blockers)
Last updated June 26, 2026