A new analysis of health insurance claims in Washington state has identified a significant increase in transgender-related diagnoses among children and teenagers between 2017 and 2023, raising questions about how the findings should be interpreted amid ongoing political debates over transgender healthcare.
The analysis, published by City Journal, a publication of the conservative Manhattan Institute, examined insurance records and identified at least 15,437 minors who received transgender-related diagnoses during the seven-year period. Researchers acknowledged that the actual number could be higher because the database did not include every insurer and contained incomplete records for 2023.
According to the analysis, approximately 1.73 percent of girls and 0.8 percent of boys ages 12 through 17 had transgender-related diagnoses recorded in 2022. Among children ages 8 through 12, the corresponding figures were 0.71 percent and 0.16 percent.
The report also identified geographical differences. Southwestern Washington, including Vancouver, recorded the highest diagnostic rates among teenage girls, exceeding 2 percent. Olympia followed closely, while Seattle recorded approximately 1.5 percent.
Leor Sapir, the report’s author, argued that the increases warrant greater scrutiny of pediatric gender medicine. He also suggested that Washington’s supportive healthcare policies and proximity to gender clinics in Oregon could influence diagnostic patterns.
However, the analysis has important limitations.
A transgender-related diagnosis does not establish that a child received puberty blockers, hormone therapy, or surgery. Nor does an increase in diagnoses independently demonstrate that medical treatments are inappropriate or that social influences caused young people to identify as transgender.
The report also compares contemporary adolescent diagnosis rates with substantially older estimates of adult gender dysphoria, despite differences in populations, diagnostic practices, and methods of identifying transgender individuals.
Other research provides additional context.
A 2024 Centers for Disease Control and Prevention report found that 3.3 percent of American high school students identified as transgender in 2023, while another 2.2 percent questioned their gender identity. The survey also documented disproportionately high rates of bullying, violence, and mental health challenges among transgender students.
Meanwhile, a separate national study published in JAMA Pediatrics found that fewer than one in 1,000 commercially insured adolescents received gender-affirming medications between 2018 and 2022.
The Washington findings arrive as voters prepare to consider November ballot measures addressing transgender participation in school sports and parental rights in education.
Although the new analysis documents an increase in recorded diagnoses, it cannot independently explain what caused that increase or establish whether affected young people received appropriate medical care.
Those distinctions remain essential as policymakers debate healthcare decisions affecting transgender youth.
