Published: January 1, 2026
This past November, New Zealand1 announced that puberty blockers would no longer be prescribed to minors for gender dysphoria, for the same reasons found in the 2025 U.S. Department of Health and Human Services (DHHS) comprehensive evidence review of pediatric gender medicine. The DHHS report2 found “shaky foundations” for the claims of benefit, which were based on low-grade evidence and little of it contrasted with robust and objective evidence of risks and harms. New Zealand “counted the cost” of these medical interventions on minors. Joining Sweden, Finland, the UK,3 and others, NZ declared puberty blockers not worth the risk.4
In view of all the evidence, why then did the major U.S. medical associations push back?5 In addition to their continued insistence that medical “gender” interventions on minors are justified, organizations such as the Endocrine Society also assure the public not to worry because such interventions are “rare” and that a “cautious approach” is being taken.6
Here the Medical Institute (MI) estimates the cost for one medicalized gender dysphoric youth over the lifespan.7 Then the cumulative costs applied to the numbers of medicalized youth are estimated for this “rare” occurrence.
Counting the Cost
Medications8
The first step in medicalization of children with respect to gender distress is puberty blockers. Here we will use an average age of 129 for beginning pubertal suppression and assume an average duration of three years10 on this medication. Children are prescribed one of two options: Injections or Implants.
Phase 1: Puberty Blockers
| One year | Three years (age 12.0-15.0) | |
|---|---|---|
| Either Implant: Supprelin LA | $45,00011 | $135,000 |
| Or Injections: Lupron-Depot Ped IM kit | $22,50012 | $67,500 |
Phase 2: Proceed to Cross-sex hormones13
| Cross-sex hormone costs | Minor 15-17 | Young Adult 18-24 | Lifespan 15-74 |
|---|---|---|---|
| MtF: Estrogen14 | |||
| Estradiol oral tablets15 — $12 + $24 spironolactone/month = $432/yr. | $1,296 | $3,024 | $25,920 |
| Patch — $27 + $24 spiro/month = $612/yr. | $1,836 | $4,284 | $36,720 |
| Injection — $78 + $24 spiro/month = $1,224/yr | $3,672 | $8,568 | $73,440 |
| Depo-Estradiol $390 + $24 spiro = $4,968/yr | $14,904 | $34,776 | $298,080 |
| FtM: Testosterone | |||
| Gel: $117/month16 = $1,404/year | $4,212 | $9,828 | $84,240 |
| Injections: $200/month17 = $2,400/yr. | $7,200 | $16,800 | $144,000 |
Using the above figures, the lifetime costs (estimating a 60-year span of hormone use) for one gender-medicalized youth ranges from $26,000 to $300,000 for males and $84,000 to $144,000 for females. Note that these costs are for the medications only and do not include labs or doctor appointments. The middle column is given to demonstrate the costs incurred by the mid-twenties.
Phase 3: Surgery
The next step in medical transition after hormones may involve surgery or surgeries. While not all desire or will have surgery, many trans-identifying individuals do, including minors. In fact, one article18 described how cross-sex hormones can increase gender dysphoria in females regarding their breasts, increasing the desire for a “top surgery,” i.e. double mastectomy. What do these surgeries cost?
Surgery Costs: Average Estimates19
| Female to Male | Low End | High End |
|---|---|---|
| Chest reconstructions | $8,500 | $11,500 |
| Hysterectomies | $32,000 | $50,000 |
| Phalloplasty | $35,000 | $50,000 |
To keep the estimates on the conservative end, several additional surgeries are not listed here that could add to the costs, e.g. metoidioplasty, facial, and body masculinization surgeries. Metoidioplasty costs between $19,000 and $42,000. It is a surgery intended to construct “a small neophallus from a hormonally enlarged clitoris.”20 While some have a metoidioplasty before a phalloplasty, most patients that choose to have either one or the other. For the purposes of this estimate, phalloplasty only will be included as the genital surgery for natal females.
| Male to Female21 | Low End | High End |
|---|---|---|
| Breast augmentation | $8,500 | $10,000 |
| Facial feminization-upper | $10,000 | $50,000 |
| Facial feminization-mid | $6,000 | $18,000 |
| Facial feminization-lower | $4,500 | $50,000 |
| Vaginoplasty | $23,000 | $24,500 |
| Labioplasty | $8,500 | $15,500 |
| Vulvaplasty | $20,500 | $22,000 |
| Orchiectomy | $2,000 | $8,000 |
Potential additional expenses not listed: Hair removal, non-breast implants or body feminization, tracheal shaves or liposuction to better fit in with the general population. There are also voice feminization surgeries,22 including laser techniques or a glottoplasty surgery, where the vocal chords are restricted in order to raise the pitch of the voice, (glottoplasty cost estimate $5,000-$10,00023 plus any additional voice therapy). Some clinics have even offered foot narrowing surgeries.
Lifetime Potential Costs Per Person
| Female to Male-One Patient | Low End | Upper End |
|---|---|---|
| Age 12-15, puberty blockers | $67,500 | $135,000 |
| Age 15-75, testosterone monthly | $84,240 | $144,000 |
| Surgeries combined24 | $75,500 | $111,500 |
| Lifetime combined | $151,740 | $390,50025 |
| Male to Female-One Patient | Low End | Upper End |
|---|---|---|
| Age 12-15, puberty blockers | $67,500 | $135,000 |
| Age 15-75, est/spiro monthly | $25,920 | $298,080 |
| Surgeries26 | $83,000 | $198,000 |
| Lifetime combined | $176,420 | $631,080 |
With conservative estimates, Puberty blockers plus lifetime hormone and surgery combined costs: one patient can range from over $150,000 to over $600,000.
In 2022, a Reuters-Komodo Health investigation of insurance claims in the U.S. found that 121,882 minors ages 6-17 had received a gender dysphoria diagnosis from 2017-2021. Over the course of those five years, 17,683 had initiated medical interventions. 4,780 minors had been placed on puberty blockers and 14,726 had begun cross-sex hormones.27
Using the calculations above, what would the medication costs be for this cohort? For estimation purposes, half of the minors are assigned to the less expensive injections and half to the more expensive implants for the average duration of three years.
Phase 1: Puberty Blockers
| N=4,780 | One Year | Three Years |
|---|---|---|
| Injections: 2,390 × $22,500 | $53,775,000 | $161,325,000 |
| Implants: 2,390 × $45,000 | $107,550,000 | $322,650,000 |
| Total | $161,325,000 | $483,975,000 |
Thus for this cohort of patients and insurance claims, the puberty blockers estimated costs for one year is over $150 million dollars. Over three years, it could easily be $500 million dollars or more.
Phase 2: Cross-Sex Hormones
N=14,276
For ease of estimation, this cohort is divided evenly between males and females.28 Thus, N=7,138 for males (MtF) and N=7,138 for females (FtM). As with puberty blockers, to keep the estimate conservative, both sexed cohorts are further divided in half, with half receiving the least expensive option and half the most expensive options.
| One Year of Hormones: N=14,276 | Cost |
|---|---|
| FtM: Testosterone—Lower Cost: 3,569 minors x $1,404 | $5,010,876 |
| FtM: Testosterone—Higher Cost: 3,569 minors x $2,400 | $8,565,600 |
| Total Female Cohort Annual Expense | $13,576,476 |
| MtF: Estradiol—Lower Cost: 3,569 minors x $432 | $1,541,808 |
| MtF: Estradiol—Higher Cost: 3,569 minors x $4,968 | $17,730,792 |
| Total Male Cohort Annual Expense | $19,272,600 |
| Combined sex cohorts annual total for 14,276 minors | $32,849,076 |
| 60-years on hormones (age 15-75): 60 x $32,849,076 | $1,970,944,560 |
The hormone prescription costs for this known cohort for one year would be $33 million or more, and the lifetime prescription costs would equal $2 billion or more.
Phase 3: Surgery Costs
| One Year of Hormones: N=14,276 | Cost |
|---|---|
| FtM: Combined Surgeries—Lower Cost: 7,138 x $75,500 | $538,919,000 |
| FtM: Combined Surgeries—Higher Cost: 7,138 x $111,500 | $795,887,000 |
| Potential Female Cohort Surgeries Expense: Between $540 million and $800 million dollars | |
| MtF: Combined Surgeries—Lower Cost: 7,138 x $83,000 | $592,454,000 |
| MtF: Combined Surgeries—Higher Cost: 7,138 x $198,000 | $1,413,324,000 |
| Potential Male Cohort Surgeries Expense: Between $600 million $1.4 billion dollars |
Surgery costs for both sex cohorts combined, range estimated by all getting either the lower cost surgery versus all getting the higher cost surgeries: From $1.1 billion to $2.2 billion dollars.
Estimated potential costs for Cross-Sex Hormones and Surgeries across the lifespan for both sex cohorts combined for Reuters N=14,276:
Lifetime costs between $3.1 billion and $4.2 billion dollars
In August 2025, the Williams Institute (WI) released an updated estimate of trans-identifying youth ages 13-17, equaling a total of 724,000 or roughly 3.3% of the U.S. youth population.29 Hypothetically, if only one percent (n=7,240) of the WI sample began medical transition with puberty blockers, the costs over three years of treatment as estimated before30 would be over $700 million dollars. If only two percent (n=14,480) of the WI sample began cross sex hormones, the cost of one year of medicines would be similar to the Reuters cohort size and estimates above, with potential lifetime costs of into the billions.
Youth Gender Medicine: Not So Rare After All
In March 2025, JAMA Pediatrics published a study31 similar to the Reuters-Komodo Health study. Hughes and his co-authors reviewed private health insurance claims records for just over five million adolescents from the years 2018-2022, identifying the number of youths who had been prescribed puberty blockers or cross-sex hormones up to age 17. They calculated number of gender medicine recipients per 100,000 total adolescents and concluded that “receipt of puberty blockers and hormones was rare.” The number of patients prescribed cross-sex hormones peaked at age 17 at 140 females and 82 males per 100,000.
While 222 per 100,000 might sound fairly rare, U.S. Census data estimates for 202432 list the number of 17-year-olds in the U.S. as 4.5 million, which equals 10,00033 17-year-olds on cross-sex hormones when the reported rate is extrapolated to the general population. The census counts of teens to mid-twenties estimates roughly 4.5 million for each year’s age group. If the same rate held true for each year’s age cohort from age 17 on, this “rare” rate can easily compound into tens of thousands of teens and young adults receiving cross-sex hormones. For instance, for the cohort spanning ages 17-24, at the reported rate, 80,000 would be receiving hormones. Lifetime costs for this potential cohort for cross-sex hormones alone could be over $11 billion dollars.34 If such a cohort went through the full range of medicalization, including surgeries, lifetime costs could range between $17 billion and $24 billion dollars.
Costs that Can’t Be Compensated
Despite the staggering financial costs, the greater cost is the harm done to young people in the name of medicine. No amount of money can restore the years lost to puberty suppression and the physical and mental development that was prevented or take away the harms that resulted. What would be sufficient compensation for a child’s healthy body, future sexual functioning, and fertility, especially taken from them when they could not give truly informed consent? In the words of one Swedish man who transitioned young and was sterilized at age 21: “I was way too young to understand what it means not ever being able to have children of your own. I didn’t understand what I was saying yes to” While he received compensation from the government for this, he remarked, “They can’t give me my ability to have kids back.”35 And while he grieves over his decision at 21; some children in the U.S. are essentially “consenting” to sterilization at age 10.
Fox Varian is a 22-year-old woman who had her breasts removed at age 16. This week, she won her landmark malpractice lawsuit in New York, receiving a judgment of $2 million.36 But $2 million can’t restore what she lost. Losses such as fertility or body parts can never be adequately be compensated.
It’s Time to Block the Blockers…for Good.
In banning puberty blockers for trans-identifying minors, New Zealand made a wise and evidence-based decision, but it came with a worrying caveat. New Zealand will await the results of the clinical drug trial commencing in the U.K., where 200+ children will be put on puberty blockers in the name of a transgender identity or gender exploration. But puberty is not the problem; suppressing it is. Children dealing with gender distress need compassionate care, not harmful medical interventions that are so profitable to some and so costly to others (the children). The Medical Institute stands with the Hippocratic Oath and medical ethics. No clinicaltrial medicalizing gender distress should be conducted on vulnerable minors. The cost is simply too high.
UPDATE
Thankfully, a UK regulatory body has paused the puberty blocker trial as of February 23 due to safeguarding concerns. However, they are in dialogue with the trial sponsor to gather more scientific evidence. The Medical Institute stands firm that there can be no scientific justification for conducting such a trial and hopes that the UK will protect its minors from this known harm.
See: https://www.clinicaltrialsarena.com/news/uk-mhra-puberty-blocker-trial-paused/
To download the research, click below:
1 https://www.nbcnews.com/world/asia/new-zealand-halts-new-puberty-blockers-young-transgender-people-rcna244925
2 https://www.hhs.gov/press-room/hhs-releases-peer-reviewed-report-discrediting-pediatric-sex-rejecting-procedures.html
3 https://webarchive.nationalarchives.gov.uk/…/final-report/
4 https://protectingpuberty.com/; https://sex-matters.org/posts/updates/the-puberty-blockers-trial-on-trial/
5 https://abcnews.go.com/…/story?id=127685179
6 https://abcnews.go.com/…/story?id=127685179
7 https://kimmonson.com/…/the-1-million-cost-per-person-for-gender-transition/
8 GoodRx note on pricing
9 Olson-Kennedy et al. (2021)…
10 Pine-Twaddell et al. (2023)…
11 Is Supprelin LA the same as Lupron? Updated Nov. 4, 2024.
12 Ibid.
13 Carmichael et al. (2021)…
14 GoodRx estrogen pricing reference
15 GoodRx testosterone pricing reference
16 https://pmc.ncbi.nlm.nih.gov/articles/PMC10316880/
17 GoodRx Xyosted pricing reference
18 Olson-Kennedy et al. (2018)…
19 https://www.genderconfirmation.com/…/cost-guide-price-breakdown/; https://www.genderconfirmation.com/bottom-surgery-cost/
20 Stojanovic et al. (2022)…
21 http://www.thetransgendercenter.com/index.php/mtf-price-list.html
22 https://www.mountsinai.org/…/transgender-voice-feminization; https://www.mayoclinic.org/…/pac-20470545
23 https://us-uk.bookimed.com/article/voice-feminization-surgery-cost/
24 Nature review on phalloplasty complications
25 Note on additional lifetime medical costs
26 van de Grift et al. (2020)…
27 https://www.reuters.com/investigates/special-report/usa-transyouth-data/
28 Williams Institute demographic note
29 https://williamsinstitute.law.ucla.edu/…/trans-adults-united-states/
30 Estimation method explanation
31 Hughes et al. (2025)…
32 https://www.census.gov/…/2020s-national-detail.html
33 Census-based calculation
34 Cost extrapolation calculation
35 https://www.cbc.ca/…/forced-sterilization-1.4045790
36 https://www.abajournal.com/…/malpractice-suit-over-gender-surgery