Pennsylvania taxpayers are paying more each year for the medical bills of low-income children who seek costly gender reassignment treatment, possibly because the hormones prescribed to change the appearance of a person’s gender are a long-term, or often a lifelong, medical commitment.
Taxpayers have been footing the bill for low-income children to change the appearance of their gender since 2015, when doctors from Pennsylvania hospitals lobbied to expand state coverage of “gender affirming” treatments for children on medical assistance through the Children’s Health Insurance Program (CHIP).
Since 2015, Pennsylvanians have spent more than $20 million on transgender surgeries and services for children age 18 and under, according to data collected from the state by the Pennsylvania Family Institute.
“This shocking report reveals Pennsylvania taxpayers are being forced to fund harmful drugs and surgeries on children, sending millions of dollars every year to carry out detrimental and irreversible procedures upon minors,” Michael Geer, president of the Pennsylvania Family Institute, said in a statement.
From 2015 to 2022, Pennsylvania has had a huge increase in funding for gender transition drugs, surgeries, and services for children.
In 2015, the state covered nearly $61,000 in childhood gender transition treatments, but by 2022, its spending had increased to more than $5 million.
The Epoch Times asked the Pennsylvania Department of Human Services (DHS) if the increase in spending is because there are many new patients seeking to change gender, or if it is an accumulation of patients from previous years who are continuing treatments. DHS did not respond before press time.
At least three Pennsylvania children’s hospitals are currently performing gender services, including the Children’s Hospital of Philadelphia (CHOP), UPMC Children’s Hospital of Pittsburgh, and Penn State Health Children’s Hospital, according to the Pennsylvania Family Institute.
Treatments
Data obtained by Pennsylvania Family Institute includes basic codes and descriptions for each treatment DHS paid for, but it does not show how many treatments were used for each patient. This means the data doesn’t show the total number of minors who received the medications and procedures.Treatments listed in the data include androgenic agents, which are used in the transition from female to male; and estrogenic agents, which are feminizing hormones powerful enough to cause a male to develop breasts.
Some girls were given Yuvafem, a vaginal insert tablet used to reduce symptoms of menopause, and Estring, another menopause insert in the form of a flexible ring that continuously releases estrogen. The Estring safety indications include a warning that using the product may increase the chance of developing dementia, and that estrogens should be used at the lowest dose possible and only for as long as needed.
Many treatments are hormones in the form of gels, creams, patches, and pills normally used for women in menopause and post-menopause.
Others are testosterone replacements, normally used in men who don’t make enough on their own. All are being prescribed for off-label use.
Training for Transition
In addition to funding drugs and procedures, Pennsylvania taxpayers have paid for more people to work in gender care.The Pennsylvania DHS gave more than $176,000 over three years to the Gender and Sexuality Development Program at CHOP to create a series of transgender therapy training workshops.
The webinars and in-person training were taken by more than 1,800 mental health providers and educators between 2018–2022.
The trainings teach that children under age 8 should be treated with “acceptance and affirmation,” and professionals can “help guide the family through social gender transition” by choosing a name, haircut, clothing style, and public bathroom of the gender the child wants to be. Puberty blocker medicines may start between ages 8–14. Ages 14 and up can be treated with testosterone, estrogen, and “gender affirming surgeries,” the training advises.
The decision to give a child puberty blockers can have permanent effects.
Puberty blockers can “put the pause button” on puberty, giving children more time to explore their gender identity, the training says, before the development of “irreversible secondary sex characteristics,” such as the natural development of breasts or deepening of the voice. If these characteristics never develop, the child may not need surgery later, the training indicates.
Puberty blockers are not cheap. The histrelin implant that goes into a child’s arm in this off-label use costs $49,000, according to the training. Histrelin is ordinarily used to treat the symptoms associated with advanced prostate cancer or precocious puberty. It can affect the growth of children and teens.
The Lupron injection, a brand name of leuprolide, taken every three months, costs $9,000 per shot, and is another prostate cancer medicine used as a puberty blocker.
“The really good news is, we usually get it covered. We have amazing social workers here at CHOP and in these clinics across the country, who work really hard to put in prior authorizations and write letters of medical necessity,” said Dr. Zachary McClain, assistant professor of pediatrics at the Perelman School of Medicine and program director of adolescent medicine, in one of the trainings, adding that insurance covers the cost 72 percent of the time.
While puberty blockers stop puberty, hormone therapy moves a child’s body toward characteristics of the gender they want to be. Hormone therapy can start when the child’s peer group starts to show external signs of puberty, usually at about age 14, the training says.
