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 2: Proceed to Cross-sex hormones¹³

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.

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.

Surgery Costs: Average Estimates¹⁹

To keep the estimates conservative, several additional surgeries are not listed here, 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

Male to Female:²¹

Potential additional expenses not listed: hair removal, implants, tracheal shaves, liposuction, voice feminization surgeries,²² etc. Glottoplasty alone costs $5,000–$10,000.²³

Lifetime Potential Costs Per Person:

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 found that 121,882 minors ages 6–17 had received a gender dysphoria diagnosis from 2017–2021. Over 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, half assigned to injections and half to implants:

Thus, puberty blockers for this cohort cost over $150 million for one year and over $500 million for three years.

Phase 2: Cross-Sex Hormones: N=14,276

Evenly divided between males and females.²⁸

Lifetime hormone costs exceed $2 billion.

Phase 3: Surgery Costs N=14,276

FtM surgeries: $540M–$800M
MtF surgeries: $600M–$1.4B

Total surgeries: $1.1B–$2.2B

Combined lifetime costs for hormones + surgeries: $3.1B–$4.2B

In 2025, the Williams Institute estimated 724,000 trans-identifying youth.²⁹ If 1% began puberty blockers, costs exceed $700M. If 2% began hormones, lifetime costs reach billions.³⁰

Youth Gender Medicine: Not So Rare After All

A 2025 JAMA Pediatrics study³¹ found 222 per 100,000 17-year-olds receiving hormones. With 4.5 million 17-year-olds,³² this equals 10,000 youth.³³ Extending to ages 17–24 yields 80,000 youth, with lifetime hormone costs exceeding $11B.³⁴

Costs that Can’t Be Compensated

Stories of regret include a Swedish man sterilized at 21:³⁵ “They can’t give me my ability to have kids back.”

Fox Varian, who had a double mastectomy at 16, won a $2M malpractice judgment.³⁶

It’s Time to Block the Blockers … for Good.

New Zealand banned puberty blockers for minors but awaits UK clinical trial results. MI opposes clinical trials on minors due to known harms.

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