Is Delaying Gender-Affirming Hormone Therapy (GAHT) for Transgender Americans Cost-Effective?

Document Type

Presentation

Loading...

Media is loading
 

Publication Date

7-22-2025

Comments

Presentation: 16:00

Abstract

Transgender people are those for whom their gender identity is incongruent with their at-birth gender assignment, and are estimated to comprise ≤ 2.0% of the U.S. population. Medical standard of care for this population is gender-affirming hormone therapy (GAHT). While U.S. adults can typically access GAHT through informed consent, and the World Professional Association for Transgender Health’s (WPATH) supports GAHT initiation at or before age 16 with guardian oversight, adolescent access remains disproportionately restricted by state legislation. Although current literature finds GAHT cost-effective, few studies address the health-economic impact of delayed treatment. To address this, a 5-year decision tree model was developed from a health system perspective to assess whether delaying initiation of GAHT for transgender youth by two years (from age 16 to 18) maintains cost-effectiveness. The model compared immediate versus delayed initiation of GAHT, including probability of suicide attempts and recovery, initiation or discontinuation of GAHT, and gender-affirming surgery. Immediate initiation of GAHT was found to have lower costs and higher effectiveness ($11,038; 4.25 QALYs), than a two-year delayed initiation ($13,699; 4.11 QALYs), yielding an incremental cost-effectiveness ratio (ICER) of $18,625.61/QALY. These results suggest immediate initiation of therapy to be the dominant treatment strategy (lower costs and higher QALYs). Sensitivity analysis (±20% of baseline values) demonstrated that immediate treatment remained the dominant strategy in 92.1% of scenarios, and in no case did the ICER exceed standard willingness-to-pay thresholds. These findings align with prior research and reinforce the clinical and economic rationale for timely GAHT access. As such, healthcare systems should follow WPATH guidelines for initiation. Policymakers are urged to reverse legislation restricting GAHT and criminalizing provision of care for minors, and repeal federal policy (e.g. H.R.1) that removes GAHT from Medicaid essential health benefits, to ensure compliance with medical standards and align with the current literature.

Language

English

This document is currently not available here.

Submit Feedback on Presentation

Share

COinS