Insurance Coverage of Puberty Blocker Therapies for Transgender Youth

Abstract

* Abbreviations: FDA — : US Food and Drug Administration GnRH — : gonadotropin-releasing hormone PAG — : pediatric and adolescent gynecology referral service PES — : pediatric endocrinology service Appropriate medical intervention along with an affirming environment has been shown to result in improved health outcomes for transgender and gender-nonconforming people.1,2 Youth whose natural pubertal development would be detrimental to their psychological and general well-being can be treated with “puberty blockers” to prevent irreversible phenotypic changes. In our experience, the most effective medications are the gonadotropin-releasing hormone (GnRH) agonist leuprolide injections (Lupron; AbbVie, Chicago, IL) or histrelin subcutaneous implant (Supprelin, Vantas; Endo Pharmaceuticals, Malvern, PA), and these have been recommended in both the Endocrine Society Guidelines and the World Professional Organization for Transgender Health Standards of Care.3,4 The safety and efficacy of these regimens have been reported in several populations.2,5 GnRH agonist pharmacotherapy can cost thousands of dollars per month. As a result, articles both in the media and in medical literature discuss the difficulty of obtaining insurance coverage for GnRH analogs used for this indication. As Dr Norman Spack stated, “Many, if not most, young adolescent American transgender patients who are deemed appropriate candidates for the recommended medical intervention . . . are unable to obtain the treatment due to insurance denial”; he estimated that insurance had covered blockers for $6000, … Address correspondence to Elyse Pine-Twaddell, 1111 N Charles St, Baltimore, MD 21201. E-mail: epine{at}chasebrexton.org

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