The number of transgender children and adolescents receiving care in the U.S. military health system rose substantially from 2010 to 2017, a new study shows.

During that time, the number of children of active or retired military personnel seeking gender-affirming care more than quadrupled, researchers found.

Until September 2016, gender-affirming care was not covered for the 1.7 million youth who may be eligible for military health service care based on their parents’ current or prior service. At that point, the Department of Defense enacted a policy allowing children of service members to receive full coverage for nonsurgical transgender and gender-diverse care, researchers note in JAMA Pediatrics.

The number of children seeking transgender and gender-diverse care in the military health system rose from 135 in all 12 months of 2010 to 528 in just the first four months of 2017, according to Dr. David A. Klein of the Uniformed Services University in Bethesda, Maryland and colleagues.

Overall during the study period, 2,533 youngsters sought this kind of care. Roughly two-thirds had female as their first recorded gender.

Half of the youngsters were under age 17 when they had their first gender-associated appointment.

“Approximately 500 children presented to care during early puberty between the ages of 10 and 14,” Klein told Reuters Health in an email. He added, “Because the sex characteristics associated with puberty can be particularly troublesome for transgender and gender-diverse adolescents, clinicians caring for such children should promptly refer these children to healthcare professionals who are familiar with gender development for consideration of fully reversible treatment to suppress puberty. This treatment provides time to determine the most appropriate next steps, which may include additional gender-affirming therapy.”

In 2010, military doctors wrote 24 new prescriptions for gender-affirming hormones, compared to 332 in just the first four months of 2017.

Co-author Dr. Elizabeth Hisle-Gorman, also at the Uniformed Services University, told Reuters Health by email, “This study shows that transgender care, which was only officially available to military dependents in 2016, is used and needed. Meeting the healthcare commitment to our military families includes providing appropriate quality transgender care to military dependent children.”

“We hope to explore how changes in availability of transgender related care can impact the overall health and well-being of military connected children,” she said. “We also think it is important to understand how other factors related to military life including parental deployment, and frequent moves, may affect these children and adolescents.”

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