**Is Oregon Fudging the Numbers on Child Sex Change Procedures?**
Oregon is currently engaged in a public records battle that could significantly influence how people understand and discuss child gender affirmation, as well as reveal how many gender-altering procedures are actually being performed on minors.
A Portland health advocate, Paul Terdal, has applied for a vast set of health insurance claims data—something he has done multiple times in the past. However, when he stated that his research focus would be gender-affirming care, the state pulled back its willingness to provide the information, suggesting a possible political motive behind withholding the data.
### The Controversy
The state of Oregon has faced accusations of skewing numbers related to minors seeking and obtaining gender-altering medical procedures. The core of the dispute centers on Oregon’s All Payer All Claims Reporting Program (APAC), which compiles medical, dental, and pharmacy claims from insurance providers and other payers. APAC is intended to be a tool for transparency, allowing researchers and officials to understand what care individuals receive and the associated costs.
According to Oregon officials, there is an established process for requesting access to specific data sets. Yet, Terdal, a consumer health advocate and visiting fellow at the organization Do No Harm, shared his experience in an op-ed for RealClearPolitics, revealing challenges in accessing the data.
### Terdal’s Findings and Request Denial
Terdal explained that he initially received approval from the Oregon Health Authority (OHA) to apply for ten years’ worth of data. But after he declared his intention to study gender-affirming care, his request was flagged and ultimately denied.
In his own words:
> “The Oregon Health Authority makes this data available for purchase, and a few years ago, I purchased access to the 2019 data for a federally funded study. I found that while Oregon had estimated only about 175 patients would obtain taxpayer-funded gender transition services at a total annual cost of no more than $200,000, more than 7,585 patients had done so at more than 100 times the initial cost estimate.
>
> That included 160 children using ‘puberty blocker’ drugs and approximately 370 children taking cross-sex hormones. There were also 33 biological girls who had mastectomies—including some as young as 15—and two 17-year-old girls who had their uteruses and ovaries removed.
>
> I found this concerning since the Oregon Department of Justice had declared in a February legal filing that ‘genital surgery is not performed on transgender minors’. Yet the state’s own data confirmed that children really do undergo genital surgery that leaves them permanently sterilized. I publicized my findings late last year.”
Terdal reached out to OHA in February to pursue a new research project. Initially, OHA offered data from 2001 through 2020, which would have been invaluable for tracking trends in gender dysphoria diagnoses, patient demographics, and types of treatments.
However, once OHA realized the focus was on gender-affirming care, they flagged his request for review, citing political concerns:
> “They were deeply concerned about the political ‘risks’ of providing me with this data.”
### Oregon Health Authority’s Response
OHA proposed several options to limit Terdal’s access:
– A contract that prohibited him from publishing detailed results.
– Purging all records related to gender dysphoria (which they ultimately determined they lacked the authority to do).
– Claiming the database was out of compliance with federal privacy laws.
Terdal disputes the privacy compliance claim, noting that this data has been sold publicly for 15 years without objection. He also highlights that, under Oregon law, minors aged 15 and older can consent to their own medical care—including gender-affirming treatments—without parental permission. The Oregon Department of Justice confirms that the 2023 law HB 2002 did not change this age threshold.
### National Context
A 2023 analysis published in JAMA Network Open reported approximately 48,000 gender-affirming procedures performed nationwide from 2016 to 2020, peaking in 2019 with around 13,000 procedures. Chest-related surgeries were the most common for both males and females.
The report detailed:
– Among adults and minors, 59.7% and 96.4% of gender-affirming surgeries, respectively, were chest-related.
– Of 636 breast reductions among cisgender male and transgender adults, 80% were on cisgender males.
– Of 151 breast reductions among cisgender male minors and transgender minors, 97% were on cisgender male minors.
Diagnosis numbers of gender dysphoria exceed treatment numbers, fueling ongoing political debates. A Reuters analysis estimated that between 2017 and 2021, at least 121,882 American children aged 6 to 17 were diagnosed with gender dysphoria. It is important to note that a diagnosis does not necessarily mean the child received medication or surgery. Both supporters and critics of youth gender care use these figures to support their arguments.
### Shifting Policies Nationwide
States have sharply divided over policies related to youth gender care. The year 2025 marked a turning point. On June 18, the U.S. Supreme Court upheld Tennessee’s law restricting puberty blockers and hormone treatments for minors, signaling that similar bans in other states may stand even as lawsuits continue.
Policy trackers at the Kaiser Family Foundation (KFF), a nonprofit health policy organization, show a growing map of restrictions. By July 2025, the Human Rights Campaign reported 27 states had bans in place.
Policies are evolving rapidly. For example, in July 2025, Kaiser Permanente announced it would pause gender-affirming surgeries for patients under 19 at its nationwide hospitals. Nevertheless, Oregon law mandates that private insurers ensure access to necessary medical care. If a hospital refuses to perform a procedure, insurers must help patients obtain it elsewhere.
### The Stakes: Trust and Transparency
Terdal expressed his frustration, writing:
> “I’m appalled to see this kind of authoritarian behavior from my own Democrat-led state government. My fellow liberals wouldn’t tolerate this from a Republican administration, and I refuse to tolerate it from my own.”
At its core, this case is about trust and transparency. Oregon argues that it must protect patient privacy, while Terdal insists that the public deserves clear, hard data.
If Terdal’s federal complaint proceeds to court, the outcome will likely shape how Oregonians—and potentially other states—converse about youth gender care in the future. Will discussions be grounded in clear, shared facts? Or will they remain scattered snapshots that leave critical questions unanswered? Only time will tell.
https://www.libertynation.com/is-oregon-fudging-the-numbers-on-child-sex-change-procedures/
