At least 15,437 minors in Washington received a transgender-related diagnosis on their health insurance claims between 2017 and 2023, according to a new analysis published by the Manhattan Institute. By 2022, 1.73 percent of teen girls aged 12 to 17 in the state carried such a diagnosis—nearly 600 times the highest adult female rate listed in the DSM-5, the standard psychiatric diagnostic manual published in 2013. Teen boys' 2022 rate of 0.8 percent was roughly 60 times higher than historic adult male estimates. The report finds these rates are consistent with a national trend of soaring transgender identification among youth, particularly adolescent girls with no prior history of gender issues.
The diagnostic rates climbed sharply during the study period. Among teen girls aged 12 to 17, the prevalence more than doubled between 2017 and 2023, while it nearly tripled for boys in the same age range. For younger children aged 8 to 12, rates grew 3.5 times for girls and almost doubled for boys. The highest concentration wasn't in Seattle but in the 986 zip code area, which includes Vancouver in southwest Washington, where over 2 percent of teen girls—more than one in 50—had a transgender-related clinical diagnosis. To put these figures in perspective, the percentage of Washington teens with such a diagnosis in 2022 was about 19 times the prevalence of pediatric Type 2 diabetes, a condition the American Diabetes Association's journal characterized as "an awakening epidemic."
MultiCare Health System, which runs Mary Bridge Children's Hospital in Tacoma, accounted for 11 percent of the 15,437 youth with transgender-related diagnoses, while Seattle Children's Hospital handled 8 percent. The report notes that MultiCare was the employer of whistleblower Tamara Pietzke, who in 2024 presented evidence that the system was medicalizing children with serious mental-health problems who wouldn't have qualified for hormonal treatments even under the permissive standards of the World Professional Association for Transgender Health. According to author Leor Sapir, a senior fellow at Manhattan Institute, Washington has "systematically eliminated barriers to pediatric medical transition," including a 2023 law that blocks state authorities from cooperating with other states' enforcement actions aimed at restricting youth access to medical interventions. The state's Medicaid program explicitly follows WPATH's recommendations, and categorical insurance exclusions of gender-affirming medical treatments are banned under state law.
The report draws connections between policy decisions and rising diagnostic rates, asking whether Washington expanded supply in response to demand or whether supply itself drove up demand. Vancouver sits directly across the Columbia River from Portland, Oregon, home to Oregon Health and Sciences University, which the report identifies as a leading center of gender-affirming medicine. Court-obtained videos from WPATH conferences revealed OHSU clinicians discussing castration surgeries for young nonbinary patients with no sexual experience, and a psychologist explaining how she helps surgeons proceed despite patients having severe psychiatric conditions including psychosis. The report suggests K-12 schools may serve as a pipeline into clinics, noting that Seattle Public Schools policies prevent disclosure of a student's gender identity to parents without the student's permission, and that Seattle-area schools have allowed health-care organizations to offer gender-affirming services, including hormonal treatments, to students on campus. Research cited in the report indicates that young teens who are socially transitioned from childhood are more likely to end up on a medical pathway, raising questions about whether social transition in schools accelerates diagnostic rates. Washington voters will face two related ballot measures this November addressing male participation in girls' sports and parental notification of school gender transitions—both polling above 50 percent support.