Oregon is in a public records fight that could shape how people talk about child gender affirmation and discover how many child sex change procedures are actually happening. A Portland health advocate says he applied for a large set of health-insurance claims, which he’s done numerous times in the past, then the state pulled back when he said he wanted to study gender-affirming care, indicating there could be a political reason for not distributing the material. The Beaver State is being accused of skewing numbers when it comes to minors seeking and getting gender-altering procedures.
Oregon’s All Payer All Claims Reporting Program (APAC) compiles medical, dental, and pharmacy claims from insurers and other payers to help researchers and officials see what care people are getting and how much it costs. The state describes APAC as a tool to “promote transparency” and says there is a process to request specific datasets.
But Paul Terdal, a consumer health advocate and visiting fellow at the group Do No Harm, explained his challenge in an opt ed for RealClearPolitics. He says he first received a green light from the Oregon Health Authority (OHA) to apply for ten years of data. After he explained that his project would look at gender-affirming care, he says the agency changed course and would not release the records he asked for. In his 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 that 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 said he contacted OHA in February, explaining he was interested in a new research project. “At first, they offered me 10 years’ worth of data – 2001 through 2020. This would have been invaluable in tracking the recent rise in gender dysphoria diagnoses, the age and other medical conditions of patients who pursue a gender transition, and the types of treatment they received,” he explained. According to him, once they discovered his area of interest, his request was flagged for review. “They were deeply concerned about the political ‘risks’ of providing me with this data.”
In Oregon, though, kids that are 15 years old can consent to their own medical care without a parent’s permission, which may include a child sex change. The Oregon Department of Justice says the 2023 law known as HB 2002 did not change that age baseline.
A 2023 JAMA Network Open analysis reported about 48,000 gender-affirming procedures were performed nationwide from 2016 to 2020, peaking at roughly 13,000 in 2019 and about 12,800 in 2020. The most common procedure or surgery was done on the chest, on both males and females. The analysis broke it down to:
“Of gender-affirming surgical procedures identified among adults and minors, 1591 of 2664 (59.7%) and 82 of 85 (96.4%) were chest-related procedures, respectively. Of the 636 breast reductions among cisgender male and TGD adults, 507 (80%) were performed on cisgender males. Of the 151 breast reductions among cisgender male minors and TGD minors, 146 (97%) were performed on cisgender male minors.”
Diagnosis numbers are bigger than treatment numbers, and they’ve fueled political debate. A Reuters analysis estimated that at least 121,882 American kids ages 6 to 17 were diagnosed with gender dysphoria from 2017 to 2021. A diagnosis doesn’t mean a child received medication or surgery, but both supporters and critics of youth gender care point to this figure to make their case.
States have split sharply on policy, and 2025 marked a turning point. On June 18, the Supreme Court upheld Tennessee’s law that restricts puberty blockers and hormones for minors, signaling that similar bans in other states may stand while lawsuits continue. Policy trackers at KFF, a non-profit health policy organization, show the map of restrictions growing. By July 2025 the Human Rights Campaign counted 27 states with bans in place.
Policies are changing quickly, though. In July, Kaiser Permanente, a group that runs medical facilities and provides insurance, said it would pause gender-affirming surgeries for patients under 19 at its hospitals nationwide. Even with that pause, Oregon law still requires private insurers to make sure people can get necessary medical care. If a hospital won’t do a procedure, the insurer must help the patient get it somewhere else.
“I’m appalled to see this kind of authoritarian behavior from my own Democrat-led state government,” Terdal wrote. “My fellow liberals wouldn’t tolerate this from a Republican administration, and I refuse to tolerate it from my own.”
In the end, this case is about trust and clarity. Oregon says it must protect patient privacy while Terdal says the public deserves hard numbers. If his federal complaint goes to court, whatever the ruling, it will shape how Oregonians – and other states – will talk about youth gender care. Will it be with clear, shared facts, or with scattered snapshots that leave key questions unanswered.