A National Institutes of Health-funded study examining the effects of puberty blockers and transgender hormones in youth sought to diversify its participant pool after initial enrollment was predominantly white and female, according to a final report obtained by the Oversight Project, a watchdog group. The study’s recruitment strategies and demographic makeup have drawn scrutiny, raising questions about representation and research priorities in taxpayer-funded medical research.
The project, titled The Impact of Early Medical Treatment in Transgender Youth, was led by Dr. Johanna Olson-Kennedy at Children’s Hospital Los Angeles. The study focused on youth aged 8 to 20 and received up to $10 million in federal funding over a nine-year period. The Oversight Project obtained the final report and provided it to the Daily Signal, highlighting concerns about the study’s approach to diversity and participant selection.
Study Demographics and Recruitment
According to the report, the majority of youth who received treatments in the study were white and female. Specifically, 67% of participants identified as white, while 9% were Hispanic, 3% Asian, and 4% black. The study was divided into two main groups: one consisting of youth aged 8–16 who received puberty blockers, and another of youth aged 12–20 who received gender-affirming hormones (GAH).
In the puberty blocker group, the gender distribution was nearly balanced, with 52% of participants assigned male at birth and 48% assigned female at birth. However, in the GAH group, the distribution was more uneven, with 65% assigned female at birth and 35% assigned male at birth. The report acknowledged these demographic imbalances, stating, “Initially, all racial and ethnic categories were eligible to enroll in the first grant period; however, it became evident that the percentages of white youth enrolling were higher than expected, reflecting the rates of youth at all four sites.”
The report’s findings suggest that the participant pool did not fully reflect the diversity of the broader population. The researchers noted that the demographic makeup of those seeking treatment at the participating clinics may have influenced the study’s initial enrollment patterns. This led to a reassessment of recruitment strategies in an effort to better represent minority and male youth.
Diversity Goals and Oversight Concerns
The study’s secondary objective was to “enhance the diversity and size of existing cohorts by enrolling additional youth of color into both cohorts and enroll additional assigned male at birth youth into the GAH cohort.” The report also emphasized the importance of enrolling ethnic and racial minority youth to more accurately reflect the clinical population seen at the study sites.
Neal Cornett, Director of State Litigation at the Oversight Project, questioned the motivations behind the push for greater diversity in the study’s participant pool. He noted that the study had initially included more girls who identified as boys and that the effort to recruit more youth of color could be related to the demographics of Los Angeles, where one of the study sites is located.
"The study looked at more girls who think they want to be boys. They want to recruit more youth of color. That could be because of the demographics of Los Angeles."
— Neal Cornett, Oversight Project Director of State Litigation
The Oversight Project expressed concerns that the explicit goal of enrolling more youth of color and more participants assigned male at birth could influence the study’s findings and the way the results are interpreted. The group questioned whether these recruitment targets might affect the objectivity or representativeness of the research, especially given the ongoing national debate over medical treatment for transgender youth.
Lack of Response From Study Leaders
Neither Children’s Hospital Los Angeles nor Dr. Olson-Kennedy, who now works in private practice, responded to requests for comment from the Daily Signal regarding the study’s recruitment strategies or its findings. The lack of response has left some questions about the rationale behind the study’s diversity goals and the impact of these efforts on the research outcomes.
The study had previously been reported as delayed in publication. According to The New York Times, Dr. Olson-Kennedy expressed concerns that the findings could be "weaponized" in the broader debate over transgender health care. The eventual release of the report and its focus on participant demographics come at a time of heightened national discussion about the medical treatment of transgender youth and the role of diversity initiatives in federally funded research.
The debate over how best to ensure representation in medical studies is ongoing. Advocates for diversity argue that research should reflect the populations most affected by the conditions being studied, while critics warn that recruitment targets could introduce bias or skew results. The NIH-funded study’s experience highlights the challenges researchers face in balancing scientific rigor, representation, and public accountability in sensitive areas of medical research.
