Stand up for the facts!
Our only agenda is to publish the truth so you can be an informed participant in democracy.
We need your help.
I would like to contribute
If Your Time is short
An October episode of Tucker Carlson’s show on X, formerly Twitter, focused on gender-affirming care for transgender people. In contrast to his guest’s claim, there are many long-term, peer-reviewed studies that examine the efficacy and effects of hormonal treatment in trans adults.
Experts also say that Carlson’s comparison of gender-affirming surgeries and female genital mutilation is wrong. One is done with consent to preserve sexual function, the other is not.
Carlson’s guest also made claims about the size of the trans health care market in billions of dollars. But experts say without knowing the methodology behind those calculations, it is hard to determine the estimate’s accuracy.
Since his firing from Fox News, former primetime host Tucker Carlson has taken his show on the digital road — to X, where he has interviewed public figures such as former President Donald Trump and independent presidential candidate Robert F. Kennedy Jr.
On Oct. 4, Carlson released an episode titled "Trans, Inc" that focused on gender-affirming health care provided to transgender people.
"Genital mutilation is not just a fad. It’s a full-blown industry," read the caption on Carlson’s X post sharing the episode. The 48-minute video criticized aspects of transgender health care, such as hormones, surgery and social affirmation. It describes "transgenderism" as "unnatural" and "demented," comparing it with "human sacrifice." Carlson could not be reached for comment.
In the video, Carlson interviewed Chris Mortiz, whom Carlson introduced as a "policy guy" who has "taken a close forensic look at where the money is coming from." From his limited online presence, we found that Moritz has worked as a lawyer, investment banker and consultant. Mortiz did not respond to our requests for comment.
The video included some claims we have fact-checked before. But here are three new assertions involving hormone treatments, gender-affirming surgeries and the trans health care market.
Moritz’s description of a total lack of research is inaccurate. The Endocrine Society’s Clinical Practice Guidelines state, "Prior to 1975, few peer-reviewed articles were published concerning endocrine treatment of transgender persons. Since then, more than two thousand articles about various aspects of transgender care have appeared."
PolitiFact found several published and peer-reviewed studies examining the long-term effects and efficacy of cross-sex hormone treatment on bone health, cardiovascular risk, mortality, psychosocial functioning and more. There is enough research that we found systematic reviews — analyses of large numbers of individual research studies — on specific aspects of treatment like bone health.
"Hormone therapy for transgender males and females confers many of the same risks associated with sex hormone replacement therapy in nontransgender persons," the Endocrine Society’s Clinical Practice Guidelines say.
The guideline outlines safe dosages and provides guidance for how physicians should monitor for potential adverse effects.
Female genital mutilation is a nonconsensual procedure that can include the partial or total removal of the clitoris, labia minora or the narrowing of the vaginal opening. The World Health Organization said it is mostly forced on girls younger than 15. More than 200 million women have been affected in 30 countries in Africa, Asia and the Middle East.
The procedure aims to reduce or eliminate sexual function and pleasure. It is widely considered a human rights violation.
Dr. Marci Bowers, a gynecological surgeon who does gender-affirming genital surgeries and restorative surgeries for female genital mutilation survivors, told PolitiFact that gender-affirming surgeries do not amount to genital mutilation — the two are entirely different.
"Transgender surgery is done with full consent of the individual," Bowers said.
Female genital mutilation is usually forced on girls younger than 15 in nonmedical and unsterile conditions. Gender-affirming surgeries, however, are performed in hospitals by trained professionals, and are rarely performed on people younger than 18, said Bowers, president of the World Professional Association for Transgender Health. When gender-affirming surgery is performed on minors, it is "only under the most severe conditions of gender dysphoria," she said.
Bowers also noted the difference in how the two procedures affect women’s sexual functionality — such as the ability to have sensation or orgasm. Gender-affirming surgeries "are generally quite elegant surgeries that leave the individual fully functional versus (female genital mutilation), which robs a woman of functionality," she said.
Mariya Taher, co-founder of Sahiyo, an organization working in Asia to end female genital mutilation, agreed with Bowers. Taher told PolitiFact her organization "strongly" believes that gender-affirming health care does not equate to genital mutilation.
"We are saddened to see the two issues are being conflated" and that female genital mutilation "is being used as a guise to target and harm trans youth and gender-diverse individuals" Taher said.
Additionally, representatives from the End FGM network in both the U.S. and Europe told PolitiFact that female genital mutilation and gender-affirming surgeries are not the same.
We are unsure how Moritz arrived at those numbers; he offered no evidence backing them up and did not answer our inquiries.
We found a few publicly available market research reports, which are often commissioned by investors deciding whether to invest in a given industry. But it is difficult to assess the reliability of these reports without knowing the methodology behind them, and estimates can vary widely, said experts.
Carlson made a broader assertion that profits are driving transgender health care: "Transgenderism, it didn't happen by accident," he said. "Some people are profiting from it."
None of the 2022 reports we found for the U.S. market added up to $4.18 billion, but some got close. Grand View Research, for example, values the U.S. sex reassignment hormone therapy market at $1.6 billion and the U.S. sex reassignment surgical market at $2.1 billion in 2022.
These values can be calculated using a combination of insurance data, federal and state data, and information directly from medical providers, explained Stephen Parente, professor of finance at the University of Minnesota Carlson School of Management. But for procedures not reimbursed by insurance, getting accurate estimates might prove more challenging. Coverage of health care services for transgender people can differ by state and health plan, according to HealthCare.gov.
"Most types of health care, including gender affirming care, involve multiple types of providers of goods and services — e.g., drugs, visits, procedures, hospital stays, etc." said Melinda Buntin, health economist and professor at Johns Hopkins Bloomberg School of Public Health. "For this reason, it is hard to assess how much is spent on specific categories of care in sum."
The market size can vary depending on what is included in a given estimate, said Supriya Munshaw, associate professor at Johns Hopkins Carey School of Business. Is it just surgery or is the hospital stay included? What about complications? How do they determine what mastectomies are gender-affirming and which are done for breast cancer?
"How are you actually calculating the number?" said Munshaw. "It might differ in different research reports."
The U.S. health care market is large to begin with, totaling $4.3 trillion in 2021, according to federal data on national health expenditures. A market of billions is a "sizable market" from an investment perspective, Munshaw said, but "it doesn't mean that if something is profitable that the healthcare industry is pushing it."
PolitiFact Researcher Caryn Baird contributed to this report.
CORRECTION, Nov. 15, 2023: Melinda Buntin is health economist and professor at Johns Hopkins Bloomberg School of Public Health. Her name was misspelled in an earlier version of this story.
Interview with Stephen Parente, Professor of Finance at the University of Minnesota Carlson School of Management, Nov. 14, 2023
Email interview with Melinda Buntin, health economist and professor at Johns Hopkins Bloomberg School of Public Health, Nov. 7, 2023
Interview with Supriya Munshaw, associate professor at Johns Hopkins Carey School of Business, Nov. 13, 2023
Email Interview with Mariya Taher, Co-founder and U.S. Executive Director of Sahiyo, Nov. 8, 2023
Email Interview with Caitlin LeMay, Director of End FGM US Network, Nov. 13, 2023
Email Interview with Myriam Mhamedi, Senior Communications and Campaign Officer at End FGM European Network, Nov, 10, 2023
Interview with Marci Bowers, Gynecological surgeon and President of the World Professional Association for Transgender Health, Oct. 12, 2023
Email interview with Jenni Gingery, Director of Communications and Media Relations at the Endocrine Society, Oct. 12, 2023
X post," Aug. 14, 2023
X post," Aug. 23, 2023
X post," Oct. 4, 2023
PolitiFact, "Rep. Mary Miller says White House is encouraging kids to take "castration" drugs, undergo surgeries," April 17, 2022
PolitiFact, "Ad goes too far with claim Joe Biden promotes surgery for trans teens," Nov. 8, 2022
PolitiFact, "Puberty blockers: The facts and the myths," Aug. 28, 2023
PolitiFact, "Rachel Levine does not support gender confirmation surgery for all children," March 2, 2021
PolitiFact, "‘Gender dysphoria’: What it is, what it isn’t and how history has changed its view," May 22, 2023
PolitiFact, "No, California no separará a padres de hijos por debates de identidad de género," Sept. 25, 2023
PolitiFact, "Is all gender-affirming care for children ‘experimental’? Experts say no," Jan. 17, 2023
Endocrine Society, "Gender Dysphoria/Gender Incongruence Guideline Resources," Sept. 1, 2017
Cleveland Clinic, "Low Testosterone (Low T): Causes, Symptoms & Treatment," Sept. 2, 2022
Mayo Clinic, "Hormone therapy: Is it right for you?" Dec. 6, 2022
World Health Organization, "Female genital mutilation," Jan. 31, 2023
UNICEF, "What is female genital mutilation?" accessed Nov. 14, 2023
PolitiFact, "Transition-related surgery limited to teens, not 'young kids.' Even then, it's rare," Aug. 10, 2022
Sahiyo, "Home Page," accessed Nov. 11, 2023
U.S. End FGM/C Network, "Home Page," accessed Nov. 13, 2023
End FGM Europe, "Home Page," accessed Nov. 13, 2023
Grand View Research, "U.S. Sex Reassignment Hormone Therapy Market Report, 2030," accessed Nov. 14, 2023
Grand View Research, "U.S. Sex Reassignment Surgery Market Size Report, 2030," accessed Nov. 14, 2023
HealthCare.gov, "Transgender health care coverage," accessed Nov. 14, 2023
Centers for Medicare & Medicaid Services, "NHE Fact Sheet," Sept. 6, 2023
Vision Research Reports, "U.S. Sex Reassignment Hormone Therapy Market Size, Growth, Trends, Report 2023-2032," accessed Oct. 16, 2023
Global Market Insights, "Sex Reassignment Surgery Market | Trends Report, 2023-2032," accessed Oct. 16, 2023
Global Market Insights, "Hormone Replacement Therapy Market Analysis | Forecast 2032," accessed Oct. 16, 2023
Clinical Endocrinology, "Mortality and morbidity in transsexual subjects treated with cross‐sex hormones," Oct. 2003
European Journal of Endocrinology, "A long-term follow-up study of mortality in transsexuals receiving treatment with cross-sex hormones," April 2011
Journal of Bone and Mineral Research, "Bone Safety During the First Ten Years of Gender‐Affirming Hormonal Treatment in Transwomen and Transmen," Dec. 2018
Journal of Clinical Medicine, "Systematic Review of the Long-Term Effects of Transgender Hormone Therapy on Bone Markers and Bone Mineral Density and Their Potential Effects in Implant Therapy," June 2019
Journal of Clinical Medicine, "The ENIGI (European Network for the Investigation of Gender Incongruence) Study: Overview of Acquired Endocrine Knowledge and Future Perspectives," April 2022
Metabolism Open, "The effects of gender-affirming hormone therapy on cardiovascular and skeletal health: A literature review," March 2022
Nature Human Behaviour, "A systematic review of psychosocial functioning changes after gender-affirming hormone therapy among transgender people," May 22, 2023
Osteoporosis International, "Cortical and trabecular bone mineral density in transsexuals after long-term cross-sex hormonal treatment: a cross-sectional study," Oct. 2004
The Journal of Clinical Endocrinology & Metabolism, "Bone Mass, Bone Geometry, and Body Composition in Female-to-Male Transsexual Persons after Long-Term Cross-Sex Hormonal Therapy," July 2012
The Journal of Clinical Endocrinology & Metabolism, "Long-Term Treatment of Transsexuals with Cross-Sex Hormones: Extensive Personal Experience," Jan. 2008
The Journal of Sexual Medicine, "Children and adolescents in the Amsterdam Cohort of Gender Dysphoria: trends in diagnostic- and treatment trajectories during the first 20 years of the Dutch Protocol," March 2023
The Journal of Sexual Medicine, "Long-Term Evaluation of Cross-Sex Hormone Treatment in Transsexual Persons," 2012
The Journal of Sexual Medicine, "The Amsterdam Cohort of Gender Dysphoria Study (1972-2015): Trends in Prevalence, Treatment, and Regrets," Feb. 2018
The Lancet - Diabetes & Endocrinology, "Mortality trends over five decades in adult transgender people receiving hormone treatment: a report from the Amsterdam cohort of gender dysphoria," Oct. 2021
Transgender Health, "A Systematic Review of the Effects of Hormone Therapy on Psychological Functioning and Quality of Life in Transgender Individuals," Jan. 2016