Fact-checking 3 claims in Tucker Carlson’s show on trans health care

Since his firing from Fox News, former prime-time 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.

Although adolescent treatment for gender dysphoria started only in the late 1990s, transgender adults have received hormonal treatment and sex reassignment surgery since the early 1970s. 

Also, people who aren’t transgender, including men with low testosterone and women in menopause, sometimes rely on hormone therapy. 

"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.