EXHIBIT 4:

Predicted means and probabilities of chronic conditions among enrollees in US commercial insurance plans, by gender spectrum, weighted and age adjusted, 2001–19

	TFN (n = 5,796)	TMN (n = 10,682)	Cisgender men (n = 547,771)	Cisgender women (n = 715,501)
Total morbidity score (mean)	2.62	3.50	1.89	2.08
Cardiovascular conditions (%)
Hypertension	28.50	29.93	22.90	27.89
Cardiac arrhythmia	13.96	19.83	12.25	11.68
Valvular disease	6.45	12.22	6.30	6.69
Peripheral vascular disorders	6.09	6.53	5.97	5.22
Congestive heart failure®	3.04	3.38	4.18	3.28
Coagulopathy	4.05	4.86	2.90	2.81
Pulmonary circulation disorders	2.16	2.27	1.75	1.78
Neurological conditions (%)
Other neurological disorders	6.40	8.00	4.86	5.04
Paralysis	1.05	1.07	1.01	0.86
Weight, diabetic, and thyroid conditions (%)
Obesity	19.17	26.68	14.73	17.50
Fluid and electrolyte disorders	13.89	17.95	9.20	10.70
Hypothyroidism	12.51	30.82	7.40	16.34
Diabetes	12.09	13.24	11.69	9.97
Abnormal weight loss	5.99	8.59	4.40	5.01
Mental health and substance use (%)
Depression	51.85	53.54	18.68	27.85
Drug use disorder	8.66	7.02	4.56	3.22
Psychoses	5.04	4.12	1.73	1.79
Alcohol use disordera	5.49	4.17	4.35	2.29
Other chronic conditions (%)
Chronic pulmonary disease	20.79	31.92	19.73	21.57
Blood loss or deficiency anemia	6.28	15.58	4.39	8.61
Liver diseasea	6.85	13.31	6.18	5.79
Renal failurea	4.22	3.57	4.50	3.72
Rheumatoid arthritis/collagen	3.93	13.83	3.89	6.87
Cancerb	4.95	3.04	5.03	5.06
AIDS/HIV	3.00	0.35	0.58	0.14
Peptic ulcer disease excluding bleeding	1.17	3.31	1.21	1.38

source Authors’ analysis derived from administrative data from Optum’s Clinformatics Data Mart Database, 2001–19. notes The data source included deidentified insurance claims for privately insured and Medicare Advantage enrollees. Total morbidity score was determined using the Elixhauser Comorbidity Index. The underlying transgender numbers vary as a result of our transgender identification criteria, as some chronic condition and transgender exclusion codes overlap with those of the Elixhauser Comorbidity Index. So as to not bias our estimates downward, we removed people from our calculations who were identified as transgender only because they fell into an inclusion category that required that they did not have the condition being analyzed. See Jasuja GK, et al., note 3 in text, for more detail. p values for these regressions are in appendix exhibit 1 (see note 22 in text). TFN is trans feminine and nonbinary. TFM is trans masculine and nonbinary.

^aTFN n = 5,658.

^bTMN n = 4,660.