Debates regarding gender-affirming care among minors have dominated news cycles in the past few weeks, beginning with the recent court verdict in favor of Varian Fox. Fox sued her medical care providers, claiming medical malpractice for gender-affirming surgery that she received as a minor in the United States. Over the past year, this topic has come up in the media repeatedly. Gender-affirming care for minors has been under significant scrutiny, especially since the presidential order Donald Trump issued in January of 2025, which aimed to block gender-affirming care for Americans under the age of 19,  highlight the stories of detransitioners in right-leaning media outlets and increase malpractice suits around gender-affirming care for minors that have become more and more frequent since 2022.

I was a recipient of gender-affirming care as a minor, and I agree that 10-year-olds, 12-year-olds and even 13-year-olds should likely not be making irreversible changes to their bodies. However, as someone who experienced suicidal thoughts associated with gender dysphoria as a teenager, I appreciate that my healthcare providers nonetheless informed my parents about all of the possible benefits and drawbacks of my healthcare options. It was important and provided pressure-free support for the decisions my family and I ended up making together. My endocrinologist that I saw as an adolescent, like all pediatricians who follow current best practices, does not believe in permanently altering the bodies of transgender youth before the age of 15, except under extreme, or extenuating circumstances.

In order to understand or make any arguments about gender care for youth, we must first understand what this care looks like. There are two distinct forms of hormonal gender-affirming care: puberty blockers and hormone therapy, or the administration of estrogen or testosterone. These two forms of therapy are different in both effect and permanence. They are administered to individuals at different ages and in different situations, beginning with entirely reversible treatment whenever possible. 

Puberty blockers are used to provide patients more time before puberty without producing permanent changes. They pause, or “block,” the progression of natural puberty for as long as they are taken. If the child decides to stop taking the medication, puberty returns to its normal course almost immediately. The FDA approved the use of these drugs in cisgender children with precocious (early) puberty in 1993 due to their efficacy and lack of side effects when properly monitored by care teams. During the pause provided by puberty blockers, children are able to further explore and understand their gender identity before experiencing sex changes of any type. Throughout this pause, healthcare providers are encouraged to provide opportunities for kids to change their mind, stop treatment and allow their body to proceed with puberty if that is what ends up feeling right to them. They should also be provided with mental health care for any concerns or for general wellbeing. After a couple of years of reflection, growth and time to mature, they are invited to begin the partially-reversible process of starting hormone therapy if they choose.

Hormone therapy, sometimes referred to as cross-sex hormone therapy, gender-affirming hormone therapy (GAHT) or hormone replacement therapy (HRT), is the administration of estrogen or testosterone in order to produce secondary sexual changes aligning with the patient’s gender identity. This is partially reversible — that is, some effects stop if the patient stops taking the hormones (such as muscle growth changes and body fat redistribution leading to a feminized or masculinized figure), while others can last years or the rest of the patient’s life (such as voice lowering on testosterone or breast growth on estrogen). Hormone therapy is administered only to older adolescents after over one year on puberty blockers, or in mid-to-late teenage years for those who did not take puberty blockers. Especially for adolescents, initial dosage is low and results in slow changes, and doctors are very involved in monitoring wanted and unwanted changes with the patient. For example, I started testosterone right before I turned16. I did not reach  the full dose I take today until I was18, and the changes to my body came about very slowly. I was excited for them to arrive, but it was important to have the opportunity to change my mind. I met with my endocrinologist frequently, and he asked about the changes that I liked, if there were any I disliked, and asked if  I wanted to change my dosage or stop altogether. 

I am satisfied with the decision that my parents, my doctors and I all came to together regarding my treatment. It was age-appropriate, safe and right for me. After clear, informative meetings with my therapist and my endocrinologist, my family and I provided informed consent and I was able to receive healthcare that felt affirming. As is the most common outcome for those that undergo gender-affirming care, I still feel great about these interventions now, over six years later. Thanks to laws protecting transgender health care for youth in California, judgments of best practice are left to  medical professionals, and decision-making power is given to the guardians  of trans youth. According to California’s state website, protection for transgender healthcare is defined as “comprehensive health care that is consistent with the standards of care for individuals who identify as [Transgender, Gender Diverse and Intersex].”

This best practice medical care for trans youth is outlined, with slight variations, by several medical organizations.  These include the eighth World Professional Organization for Transgender Health (WPATH) Standards of Care document, as well as  guidance from the American Medical Association (AMA) and the American Academy of Pediatrics (AAP), which reaffirmed their support for gender-affirming pediatric healthcare in 2023 The medical profession continues to gather data and develop evidence-based guidelines aimed at producing the best outcomes and supporting happy, healthy patients.

In cases such as Varian Fox’s, where the standards of care for transgender youth were inadequately followed and the patients and their guardians were insufficiently informed about the care these youth were receiving, I understand fearing such healthcare. The kind of “care” outlined by Fox, including permanent changes made younger than 18 harmful. Children and their parents should not feel pressured into any permanent gender changes. The fear of any gender affirming care for minors however, is perhaps better directed to the inadequate adherence to the standards of care, rather than at appropriately administered, initially reversible care provided to young minors. Children and young adolescents should be provided time and space to solidify their identities, mature and understand the gravity of permanent decisions before making any. 

Next time you read a news article describing transgender care for minors, you might consider: Is the treatment being described reversible? Were the best practices adhered to by the involved care professionals?