Dr. Will Malone, an endocrinologist and founder of the Society for Evidence-Based Gender Medicine, objects that “Cognitive maturity doesn’t occur until the age of 25,” and notes that it’s very unusual for a woman under 25 to be given a hysterectomy other than for life-threatening conditions, even if she requests it, because doctors don’t consider people that young to be fully capable of making an informed decision.

Other nations have begun to rethink their approach. In 2020, Finland revised its treatment guidelines out of concern that the hormone and surgery approach was not well-supported. Practitioners now focus more on psychological therapy and draw distinctions between early-onset dysphoria and the adolescent variety. Sweden, Australia, and New Zealand have likewise moved to require thorough mental health evaluations for young gender dysphoria patients. In Great Britain, Keira Bell, a destransitioner who says she was prescribed testosterone and underwent a mastectomy without proper psychological counseling, won her case in Britain’s high court, which resulted in a ruling that young people under 16 could not give informed consent for puberty blockers.

The World Professional Association for Transgender Health has also endorsed a more cautious approach. A new chapter of their guidelines stresses that adolescents presenting with gender dysphoria must undergo psychological assessments and must have questioned their sexual identity for “several years” before being treated with puberty blockers or hormones.