Kaiser Permanente, a healthcare company with hospitals across the United States, issued a mandatory training course for all Kaiser employees in Southern California. The course covered topics on “gender-affirming care,” which included information on mastectomies, hysterectomies, vaginoplasties, and phalloplasties. Internal documents indicated that these procedures are allowed to be performed on minors. The training also offered tips for proper binding and tucking. …

The criteria for Mastectomies is minimal. Girls under the age of eighteen are eligible for the surgery, as long as they receive parental consent and one letter within twelve months. Hormone therapy is not required to undergo the procedure, but it is required for hysterectomies (removal of the uterus), and orchiectomies (removal of the testicles). Adolescents can also receive “gender-affirming” estrogen and testosterone therapy, which can affect fertility and sexual function, and might lead to health problems.