Instead of making hormone therapy and gender affirming surgery unavailable to anyone under 18, there should be more resources offered to trans youth to help them make medical decisions.

• Studies have shown that children who do not conform to the gender binary do indeed have a strong sense of who they are, despite the common worry that a child is not old enough to decide to undergo hormone therapy/gender affirming surgery.
• Instead of banning hormone therapy/surgery for under-18’s, there should be more focus on supporting them and offering safe spaces for them to express their gender identity until they can definitively choose to undergo therapy or not. The Trevor Project led a National Survey on LGBTQ Youth Mental Health and found that 60% of trans and non binary youth have engaged in self harm. More than half of trans and non binary youth have heavily considered suicide. Banning hormone therapy or gender affirming surgery would not help with either of these statistics and would instead likely raise them.
• Licensed therapists can be gender specialists: "A licensed therapist who has a VAST amount of knowledge about gender dysphoria, gender identity, gender nonconformity, transphobia (and how it works in real life) and how to help clients with transition (in its variety of forms).” These types of therapists should be more accessible and popularized in order to help trans youth and also to relieve some of the stigma transgender people experience. These therapists can also help young people make decisions surrounding their medical transition.
• Banning hormone therapy and gender affirming surgery is focusing on the wrong problem. The problem is the way that trans and non binary youth are treated, and medical and emotional support is the answer– not bans on potentially life-saving treatments.

This is especially true for minors. But nobody should have such surgery. Honestly, how is sex reassignment surgery less drastic than (the inaptly named) "conversion" therapy?!?!?

We are really damned if we do and damned if we don't here... Gender transition is best done before puberty, but that's also the time we can do the most damage to a kid should their gender identity change/refine over time in a way not consistent with the original plan.

I see no reliably winning strategy to handling kids who are trans.

Edit: Actually one caveat. I'm talking specifically about hormone therapy.

Gender reassignment surgery is too crazy of a commitment. It shouldn't be happening to anyone in their childhood. I'm sorry. 18+ for the surgery, arguable for the hormone therapy.

Hormone blockers should be used for minors instead of surgery.

Commentary

This commentary will seek to explain what these two terms actually mean and involve, the science and the side effects, to avoid misunderstandings informing one's opinions.

Gender Reassignment Surgery

• Gender reassignment surgery is a surgical procedure, or series of such, in which a transgender person's physical appearance and function of their existing sexual characteristics are altered to resemble those socially associated with their identified gender.
• Patients must undergo extensive psychological evaluation prior to surgery to ensure it is the correct decision.
• Surveys report that around 1 in 4 transgender and nonbinary people choose gender affirmation surgery.
• Results are permanent, however in rare cases of extreme regret patients could potentially seek a further reassignment surgery to restore the physical characteristics of their original sex.
• Risks can be high as with any major surgery, for infection, blood clots, lack of sensation etc.
• The results of a 50-year survey published in 2010 of a cohort of 767 transgender people in Sweden found that about 2 percent of participants expressed regret after undergoing gender-affirming surgery.

Hormone Therapy

• Hormone therapy in the context of transgender patients, broadly speaking, is the use of hormones for medical treatment.

• There are 2 key forms of hormone therapy used for transgender patients:

1. Hormone replacement therapy, or HRT, is used to alter hormone levels to match one's gender identity by intaking hormones that induce physical changes in the body similar to that of the puberty corresponding to their gender identity, such as changes in body hair, voice pitch, breast tissue, facial bone structure etc. These changes are permanent.
   Why is it done?

• Make gender dysphoria less severe
• Reduce psychological and emotional distress
• Improve psychological and social functioning
• Improve sexual satisfaction
• Improve quality of life
  However, risks include infertility, weight gain, and blood clots.

2. Puberty blockers are another form of hormone therapy which involves blocking the hormones (testosterone and estrogen) that lead to puberty-related changes in your body, thus delaying puberty. This stops things like periods and breast growth, or voice-deepening and facial hair growth.
   Because of this, ideally treatment should start before puberty /the development of secondary sex characteristics so that teens can go through puberty as their identified gender. This would mean taking hormone therapy under the age of 18.
   The effects of puberty blockers are reversible, not permanent, and the puberty of their biological sex would resume as soon as the hormone medication stops being taken.

• The numbers of those regretting procedures are lowest for nonsurgical transition methods, like taking puberty blockers.

• According to a 2018 study of a cohort of transgender young adults at the largest gender-identity clinic in the Netherlands, 1.9 percent of adolescents who started puberty suppressants did not go on to pursue hormone therapy, typically the next step in the transition process.

• Hormone therapy is a safe, well-researched method and is not new - it is used for the treatment of many other things including cancer, menopause and hypothyroidism.

• Contraceptive pills are also a form of hormone therapy.

The two shouldn't be grouped together. Hormone Therapy (e.g. puberty blockers) should be allowed, but you should have to wait until you're an adult before having surgery