By Vish Karthikeyan ’27

In September, the founding director of the Stanford LGBTQ+ Family Building Clinic, Brent Monseur, resigned amidst Stanford Medicine’s decision to pause gender-affirming surgeries for transgender patients below the age of 19. This decision was followed by the Trump administration’s executive order that outlawed “chemical and surgical mutilation of children” in institutions receiving federal research funding. 

This decision is akin to those taken by several other major healthcare providers in California, such as Kaiser Permanente and Children’s Hospital Los Angeles, following which protests erupted throughout California. “Transgender rights are human rights”—the rhetoric that prevails broadly in these arenas—makes one wonder about the degree to which denying elective surgery to trans kids is deleterious. 

While there exists no broad international standard, the general consensus is to avoid surgeries on children unless absolutely necessary—the World Professional Association for Transgender Health (WPATH) Standards of Care do not particularly encourage them on minors. 

Extremely rare, documented cases of irreversible gender-affirming surgeries such as mastectomies, vaginoplasties, and phalloplasties are performed on minors after careful and holistic consideration of a variety of factors, including history and severity of dysphoria and family environment. 

The widely held belief that surgery for trans kids could be “medically necessary” and “life-saving” is false. While it is alarming to come across stories of people “choosing a living daughter over a dead son”, they obscure the nuance that goes into medical professionals deciding what course of treatment is appropriate for a child with gender dysphoria. 

It is well-documented that trans youth are particularly more prone to mental health disorders such as depression and suicidal ideation. States with laws restricting transgender care had up to 72% higher suicide attempt rates among trans youth. However, keeping gender-affirming surgeries open for minors does not improve mental health outcomes of the larger trans adolescent population. Multiple studies, including a November 2025 US Department of Health and Human Services (HHS) peer-reviewed report, found no reliable evidence that surgeries (or puberty blockers/hormones) reduce suicide mortality, attempts, depression, or anxiety in minors long-term. It is factors like family support that reduce suicide attempts by 82%.

A monumental portion of the debate that abounds as to whether gender-affirming care is permissible for minors, particularly surgery, cites consent incapacity, procedure irreversibility, and desistance rates (the number of patients de-transitioning to their gender assigned at birth) as reasons against such procedures. However, I believe the question should not be about whether minors can consent to such procedures. In fact, a multitude of studies underscore minors’ capabilities of consenting, particularly to irreversible medical procedures such as abortion or DSD surgeries. Why then is it prudent to consider a minimum age for gender-affirming surgeries? 

While adolescents may understand the risks and benefits associated with surgery, there exists no safe objective standard for the determination of the “medical necessity” of such procedures. Right now, persistence, intense dysphoria, extensive assessments, and family support remain the only standards for determining when surgery becomes absolutely necessary. 

As with most other psychiatric conditions, the effects associated with dysphoria are highly subjective. If the standard of care being waiting for a certain age to perform elective surgeries is abolished, it becomes easier for the patient to portray their distress as deserving surgery and easier for medical practitioners to view the distress as a clinical justification. 

While the literature on distress rates is profoundly varied, it is safe to say that a huge proportion of minors receiving gender-affirming surgery in general do not later develop adverse mental health outcomes. This does not, however, negate the existence of a small group of detransitioners—a group that will only get larger with no standard minimum age for gender-affirming surgeries. 

Entertain this analogy: a considerable—if not vast—proportion of people under the age of 21 are fully capable of understanding the risks associated with drinking and thus drink responsibly, albeit illegally. Why do we not consider the legality of drinking for individuals on a case-by-case basis, then? The legal drinking age exists to prevent those underage who are not capable of exercising such safe judgments from availing themselves of serious harm, although they are only a minority. Similar arguments can be made for the age of consent, the minimum age for voting, the minimum driving age, and so on. 

Much of current gender-affirming medicine in the United States is focused on giving children what they want as quickly as possible. When a strong or dramatic solution is on the table, people, particularly minors, tend to reinterpret their own distress or difficulty as qualifying for that solution. This is the sociological foundation of problem inflation, which unfortunately plagues much of contemporary medical practice (Conrad, 2007). 

The “I-will-get-what-I-am-conditioned-to-think-I-need” mentality is obliterating the scope for rational and research-oriented policy in California and beyond. Soon, the prescribed need for antidepressants or GLP-1 agonists becomes a “medical necessity” while all you really needed were some drastic lifestyle modifications. (Of course, not all who are on antidepressants don’t really need them.) 

This narrative ought to then become the new norm out of fear of public censure. For instance, for one of my classes this quarter, we had to read without context the story of a child transitioning from kindergarten onward. 

California’s Transgender, Gender Diverse, and Intersex Inclusive Care Act makes it discriminatory to deny any form of gender-affirming care deemed “medically necessary,” without offering a clear standard for determining necessity in minors. When medical necessity becomes indistinguishable from subjective distress, restraint is recast as discrimination, thanks to a failure of policy to draw the very boundaries that protect children from irreversible harm.

Photo Credit: Jim Seida / NBC News