What is gender-affirming surgery? Can minors have “the” surgery?

Gender-affirming hormones are life-saving for transgender youth and adults. A recent study from the Trevor Project shows that transgender youth with access to gender-affirming hormones have lower rates of depression and are at a lower risk for suicide. A study by Stanford University School of Medicine found that positive mental health outcomes were higher for transgender people who accessed gender-affirming hormones as teenagers versus those who accessed it as adults. A third study, published in the New England Journal of Medicine, found that, two years after initiating gender-affirming hormones, transgender youth reported higher levels of life satisfaction and positive affect, and lower levels of gender dysphoria, depression and anxiety.

There is no single gender-affirming surgery – nor does a person have to have any surgery, or a specific surgery, to be transgender. Gender-affirming surgery includes a wide range of procedures such as plastic surgery to change features in the face to be more typically masculine or feminine, “top surgery” to make changes to the chest or torso or “bottom surgery” to make changes to genitals.

Transgender and non-binary people typically do not have gender-affirming surgeries before the age of 18. In some rare exceptions, 16 or 17 year-olds have received gender-affirming surgeries in order to reduce the impacts of significant gender dysphoria, including anxiety, depression, and suicidality. However, this is limited to those for whom the surgery is deemed clinically necessary after discussions with both their parents and doctors, and who have been consistent and persistent in their gender identity for years, have been taking gender-affirming hormones for some time, who have undergone informed consent discussions and have approvals from both their parents and doctors, and who otherwise meet standards of care criteria (such as those laid out by WPATH).

They are the same procedures that have safely and effectively been given to cisgender and intersex people for decades, for a host of cosmetic and medical reasons

In all cases, regardless of the age of the patient, gender-affirming surgeries are only performed after multiple discussions with both mental health providers and physicians (including endocrinologists and/or surgeons) to determine if surgery is the appropriate course of action.

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None of these surgical procedures are unique to transgender people. Prior research shows that post-surgical complication rates are similarly low among transgender and cisgender people receiving the same type of surgery – if not lower among transgender people.

What is the impact of parental support – or lack of support – on transgender young people?

The single most important thing anyone can do to support the transgender and non-binary people in their lives, regardless of their age, is to support and affirm them and their journey. A simple first step is committing to use their chosen name and pronouns – and, if you make a mistake, to simply apologize, correct yourself and move on.

When parents, caregivers and teachers support a transgender youth’s journey in transitioning, they are helping them to live authentically and grow into the person they are meant to be – just like all other children and adolescents their ages do. Adolescence is typically the time when all youth begin to develop autonomy and independence and learn about themselves and their identity, as they prepare for adulthood. When parents and families support their children through actions such as respecting their opinions, showing interest in their activities and interests and providing a loving, affirming, and trusting home, it can go a long way towards ensuring they will successfully develop into happy and healthy adolescents and adults.

And parental support can save lives. Previous research has found that transgender youth who are able to socially transition and simply have their gender identity, name and pronouns affirmed report higher levels of resilience and positive well-being and lower levels of depression, anxiety, gender dysphoria, and suicidality, relative to transgender youth who are not affirmed.