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Transgender youth are children or adolescents who do not identify with the sex they were assigned at birth. Because transgender youth are usually dependent on their parents for care, shelter, financial support, and other needs, transgender youth face different challenges compared to adults. Professional medical associations state that appropriate care may include supportive mental health care, social transition, and puberty blockers, which delay puberty and the development of secondary sex characteristics to give children time to make decisions about more permanent courses of action.^[1]^[2]^[3]

Coming out

Transgender youth may encounter family exclusion and face discrimination.^[4] Some transgender youth feel that they need to remain closeted until they feel that it is safe and appropriate to come out and reveal their gender identity to their family members, and friends. In the LGBT community, to "come out" means to acknowledge one's sexual identity or gender identity and make it known to the public.

Family acceptance

Family acceptance or lack thereof has a significant impact on the lives of transgender youth.^[4] It may be impossible to predict a parent's reaction to the news of their child's gender identity and the process can be fraught for many transgender youths. In some cases, parents will react negatively to such news, and may disown the child or kick the youth out of the home. Current research suggests that transgender youth who have been entered into the juvenile justice system are more likely to have experienced family rejection, abuse, and abandonment compared to those youth who are not transgender. Because transgender youth depend on their parents for support and acceptance, family exclusion can result in them becoming emotionally vulnerable and regretting their decision to come out.^[5] Parents can find gender-affirmative counsellors and doctors and connect their children with LGBTQ support groups. Many parents join organizations such as Mermaids in the UK and PFLAG in the US so they can meet other parents and learn how to advocate for their children. Additionally, reactions of parents to transgender children can change over time. For example, parents who initially reacted with negativity and hostility may eventually come around to support their transgender children.

Support

Research has overwhelmingly indicated that familial support and acceptance of transgender youth has resulted in more positive life outcomes for the individual regarding their mental, physical, and emotional health.^[6]^[7]^[8]

Studies have indicated a number of ways that parents or guardians of transgender youth can show support and acceptance for their child with one of them being the opportunity for the child to speak about their gender identity. Transgender youth have found greater success and emotional stability when parents took on a supportive role rather than a controlling and dismissive stance. Troubleshooting problems during the transition as they arise, rather than pushing views on the child and dictating their process has allowed for healthier transitions.^[8]^[9] Additionally, informing professionals and other critical individuals in the child's life aides in developing a support network for the transgender youth.^[8]^[9]^[10]

Parents access to information is critical in aiding and advocating for transgender youth. Access to information supports parents in providing youth with resources regarding their gender identity such as medical care, counselling, educational literature, and local youth groups that can provide access to others in the transgender community.^[8]^[9]

Support in school is also important to the wellbeing and mental health of trans youth. Many schools seek to support trans pupils and educators can look to a variety of trans inclusion school guidance documents to shape their support of trans pupils of all ages and the literature continues to consider best practice within the educational setting.^[11]

Health risks

Family acceptance of transgender youth predicts an increase in greater self-esteem, social support, and general health status. It also protects against depression, substance abuse, and suicidal ideation and behaviors.^[12] As recent as 2015, research has shown that in carefully selected patients, people who transition young suffer few ill effects,^[13] and maintain a higher level of functioning than before transitioning. Additionally, results of treatment such as counselling are considered better when it is offered at an earlier age.

Family behaviors can increase or decrease health risks of transgender youth.^[14] Behaviors such as physical or verbal harassment, pressure to conform to gender norms, and excluding the youth from family events, will lead to higher health risks such as depression and suicide.^[15] On the positive end, behaviors such as supporting the youth's gender identity by talking about it and working to support their choice even though the parent might be uncomfortable make a significant impact on boosting the youth's confidence, which works to combat health risks associated with rejection.^[13]

Medical interventions

Puberty blockers are sometimes prescribed to trans children who have not yet begun puberty to temporarily halt the development of secondary sex characteristics.^[16] Puberty blockers allow patients more time to solidify their gender identity before starting puberty.^[17] While few studies have examined the effects of puberty blockers for transgender and gender non-conforming adolescents, the studies that have been conducted indicate that these treatments are reasonably safe and can improve psychological well-being.^[18]^[19]^[20] The potential risks of pubertal suppression in gender dysphoric youth treated with GnRH agonists may include adverse effects on bone mineralization.^[21]^[22] Additionally, genital tissue in transgender women may not be optimal for potential vaginoplasty later in life due to underdevelopment of the penis.^[23] Research on the long term effects on brain development is limited.^[22]^[24]^[25] In the Netherlands, youth are allowed to begin cross sex hormones at age 16, following their course of puberty blockers.^{[citation needed]}

Many studies support the rights of children to provide informed consent to puberty blockers, noting that if parents are unjustly opposed to a child's transition the child would have no recourse for needed treatment, drawing parallels to the right of children of Jehovah's Witnesses to blood transfusions, in addition to noting the psychological benefits from access to blockers and intense psychological and physical harm that can come from lack of access. Trans minors, especially homeless trans youth, without standard access to blockers may seek them from unreliable sources leading to dangerous side effects. Trans youth have also spoken out in support of their right to blockers according to physical developmental.^[26]^[27]^[28]^[29]^[30]^[31]^[32]

Some studies have claimed that most children end up identifying with their biological sex after reaching puberty, a situation labeled "desistance", though current research agrees if gender dysphoria does continue into adolescence it is far more likely to persist into adulthood. However, the research supporting high childhood desistance rates has been criticized by other researchers on various fronts. The research depends on improper classifications of dysphoria both according to the then current DSM-IV, which conflated gender noncomformity with a stated identification with a different gender than assigned at birth, and the DSM-V which required stated gender identity for diagnosis. However, evidence shows significant positive correlation between intensity of reported dysphoria and persistence. The papers also overestimated rates of desistance by classifying those who stopped participating or identified as nonbinary as desisters. The follow up research referenced had mean participation ages ranging from 16 to 23, but studies have shown those who appear to have desisted may retransition socially or medically at later ages. The terminology of desistance was also critiqued for imposing a binary wherein a cisgender identity is valid at any point but a transgender identity must be stable to be respected. In addition, the research overemphasized the possibility of adult regret but ignored the experiences of detransitioners who expressed satisfaction with their treatment and opportunity to explore their genders. The research in favor of high desistance also contains procedures classified by numerous health organizations as conversion therapy for classifying a transgender identity in adulthood as undesirable and recommending against prepubertal social transition, in addition previous participants have described the studies as traumatizing.^[33]^[34]^[35]

In Bell v Tavistock, the High Court of Justice of England and Wales ruled that it was unlikely that a child under the age of 16 could be Gillick competent to consent to puberty blocking treatment.^[36] This was overturned by the court of appeal, which ruled that children under 16 could consent to receive puberty blockers.^[37]

For those who are above age 18 and do not require parental consent, there are several medical interventions available. For those wishing to transition from male to female, options consist of facial feminisation surgery, vaginoplasty, breast augmentation surgery, and cross-sex hormones. For those wishing to transition from female to male, options consist of penile construction surgery, breast reduction surgery, and cross-sex hormones.^[38] In order for any individual to receive these medical treatments, they must have a written diagnosis of gender dysphoria and have undergone up to a year's worth of therapy if they are a United States citizen.^[39] If they are a citizen of Malta, there is a quick and relatively simple paperwork process to change their gender marker.^[40] In contrast, the United States has a difficult and extensive process that requires medical proof of need and returning to your home state to obtain various legal documents. In the United States to change an individual's existing gender marker and name, visits must be made to change the driver's license, social security card, banking documents, and passport.^{[citation needed]} The State of New York will soon be allowing the administration of Medicaid coverage for the distribution of hormones to transgender teens and youth.^[41]

Vulnerability

Transgender youth are extremely vulnerable to a multitude of problems, including substance use disorders, suicide, childhood abuse, sexual abuse/assault, and psychiatric disorders.^[42]

Gender dysphoria

Gender dysphoria is a strong, persistent discomfort and distress with one's gender, anatomy, birth sex, and even societal attitudes toward their gender variance.^[43] Transgender youth who experience gender dysphoria tend to be very conscious of their body; appearance, weight, and other people's opinions of their body may become very important.^[44]^{[better source needed]} A part of gender dysphoria is gender incongruence, which is the disconnect between gender and sex. Incongruence, in its most basic form, is the emotional and/or mental part of dysphoria.

Physical, sexual, and verbal abuse

Transgender youth are at an increased risk for physical, verbal, and sexual abuse. Children who experience physical abuse, verbal abuse, and sexual abuse are also more likely to be gender dysphoric; the evidence is not clear as to the relationship between abuse and sexual identity in regards to which is the cause and which is the effect, but does show a correlation between childhood abuse and gender identity.^[44]^[45]} As one transgender youth said, "Throughout my whole life, I was abused physically and mentally by relatives in my family. Have marks on my body. I have things that I remember happened to me."^[42] Youth who have parental support of their preferred gender presentation are much more likely to be better off in several ways: mentally, financially, academically, etc. Transgender youth who face physical abuse may be forced to leave their homes, or choose to leave, which can be a particularly traumatic experience. The lack of housing was found to often lead to financial difficulties for such youth. Lack of support at home and constant harassment at school may lead to academic difficulties for the youth as well, who face a much higher drop out level compared to their cisgender counterparts.^[42]

Homelessness and survival sex

In the US, according to the National Healthcare for the Homeless Council, one-fifth of LGBT youth have unstable housing or lack housing altogether, as of 2014.^[46] As a result, it is estimated that between 20 and 40% of homeless youth are a part of the LGBT population.^[13] Reasons for LGBT youth not being able to have stable housing include family rejection/conflict, varying forms of violence, and difficulty within various institutions such as school or the foster care system.^[46] Even when LGBT youth find themselves in homeless shelters, they are not having their needs met, leaving them at disproportionate rates on the streets compared to their heterosexual and cisgender peers, who fit within the gendered housing they are given and do not require additional services in their shelter placement.^[47]

One practice that results from transgender youth's inability to attain appropriate shelter is survival sex, the act of engaging in sexual activity with another individual in order to meet one's basic survival needs.^[25] One multi-city study found that about one in four homeless and runaway youth has engaged in survival sex.^[48] Sex is typically exchanged for money, but may also be exchanged for a bed for the night, food, or clothing. While there is an awareness of the possible dangers associated with survival sex, some youth who engage in the practice may derive a sense of pride in being able to support oneself through it. Risks associated with survival sex include the transmission of STI/STDs (sexually transmitted infection/disease).^[25]

Lack of access to healthcare

Transgender youth face many hardships in obtaining medical treatment for gender dysphoria. This lack of access is often due to doctors refusing to treat youth, or youth fearing negative reactions from health care providers. Psychiatrists, endocrinologists and family physicians now have clear guidelines on how to provide care to trans youth of early puberty through its completion.^[49] These are in wide use in Europe, UK, and in North America.^{[citation needed]} While in other countries, doctors may be generally reluctant to provide hormone therapy to youths under 16, and obtaining sex reassignment surgery prior to the age of 18 is almost impossible in most countries. Some of the medical professionals who are permitted to prescribe hormones include medical providers, nurse practitioners, and physician assistants.^[50]

Many youth who have used hormones to develop desired secondary male or female sex characteristics have obtained these hormones illicitly. This can result in a multitude of health problems for the youth, including improper pubertal growth and HIV due to contaminated needles. Sexually transmitted infections are a large health problem for transgender teens as well, as sexual partners often do not perceive these youth as health risks, especially since male-to-female youth cannot become pregnant. This trend of unprotected sex among the transgender population puts them at increased risk and has led to higher numbers of STIs among the group^[42] However, the latest revision of the Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People has addressed the needs of transgender children.

Bullying

School settings can be some of the toughest for transgender youth. Several problems may be faced at schools, including verbal and physical harassment and assault, sexual harassment, social exclusion and isolation, and other interpersonal problems with peers. Transgender students were much more likely than their peers to report harassment, assault, and feeling unsafe in school settings.^[51] These experiences vary between individuals and schools attended. Larger schools tend to have safer climates for transgender students, as do schools with more low income and religious and ethnic minorities.^[52]

In the United States, a 2009 study of 6th through 12th grade transgender students showed that most experienced a hostile school climate with regular harassment from peers. 82% of these youth reported that they felt unsafe at school because of their gender identity, and almost 90% reported experiencing homophobic harassment from peers frequently. A majority of these students also reported physical harassment at school, with nearly half reporting that they had been punched, kicked, or injured with a weapon. Sexual harassment among these students was also reported with alarming frequency (76%). Restrooms and locker rooms pose an especially high threat to transgender students. They frequently reported fear and anxiety about using these facilities at school because of experiences of harassment by both peers and adults when using them. Negative comments about gender presentation may be frequently overheard in these places, and surveyed students have reported being "pushed around," "getting the crap beat out of them," and "getting their asses kicked" by peers.^[53] A 2017 study of U.S. students in grades 9–12 found that 27% of transgender students reported feeling unsafe at school, a sharp contrast with only 5% of cisgender boys and 7% of cisgender girls who reported similar feelings.^[54]

Unfortunately, school administrations often do not take reports of victimisation of transgender students seriously. Only a third of transgender students who reported victimization to school staff members feel that their situation was taken care of adequately and effectively. The other two thirds often run into situations where the school staff members blame the victimized students. One student, when reporting bullying, said that they were told "that I need to stop flaunting my sexuality".^[53] School administrations often single out transgender students and discipline them for behaviour such as wearing appropriate clothes for their gender identity, using restrooms consistent with their gender identity, and insisting on using their preferred name and personal pronouns. These things serve no educational purpose and only isolate transgender students further.^[53]

High drop out rates and low grade point averages seem to plague the transgender population. The severity and frequency of bullying and harassment are directly correlated to these things. In one study of transgender youth, three quarters of the participants dropped out of school, almost all citing the main reason the constant acts of violence against them due to their gender identity. Anti-transgender bullying in schools has also been found to directly correlate with other negative outcomes, such as homelessness, unemployment, incarceration, and drug use.^[53]

Suicide

Though several studies that estimate life-threatening behavior for gay, lesbian, and bisexual youth have been done, few have been done regarding transgender youth, and thus comparable estimates do not exist. The few studies that have been done, however, have all concluded that transgender youth are at increased risk even over their gay, lesbian, and bisexual counterparts. A 2007 study of transgender youth found that, of the youth interviewed, about half had seriously contemplated ending their own lives. Of those who had thought about suicide, about half had actually made an attempt. Overall, 18% of all interviewed transgender teenagers reported an attempted suicide that was linked to their transgender identity.^[44] A similar study was conducted with gay, lesbian, and bisexual youth, with results showing 15% had made a suicide attempt that was due at least partly to their sexual orientation.^[55] Both of these numbers are higher than the 8.5% of high school population overall who had reported life-threatening behavior.^[25] In a recent study, it is found that these statistics are even higher for those who are homeless or have been rejected from receiving medical care due to their gender identity; this brings the numbers up to 69% with a general statistic stating that around 40% of transgender youth have attempted suicide.^[56] In the 2011 National Transgender Discrimination Survey, which surveyed 6,450 transgender individuals, 41% of respondents reported attempting suicide compared to 1.6% of the general population (a rate 25 times more elevated). Reported rates of attempted suicide were even higher for those who were unemployed, experienced harassment and physical or sexual abuse, or low household income.^[57]

Youth are generally predisposed to life-threatening behaviors due to a number of conditions, such as self-hatred, victimisation via bullying, substance abuse, etc. Transgender youth may also face victimization from peers and family members’ negative reactions to their atypical gender presentation, increasing their risk of life-threatening behaviors.^[44]^{[better source needed]} Awareness of the suicide rates of LGBT youth spiked post-2010, as a result of significant publicity being given to the suicides of Leelah Alcorn, Skylar Lee, and Ash Haffner only being a few.^[58]

Critics such as Andrew Gilligan have claimed that figures for youth transgender suicide are grossly exaggerated by transgender groups. Gilligan in particular has claimed that rates in the United Kingdom are less than 1%.^[59] Numerous studies, though, across various countries, have noted suicide attempt rates for transgender children ranging from 30 to 50%, at least double the rates of age-matched cisgender peers.^[60]^[61]^[62]^[63]

Court experiences

Individuals involved in the juvenile justice system have reported that transgender youth have an exceptionally difficult experience. This is because transgender youth are in a vulnerable stage and unlike cisgender or LGBQIA youth, a sentence to a juvenile detention facility could mean that their transition is stopped while they are detained. That is damaging to their mental health, and an experience that other youth are not subjected to.

Juvenile justice professionals are bound to the rules of ethics to ensure all youth are treated fairly. However, many transgender youth felt as if they were not adequately represented or respected in court.^[64] This included treatment from prosecutors, court-appointed defense attorneys, and judges, whether it is ignoring the appropriate pronouns, or in one case a judge refusing to hear the case of one transgender girl due to the way she was dressed.^[64] Judges are supposed to refrain from prejudice and biases while maintaining that attorneys abide by those same guidelines as well.^[65]

Prosecutors are required to ensure that all individuals are treated fairly and are not discriminated against.^[65] In one case, a prosecutor requested confinement for a transgender defendant rather than being returned home. The judge agreed to the sentence, even though they did not seem suicidal, dangerous, or appear to be a flight risk.^[65] An additional problem for some transgender youth is having an effective and zealous defense. Some report having had a defense attorney who went directly against their client's wishes due to his or her own personal beliefs.^[65] In some cases, the defense attorneys told the courts to leave transgender individuals in places from which they wanted to be removed, because those youths felt those places were unsafe due to lack of support and acceptance.^[65]

Detention centers

After court sentencing, youth are placed in detention centers where they are processed and assigned their placements within the facility. During intake, the goal is to address safety concerns of the youth, identify those who are vulnerable, and then house juveniles based upon their birth gender.^[66] Regardless of placements, transgender youth are targets for violence, and about eighty percent of individuals surveyed reported that the lack of safety in facilities as a serious concern.^[5] The survey of youth confined made no distinction between transgender and LGB youth, as their experiences are similar. Furthermore, the placement of LGBTQ youth is a complicated issue because their wants and needs have to be balanced with what is best for their safety.

In most facilities, youth are detained with their birth sex. Detainees are sometimes forced to alter their gender presentation (e.g. by cutting their hair). Medical experts state that this process can put transgender youth in distress and undermine their emotional stability. In contrast, juvenile detention center staff claim that this process is in the best interest for transgender youth and for their peers in the center because it decreases the opportunity for physical and sexual violence.

In a 2009 survey, some detentions centers stated that they already had difficulties with housing girls and boys on the same campus, and mixing in transgender youth according to their chosen gender in one dormitory would only create more problems. Transgender (female-to-male) boys are harder to place because of the high level of violence in the boy's facilities, and the high risk of sexual assault.^[65] One trans boy surveyed expressed concern about his safety in male units, saying "I’m not going to be ignorant...I know how males are."^[65]

As a result of these difficulties, transgender youth are frequently placed in solitary confinement. The centers assert that the solitary confinement is for their safety because the facilities cannot keep them protected if they are mixed in with the general population. However, confinement strips them of any recreational and educational programming that is imperative to maintaining mental stability. Oftentimes these isolations are based on beliefs that LGBTQ youth are sexual predators, and should not be around other confined youth, or with individuals of the opposite gender.^[5] One transgender youth in New York was placed in isolation for three weeks, despite her request to be placed in general population.^[67] Following her isolation, she was placed in observation for three months, whereas others are only in observation for one week.^[67]

Additionally, the safety of detention facilities is a primary issue as reported from LGBT youth in detention centers and individuals who work in the juvenile justice system.^[68] Transgender youth are at risk for abuse from both staff and other youth in the center.^[5] This can include staff abusing the youth or ignoring incidents of rape and abuse.^[5] Youth who were interviewed stated that they feared for their safety, and complaints about abuse went unheard and unresolved.^[68]

Staff members in juvenile detention centers are not properly trained in order to deal with some of the issues faced by transgender youth, such as use of proper pronouns or adequate clothing choices.^[69] This can be due to the varying amount of comfort around the issue of transgender youth and sexual identification, which has an impact on the treatment the youth receive.^[69] For example, one transgender girl stated that she did not have problems with the boys in her detention center, but she did with the staff.^[65] She said the staff would call her "him" and "he," even though she identified as female,^[65] and they refused to accept her transition from male to female.

Accommodation in schools

A national survey conducted by GLSEN found that 75% of transgender youth feel unsafe at school, and those who are able to persevere have significantly lower GPAs and are more likely to miss school out of concern for their safety.^[70] These students also reported to be less likely to plan on continuing their education as a result to their unsafe environment.^[71]

In recent years, some transgender children have received counseling and, in some cases, medical treatment for their condition, as well as the ability to change their gender identity. In some countries, schools are working to accommodate gender identity and expression by eliminating traditional gendered activities.^[72]

A safe school climate is essential for transgender, gender dysphoric, and gender non-conforming children, who likely experience stress and anxiety due to their desire to transition or display themselves as a different gender. While many schools have become more accepting and allow children to express their desired gender identity, current research shows that there is an increased amount of harassment, bullying, indifference by school staff, and antigay victimization towards transgender and gender non-conforming youth.^[73] Also, many schools may not allow children to use the bathroom of their choice. Other schools may enforce LGBTQ-related policies and implement necessary staff trainings to minimize these social hazards for transgender and gender non-conforming children. To accommodate the transgender students, In July 2018, 40 schools in UK banned skirts to make school uniform gender neutral.^{[citation needed]}

Families with a transgender child living within an intolerant community may face challenging issues. Gwen Araujo of Newark, California, was a young person who was living as female, when she had been assigned to the male gender at birth. When her trans status was revealed at a party she attended, she became the victim of violent crimes that resulted in her death.^[74]

Many transgender students feel as if they must hide their true identity when entering the school environment. A major part of why transgender people may feel this way is because school administrators as well as the general non-LGBTQ student population are not provided with the necessary knowledge required to help support their transgender peers.^[75]

Societal and legal attitudes

On a global scale, transgender individuals face varying levels of acceptance or denial based on their location's attitude towards the LGBT community. Factors that influence acceptance or denial of their identity tend to surround political interests, religious affiliations, and whether their identity is still labeled as a mental health disorder.^[76] Acceptance levels tend to predominantly be higher in countries located in the Global North.^[76] Despite higher levels, acceptance rates still vary from country to country, Malta and the United States of America are two examples of countries where legislation and the social acceptance levels have curated a safer environment for transgender individuals.

Malta

In early April 2015, Malta adopted a bill titled the 'Gender Identity, Gender Expression and Sex Characteristics Act' (GIGESC Bill). The bill allows minors to have their parents apply to have their legal gender marker changed for them or to have a gender marker held from their birth certificate until their gender identity has been self-determined. The bill also prevents surgeries from being performed on intersex infants until their gender identity has been discovered; the parents are no longer required to make an immediate decision and medical personnel cannot override this decision because the bill also outlaws the request to view medical records.^[77] For individuals who are no longer a minor, they only need to request a notary for self declaration, again the individual cannot be asked for medical records when changing their legal gender or performing any other legal changes in conjunction to their gender identity. Also, the entire process can be completed in less than thirty days.^[77] In order to continue Malta's progress in LGBT protections and rights, the government has set up a council called the LGBTIQ Consultative Council, this action shows their commitment and dedication to actually enforcing the Bill. While there are other European countries who have created allowances and encouraged acceptance of transgender individuals, most require compulsory sterilization and have lengthy legal proceedings.^[78]

United States

Discrimination in the United States is considered illegal.^[79] Many transgender youth face struggles in attempting to transition and to be accepted in the U.S. According to the Human Rights Campaign, as of 2015, in 32 states an individual can be fired for being transgender and in 33 states an individual can be refused housing.^[80]^[81] Transgender people are also disproportionately targeted for hate crimes. One report studying data from 1995 to 1999 found that 20% of transgender people who were murdered were victims of anti-transgender hate crimes. Anti-transgender violence also caused 40% of police reports by the transgender population.^[82] In 2013, the state of California signed a bill in to legislation titled the School Success and Opportunity Act giving transgender students the full rights and opportunities that their cisgender peers are granted.^[83] For individuals who are minors, if their parents consent, they are able to begin receiving puberty blockers at a young age and later receive cross sex hormones and then transitional surgeries upon turning 18 years of age.^[84]^{[better source needed]} For those who are not minors, they are able to participate in any body altering transitional experience that they desire if they are able to financially afford it and after going through a year of therapy to affirm this decision, but will have to jump over several hurdles for it to also be legally marked.^[38] The western and northeastern states are currently the most tolerant of the transgender population and have the most laws to protect those individuals.^[85]

During the first 4 months of 2021, there was a wave of legislation aiming to restrict access to gender-affirming healthcare treatments to transgender youth, as 28 Republican-controlled state legislatures have drafted or passed a number of bills of this sort.^[86] In April, Arkansas passed the Save Adolescents From Experimentation (SAFE) Act, which banned medical treatment and procedures for transgender youth under the age of 18. The law warns health care providers that administering procedures such as puberty-blockers, cross-sex hormone therapy, and gender-affirming surgeries can result in losing their medical license.^[86] Colorado, Florida, Illinois, Kentucky, Missouri, Oklahoma, South Carolina, South Dakota, and West Virginia have proposed similar laws that would prevent trans youth from having access to gender-affirming health care.^[86] Opponents of the bills criminalizing transition-related treatment for transgender youth are concerned that it prevents doctors from following health care guidelines approved by organizations like the American Medical Association.^[86]

On May 10, 2021, the Biden administration announced that it would provide transgender people protection against discrimination in health care, in an effort to restore civil rights protections for LGBTQ people that were eliminated by his predecessor.^[87] The policy reestablished that the federal government will protect transgender people, once again prohibiting discrimination on the basis of sexual orientation and gender identity by health care providers and health-related organizations who receive federal funding.^[87]

Health and Human Services’ (HHS) reversal of Affordable Care Act, Section 1557 was backed up by landmark Supreme Court decision Bostock v. Clayton County (2020) that ruled that LGBTQ individuals are protected against employment discrimination on the basis of their gender identity or sexual orientation.^[88] HHS concludes that the Bostock decision applies to health care as well, which led to the revising of the ACA civil rights provision.^[87] HHS Secretary Xavier Becerra said in a statement: “The Supreme Court has made clear that people have a right not to be discriminated against on the basis of sex and receive equal treatment under the law, no matter their gender identity or sexual orientation. Fear of discrimination can lead individuals to forgo care, which can have serious negative health consequences”.^[87]

Transgender youth activists

Eli Erlick (b. 1995), American trans activist^[89]
Aimee Challenor (b. 1997), British politician and transgender activist^[90]
Jazz Jennings (b. 2000), American activist and television personality^[91]
Lily Madigan (b.1998), British activist, and first openly transgender woman to become a Women's Officer within the Labour Party^[92]
Nicole Maines (b. 1997), American actress and transgender rights activist, plays the first television transgender superhero on CW's Supergirl^[93]

Media representations

The film Ma Vie en Rose (My Life in Pink) (1997) by Alain Berliner follows a young child named Ludovic who is assigned male but who lives as a girl and tries to make others agree with her identification. Ludovic's "gender play" incurs conflict within the family and prejudice from the neighbors.^[94]

The film Tomboy (2011) by Céline Sciamma follows a 10-year-old with the given name Laure who, after moving to a new neighborhood, dresses as a boy and adopts the name Mikäel.

The 2015 Documentary film Louis Theroux: Transgender Kids follows documentarian Louis Theroux's exploration of the burgeoning transgender youth therapy community in San Francisco, California. He interviews several transgender youth as they engage in medical, social, and psychological therapies to conform to their desired gender identities.^[95]

References

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^ Horton, Cal (2020). "Thriving or Surviving? Raising Our Ambition for Trans Children in Primary and Secondary Schools". Frontiers in Sociology. 5: 67. doi:10.3389/fsoc.2020.00067. PMC 8022833. PMID 33869473.
^ Ryan, Caitlin; Russell, Stephen T.; Huebner, David; Diaz, Rafael; Sanchez, Jorge (1 November 2010). "Family Acceptance in Adolescence and the Health of LGBT Young Adults". Journal of Child and Adolescent Psychiatric Nursing. 23 (4): 205–213. doi:10.1111/j.1744-6171.2010.00246.x. ISSN 1744-6171. PMID 21073595.
^ ^a ^b ^c "Serving transgender youth: Challenges, dilemmas, and clinical examples". PsycNET.apa.org. Retrieved 21 April 2016.
^ Grossman, Arnold H.; D'Augelli, Anthony R. (1 October 2007). "Transgender Youth and Life-Threatening Behaviors". Suicide and Life-Threatening Behavior. 37 (5): 527–537. doi:10.1521/suli.2007.37.5.527. ISSN 1943-278X. PMID 17967119.
^ "Family Acceptance Project — Helping LGBT Youths". www.socialworktoday.com. Retrieved 26 January 2021.
^ Stevens, Jaime; Gomez-Lobo, Veronica; Pine-Twaddell, Elyse (1 December 2015). "Insurance Coverage of Puberty Blocker Therapies for Transgender Youth". Pediatrics. 136 (6): 1029–1031. doi:10.1542/peds.2015-2849. ISSN 0031-4005. PMID 26527547.
^ Alegría, Christine Aramburu (1 October 2016). "Gender nonconforming and transgender children/youth: Family, community, and implications for practice". Journal of the American Association of Nurse Practitioners. 28 (10): 521–527. doi:10.1002/2327-6924.12363. ISSN 2327-6924. PMID 27031444. S2CID 22374099.
^ Mahfouda, Simone; Moore, Julia K; Siafarikas, Aris; Zepf, Florian D; Lin, Ashleigh (2017). "Puberty suppression in transgender children and adolescents". The Lancet Diabetes & Endocrinology. 5 (10). Elsevier BV: 816–826. doi:10.1016/s2213-8587(17)30099-2. ISSN 2213-8587. PMID 28546095. The few studies that have examined the psychological effects of suppressing puberty, as the first stage before possible future commencement of CSH therapy, have shown benefits."
^ Rafferty, Jason (October 2018). "Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents". Pediatrics. 142 (4): e20182162. doi:10.1542/peds.2018-2162. PMID 30224363. Retrieved 23 July 2019. Often, pubertal suppression...reduces the need for later surgery because physical changes that are otherwise irreversible (protrusion of the Adam's apple, male pattern baldness, voice change, breast growth, etc) are prevented. The available data reveal that pubertal suppression in children who identify as TGD generally leads to improved psychological functioning in adolescence and young adulthood.
^ Hembree, Wylie C; Cohen-Kettenis, Peggy T; Gooren, Louis; Hannema, Sabine E; Meyer, Walter J; Murad, M Hassan; Rosenthal, Stephen M; Safer, Joshua D; Tangpricha, Vin; T'Sjoen, Guy G (November 2017). "Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline". The Journal of Clinical Endocrinology & Metabolism. 102 (11): 3881. doi:10.1210/jc.2017-01658. PMID 28945902. Treating GD/gender-incongruent adolescents entering puberty with GnRH analogs has been shown to improve psychological functioning in several domains
^ Rafferty, Jason (October 2018). "Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents". Pediatrics. 142 (4): e20182162. doi:10.1542/peds.2018-2162. PMID 30224363. Retrieved 23 July 2019.
^ ^a ^b Rosenthal SM (2016). "Transgender youth: current concepts". Ann Pediatr Endocrinol Metab. 21 (4): 185–192. doi:10.6065/apem.2016.21.4.185. PMC 5290172. PMID 28164070.
^ Giovanardi, Guido (1 September 2017). "Buying time or arresting development? The dilemma of administering hormone blockers in trans children and adolescents". Porto Biomedical Journal. 2 (5): 153–156. doi:10.1016/j.pbj.2017.06.001. ISSN 2444-8664. PMC 6806792. PMID 32258611.
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External links

If You Are Concerned About Your Child's Gender Behaviors: A Parent guide. A publication of Children's National Medical Center's Outreach Program for Children with Gender-Variant Behavior and Their Families
ABC News: Understanding Transgender Children
Transgender Community Questions & Answers With Johanna Olson, MD – CHLA's Transyouth Program
Case, Kim A.; Meier, S. Colton (January 2014). "Developing Allies to Transgender and Gender-Nonconforming Youth: Training for Counselors and Educators". Journal of LGBT Youth. 11 (1): 62–82. doi:10.1080/19361653.2014.840764. ISSN 1936-1653. S2CID 143135968.

[WPATH-1] Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People (PDF). World Professional Association for Transgender Health. 2012. pp. 20–21.

[apahelp-2] "Guidelines for Psychological Practice With Transgender and Gender Nonconforming People" (PDF). American Psychological Association. Retrieved 17 July 2020.

[aap-3] "Supporting and Caring For Transgender Children" (PDF). American Academy of Pediatrics. Retrieved 17 July 2020.

[Said-4] Said, Hashem (3 October 2014). "Young trans people still struggling for social acceptance". Al Jazeera America. Retrieved 21 April 2016.

[Hunt,_J._2012-5] Hunt, J., & Moodie-Mills, A. (2012). The unfair criminalization of gay and transgender youth: An overview of the experiences of LGBT Youth in the Juvenile Justice System. Washington, DC: Center for American Progress.

[6] Catalpa, Jory M.; McGuire, Jenifer K. (1 February 2018). "Family Boundary Ambiguity Among Transgender Youth". Family Relations. 67 (1): 88–103. doi:10.1111/fare.12304. ISSN 1741-3729.

[7] Le, Victory; Arayasirikul, Sean; Chen, Yea-Hung; Jin, Harry; Wilson, Erin C (1 July 2016). "Types of social support and parental acceptance among transfemale youth and their impact on mental health, sexual debut, history of sex work and condomless anal intercourse". Journal of the International AIDS Society. 19 (3 (Suppl 2)): 20781. doi:10.7448/ias.19.3.20781. ISSN 1758-2652. PMC 4949317. PMID 27431467.

[:12-8] Riley, Elizabeth; Sitharthan, Gomathi; Clemson, Lindy; Diamond, Milton (April 2013). "Recognising the needs of gender-variant children and their parents". Sex Education. 13 (6): 644–659. doi:10.1080/14681811.2013.796287. S2CID 146453141.

[:13-9] "Supporting & Caring for Transgender Children | Human Rights Campaign". Human Rights Campaign. Retrieved 20 April 2018.

[10] Katz-Wise, Sabra L.; Budge, Stephanie L.; Orovecz, Joe J.; Nguyen, Bradford; Nava-Coulter, Brett; Thomson, Katharine (2017). "Imagining the future: Perspectives among youth and caregivers in the trans youth family study". Journal of Counseling Psychology. 64 (1): 26–40. doi:10.1037/cou0000186. PMC 5224913. PMID 28068129.

[11] Horton, Cal (2020). "Thriving or Surviving? Raising Our Ambition for Trans Children in Primary and Secondary Schools". Frontiers in Sociology. 5: 67. doi:10.3389/fsoc.2020.00067. PMC 8022833. PMID 33869473.

[12] Ryan, Caitlin; Russell, Stephen T.; Huebner, David; Diaz, Rafael; Sanchez, Jorge (1 November 2010). "Family Acceptance in Adolescence and the Health of LGBT Young Adults". Journal of Child and Adolescent Psychiatric Nursing. 23 (4): 205–213. doi:10.1111/j.1744-6171.2010.00246.x. ISSN 1744-6171. PMID 21073595.

[:0-13] "Serving transgender youth: Challenges, dilemmas, and clinical examples". PsycNET.apa.org. Retrieved 21 April 2016.

[14] Grossman, Arnold H.; D'Augelli, Anthony R. (1 October 2007). "Transgender Youth and Life-Threatening Behaviors". Suicide and Life-Threatening Behavior. 37 (5): 527–537. doi:10.1521/suli.2007.37.5.527. ISSN 1943-278X. PMID 17967119.

[15] "Family Acceptance Project — Helping LGBT Youths". www.socialworktoday.com. Retrieved 26 January 2021.

[Stevens_2015-16] Stevens, Jaime; Gomez-Lobo, Veronica; Pine-Twaddell, Elyse (1 December 2015). "Insurance Coverage of Puberty Blocker Therapies for Transgender Youth". Pediatrics. 136 (6): 1029–1031. doi:10.1542/peds.2015-2849. ISSN 0031-4005. PMID 26527547.

[Alegría_2016-17] Alegría, Christine Aramburu (1 October 2016). "Gender nonconforming and transgender children/youth: Family, community, and implications for practice". Journal of the American Association of Nurse Practitioners. 28 (10): 521–527. doi:10.1002/2327-6924.12363. ISSN 2327-6924. PMID 27031444. S2CID 22374099.

[lancet_pubertyblockers-18] Mahfouda, Simone; Moore, Julia K; Siafarikas, Aris; Zepf, Florian D; Lin, Ashleigh (2017). "Puberty suppression in transgender children and adolescents". The Lancet Diabetes & Endocrinology. 5 (10). Elsevier BV: 816–826. doi:10.1016/s2213-8587(17)30099-2. ISSN 2213-8587. PMID 28546095. The few studies that have examined the psychological effects of suppressing puberty, as the first stage before possible future commencement of CSH therapy, have shown benefits."

[:6-19] Rafferty, Jason (October 2018). "Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents". Pediatrics. 142 (4): e20182162. doi:10.1542/peds.2018-2162. PMID 30224363. Retrieved 23 July 2019. Often, pubertal suppression...reduces the need for later surgery because physical changes that are otherwise irreversible (protrusion of the Adam's apple, male pattern baldness, voice change, breast growth, etc) are prevented. The available data reveal that pubertal suppression in children who identify as TGD generally leads to improved psychological functioning in adolescence and young adulthood.

[Hembree_et_al-20] Hembree, Wylie C; Cohen-Kettenis, Peggy T; Gooren, Louis; Hannema, Sabine E; Meyer, Walter J; Murad, M Hassan; Rosenthal, Stephen M; Safer, Joshua D; Tangpricha, Vin; T'Sjoen, Guy G (November 2017). "Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline". The Journal of Clinical Endocrinology & Metabolism. 102 (11): 3881. doi:10.1210/jc.2017-01658. PMID 28945902. Treating GD/gender-incongruent adolescents entering puberty with GnRH analogs has been shown to improve psychological functioning in several domains

[rafferty_2018-21] Rafferty, Jason (October 2018). "Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents". Pediatrics. 142 (4): e20182162. doi:10.1542/peds.2018-2162. PMID 30224363. Retrieved 23 July 2019.

[autogenerated1-22] Rosenthal SM (2016). "Transgender youth: current concepts". Ann Pediatr Endocrinol Metab. 21 (4): 185–192. doi:10.6065/apem.2016.21.4.185. PMC 5290172. PMID 28164070.

[23] Giovanardi, Guido (1 September 2017). "Buying time or arresting development? The dilemma of administering hormone blockers in trans children and adolescents". Porto Biomedical Journal. 2 (5): 153–156. doi:10.1016/j.pbj.2017.06.001. ISSN 2444-8664. PMC 6806792. PMID 32258611.

[deVries2012-24] Vries, Annelou L. C.; Cohen-Kettenis, Peggy T. (2012). "Clinical management of gender dysphoria in children and adolescents: the Dutch approach". Journal of Homosexuality. 59 (3): 301–320. doi:10.1080/00918369.2012.653300. ISSN 1540-3602. PMID 22455322. S2CID 11731779.

[:1-25] Shapiro, Lila. "New Report Offers A Look At 'Survival Sex' and the LGBTQ Youth Who Are Turning To It". The Huffington Post. Retrieved 13 May 2017.

[26] Beattie, Cameron (1 January 2022). "High court should not restrict access to puberty blockers for minors". Journal of Medical Ethics. 48 (1): 71–76. doi:10.1136/medethics-2020-107055. ISSN 0306-6800. PMID 33593872. S2CID 231939788.

[27] Kremen, Jessica; Williams, Coleen; Barrera, Ellis P.; Harris, Rebecca M.; McGregor, Kerry; Millington, Kate; Guss, Carly; Pilcher, Sarah; Tishelman, Amy C.; Baskaran, Charumathi; Carswell, Jeremi (1 May 2021). "Addressing Legislation That Restricts Access to Care for Transgender Youth". Pediatrics. 147 (5): e2021049940. doi:10.1542/peds.2021-049940. ISSN 0031-4005. PMID 33883246. S2CID 233351473.

[28] Hoffman, Neal D.; Alderman, Elizabeth M. (1 December 2021). "Improving Our Understanding of Medical Decision-Making Competence in Puberty Suppression". Pediatrics. 148 (6): e2021053451. doi:10.1542/peds.2021-053451. ISSN 0031-4005. S2CID 240421673.

[29] Giordano, Simona; Garland, Fae; Holm, Soren (1 May 2021). "Gender dysphoria in adolescents: can adolescents or parents give valid consent to puberty blockers?". Journal of Medical Ethics. 47 (5): 324–328. doi:10.1136/medethics-2020-106999. ISSN 0306-6800. PMID 33692171. S2CID 232172479.

[30] Vrouenraets, Lieke Josephina Jeanne Johanna; Fredriks, A. Miranda; Hannema, Sabine E.; Cohen-Kettenis, Peggy T.; de Vries, Martine C. (1 October 2016). "Perceptions of Sex, Gender, and Puberty Suppression: A Qualitative Analysis of Transgender Youth". Archives of Sexual Behavior. 45 (7): 1697–1703. doi:10.1007/s10508-016-0764-9. ISSN 1573-2800. PMC 4987409. PMID 27251640.

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@@ Line 21: / Line 21: @@
 Parents access to information is critical in aiding and advocating for transgender youth. Access to information supports parents in providing youth with resources regarding their gender identity such as medical care, counselling, educational literature, and local youth groups that can provide access to others in the transgender community.<ref name=":12" /><ref name=":13" />
-Support in school is also important to the wellbeing and mental health of trans youth. Many schools seek to support trans pupils and educators can look to a variety of trans inclusion school guidance documents to shape their support of trans pupils of all ages and the literature continues to consider best practice within the educational setting.<ref>{{Cite journal|last=Horton|first=Cal|date=2020|title=Thriving or Surviving? Raising Our Ambition for Trans Children in Primary and Secondary Schools|url=https://www.frontiersin.org/articles/10.3389/fsoc.2020.00067/full|journal=[[Frontiers in Sociology]]|via=Frontiers in Sociology}}</ref>
+Support in school is also important to the wellbeing and mental health of trans youth. Many schools seek to support trans pupils and educators can look to a variety of trans inclusion school guidance documents to shape their support of trans pupils of all ages and the literature continues to consider best practice within the educational setting.<ref>{{Cite journal|last=Horton|first=Cal|date=2020|title=Thriving or Surviving? Raising Our Ambition for Trans Children in Primary and Secondary Schools|journal=[[Frontiers in Sociology]]|volume=5|page=67|doi=10.3389/fsoc.2020.00067|pmid=33869473|pmc=8022833|doi-access=free}}</ref>
 === Health risks ===
@@ Line 31: / Line 31: @@
 Puberty blockers are sometimes prescribed to trans children who have not yet begun puberty to temporarily halt the development of secondary sex characteristics.<ref name="Stevens 2015">{{Cite journal|last1=Stevens|first1=Jaime|last2=Gomez-Lobo|first2=Veronica|last3=Pine-Twaddell|first3=Elyse|date=2015-12-01|title=Insurance Coverage of Puberty Blocker Therapies for Transgender Youth|url=http://pediatrics.aappublications.org/content/136/6/1029|journal=Pediatrics|language=en|volume=136|issue=6|pages=1029–1031|doi=10.1542/peds.2015-2849|issn=0031-4005|pmid=26527547|doi-access=free}}</ref> Puberty blockers allow patients more time to solidify their gender identity before starting puberty.<ref name="Alegría 2016">{{Cite journal|last=Alegría|first=Christine Aramburu|date=2016-10-01|title=Gender nonconforming and transgender children/youth: Family, community, and implications for practice|journal=Journal of the American Association of Nurse Practitioners|language=en|volume=28|issue=10|pages=521–527|doi= 10.1002/2327-6924.12363|pmid=27031444|s2cid=22374099|issn=2327-6924}}</ref> While few studies have examined the effects of puberty blockers for transgender and [[Childhood gender nonconformity|gender non-conforming]] adolescents, the studies that have been conducted indicate that these treatments are reasonably safe and can improve psychological well-being.<ref name="lancet_pubertyblockers">{{cite journal | last1=Mahfouda | first1=Simone | last2=Moore | first2=Julia K | last3=Siafarikas | first3=Aris | last4=Zepf | first4=Florian D | last5=Lin | first5=Ashleigh | title=Puberty suppression in transgender children and adolescents | journal=The Lancet Diabetes & Endocrinology | publisher=Elsevier BV | volume=5 | issue=10 | year=2017 | issn=2213-8587 | doi=10.1016/s2213-8587(17)30099-2 | pmid=28546095 | pages=816–826 |quote=The few studies that have examined the psychological effects of suppressing puberty, as the first stage before possible future commencement of CSH therapy, have shown benefits."}}</ref><ref name=":6">{{cite journal |last1=Rafferty |first1=Jason |title=Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents |journal=Pediatrics |date=October 2018 |volume=142 |issue=4 |pages=e20182162 |url=https://pediatrics.aappublications.org/content/142/4/e20182162 |access-date=23 July 2019|quote=Often, pubertal suppression...reduces the need for later surgery because physical changes that are otherwise irreversible (protrusion of the Adam’s apple, male pattern baldness, voice change, breast growth, etc) are prevented. The available data reveal that pubertal suppression in children who identify as TGD generally leads to improved psychological functioning in adolescence and young adulthood.|doi=10.1542/peds.2018-2162 |pmid=30224363 |doi-access=free }}</ref><ref name="Hembree_et_al">{{cite journal |last1=Hembree |first1=Wylie C |last2=Cohen-Kettenis |first2=Peggy T |last3=Gooren |first3=Louis |last4=Hannema |first4=Sabine E |last5=Meyer |first5=Walter J |last6=Murad |first6=M Hassan |last7=Rosenthal |first7=Stephen M |last8=Safer |first8=Joshua D |last9=Tangpricha |first9=Vin |last10=T'Sjoen |first10=Guy G |title=Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline |journal=The Journal of Clinical Endocrinology & Metabolism |date=November 2017 |volume=102 |issue=11 |page=3881|quote=Treating GD/gender-incongruent adolescents entering puberty with GnRH analogs has been shown to improve psychological functioning in several domains|doi=10.1210/jc.2017-01658 |pmid=28945902 |doi-access=free }}</ref> The potential risks of pubertal suppression in [[Gender dysphoria in children|gender dysphoric youth]] treated with [[GnRH agonist]]s may include adverse effects on bone mineralization.<ref name="rafferty_2018">{{cite journal |last1=Rafferty |first1=Jason |title=Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents |journal=Pediatrics |date=October 2018 |volume=142 |issue=4 |pages=e20182162 |url=https://pediatrics.aappublications.org/content/142/4/e20182162 |access-date=23 July 2019|doi=10.1542/peds.2018-2162 |pmid=30224363 |doi-access=free }}</ref><ref name="autogenerated1">{{cite journal|pmc=5290172 | pmid=28164070 | doi=10.6065/apem.2016.21.4.185 | volume=21 | issue=4 | title=Transgender youth: current concepts | author=Rosenthal SM | journal=Ann Pediatr Endocrinol Metab | pages=185–192| year=2016 }}</ref> Additionally, genital tissue in transgender women may not be optimal for potential [[vaginoplasty]] later in life due to underdevelopment of the penis.<ref>{{Cite journal|date=2017-09-01|title=Buying time or arresting development? The dilemma of administering hormone blockers in trans children and adolescents|journal=Porto Biomedical Journal|language=en|volume=2|issue=5|pages=153–156|doi=10.1016/j.pbj.2017.06.001|issn=2444-8664|doi-access=free|last1=Giovanardi|first1=Guido|pmid=32258611|pmc=6806792}}</ref> Research on the long term effects on brain development is limited.<ref name="autogenerated1" /><ref name="deVries2012">{{cite journal|last1=de Vries|first1=Annelou L. C.|last2=Cohen-Kettenis|first2=Peggy T.|title=Clinical management of gender dysphoria in children and adolescents: the Dutch approach|journal=Journal of Homosexuality|date=2012|volume=59|issue=3|pages=301–320|doi=10.1080/00918369.2012.653300|issn=1540-3602|pmid=22455322|s2cid=11731779}}</ref><ref name=":1" /> In the Netherlands, youth are allowed to begin cross sex hormones at age 16, following their course of puberty blockers.{{citation needed|date=March 2021}}
-Many studies support the rights of children to provide informed consent to puberty blockers, noting that if parents are unjustly opposed to a child's transition the child would have no recourse for needed treatment, drawing parallels to the right of children of Jehovah's Witnesses to blood transfusions, in addition to noting the psychological benefits from access to blockers and intense psychological and physical harm that can come from lack of access. Trans minors, especially homeless trans youth, without standard access to blockers may seek them from unreliable sources leading to dangerous side effects. Trans youth have also spoken out in support of their right to blockers according to physical developmental.<ref>{{Cite journal |last=Beattie |first=Cameron |date=2022-01-01 |title=High court should not restrict access to puberty blockers for minors |url=https://jme.bmj.com/content/48/1/71 |journal=Journal of Medical Ethics |language=en |volume=48 |issue=1 |pages=71–76 |doi=10.1136/medethics-2020-107055 |issn=0306-6800 |pmid=33593872}}</ref><ref>{{Cite journal |last=Kremen |first=Jessica |last2=Williams |first2=Coleen |last3=Barrera |first3=Ellis P. |last4=Harris |first4=Rebecca M. |last5=McGregor |first5=Kerry |last6=Millington |first6=Kate |last7=Guss |first7=Carly |last8=Pilcher |first8=Sarah |last9=Tishelman |first9=Amy C. |last10=Baskaran |first10=Charumathi |last11=Carswell |first11=Jeremi |date=2021-05-01 |title=Addressing Legislation That Restricts Access to Care for Transgender Youth |url=https://doi.org/10.1542/peds.2021-049940 |journal=Pediatrics |volume=147 |issue=5 |pages=e2021049940 |doi=10.1542/peds.2021-049940 |issn=0031-4005}}</ref><ref>{{Cite journal |last=Hoffman |first=Neal D. |last2=Alderman |first2=Elizabeth M. |date=2021-12-01 |title=Improving Our Understanding of Medical Decision-Making Competence in Puberty Suppression |url=https://doi.org/10.1542/peds.2021-053451 |journal=Pediatrics |volume=148 |issue=6 |pages=e2021053451 |doi=10.1542/peds.2021-053451 |issn=0031-4005}}</ref><ref>{{Cite journal |last=Giordano |first=Simona |last2=Garland |first2=Fae |last3=Holm |first3=Soren |date=2021-05-01 |title=Gender dysphoria in adolescents: can adolescents or parents give valid consent to puberty blockers? |url=https://jme.bmj.com/content/47/5/324 |journal=Journal of Medical Ethics |language=en |volume=47 |issue=5 |pages=324–328 |doi=10.1136/medethics-2020-106999 |issn=0306-6800 |pmid=33692171}}</ref><ref>{{Cite journal |last=Vrouenraets |first=Lieke Josephina Jeanne Johanna |last2=Fredriks |first2=A. Miranda |last3=Hannema |first3=Sabine E. |last4=Cohen-Kettenis |first4=Peggy T. |last5=de Vries |first5=Martine C. |date=2016-10-01 |title=Perceptions of Sex, Gender, and Puberty Suppression: A Qualitative Analysis of Transgender Youth |url=https://doi.org/10.1007/s10508-016-0764-9 |journal=Archives of Sexual Behavior |language=en |volume=45 |issue=7 |pages=1697–1703 |doi=10.1007/s10508-016-0764-9 |issn=1573-2800 |pmc=4987409 |pmid=27251640}}</ref><ref>{{Cite journal |last=Clark |first=Beth A. |last2=Marshall |first2=Sheila K. |last3=Saewyc |first3=Elizabeth M. |date=2020-02-01 |title=Hormone therapy decision-making processes: Transgender youth and parents |url=https://www.sciencedirect.com/science/article/pii/S014019711930243X |journal=Journal of Adolescence |language=en |volume=79 |pages=136–147 |doi=10.1016/j.adolescence.2019.12.016 |issn=0140-1971}}</ref><ref>{{Cite journal |last=Priest |first=Maura |date=2019-02-01 |title=Transgender Children and the Right to Transition: Medical Ethics When Parents Mean Well but Cause Harm |url=https://doi.org/10.1080/15265161.2018.1557276 |journal=The American Journal of Bioethics |volume=19 |issue=2 |pages=45–59 |doi=10.1080/15265161.2018.1557276 |issn=1526-5161 |pmid=30784385}}</ref>
+Many studies support the rights of children to provide informed consent to puberty blockers, noting that if parents are unjustly opposed to a child's transition the child would have no recourse for needed treatment, drawing parallels to the right of children of Jehovah's Witnesses to blood transfusions, in addition to noting the psychological benefits from access to blockers and intense psychological and physical harm that can come from lack of access. Trans minors, especially homeless trans youth, without standard access to blockers may seek them from unreliable sources leading to dangerous side effects. Trans youth have also spoken out in support of their right to blockers according to physical developmental.<ref>{{Cite journal |last=Beattie |first=Cameron |date=2022-01-01 |title=High court should not restrict access to puberty blockers for minors |url=https://jme.bmj.com/content/48/1/71 |journal=Journal of Medical Ethics |language=en |volume=48 |issue=1 |pages=71–76 |doi=10.1136/medethics-2020-107055 |issn=0306-6800 |pmid=33593872|s2cid=231939788 }}</ref><ref>{{Cite journal |last1=Kremen |first1=Jessica |last2=Williams |first2=Coleen |last3=Barrera |first3=Ellis P. |last4=Harris |first4=Rebecca M. |last5=McGregor |first5=Kerry |last6=Millington |first6=Kate |last7=Guss |first7=Carly |last8=Pilcher |first8=Sarah |last9=Tishelman |first9=Amy C. |last10=Baskaran |first10=Charumathi |last11=Carswell |first11=Jeremi |date=2021-05-01 |title=Addressing Legislation That Restricts Access to Care for Transgender Youth |url=https://doi.org/10.1542/peds.2021-049940 |journal=Pediatrics |volume=147 |issue=5 |pages=e2021049940 |doi=10.1542/peds.2021-049940 |pmid=33883246 |s2cid=233351473 |issn=0031-4005}}</ref><ref>{{Cite journal |last1=Hoffman |first1=Neal D. |last2=Alderman |first2=Elizabeth M. |date=2021-12-01 |title=Improving Our Understanding of Medical Decision-Making Competence in Puberty Suppression |url=https://doi.org/10.1542/peds.2021-053451 |journal=Pediatrics |volume=148 |issue=6 |pages=e2021053451 |doi=10.1542/peds.2021-053451 |s2cid=240421673 |issn=0031-4005}}</ref><ref>{{Cite journal |last1=Giordano |first1=Simona |last2=Garland |first2=Fae |last3=Holm |first3=Soren |date=2021-05-01 |title=Gender dysphoria in adolescents: can adolescents or parents give valid consent to puberty blockers? |url=https://jme.bmj.com/content/47/5/324 |journal=Journal of Medical Ethics |language=en |volume=47 |issue=5 |pages=324–328 |doi=10.1136/medethics-2020-106999 |issn=0306-6800 |pmid=33692171|s2cid=232172479 }}</ref><ref>{{Cite journal |last1=Vrouenraets |first1=Lieke Josephina Jeanne Johanna |last2=Fredriks |first2=A. Miranda |last3=Hannema |first3=Sabine E. |last4=Cohen-Kettenis |first4=Peggy T. |last5=de Vries |first5=Martine C. |date=2016-10-01 |title=Perceptions of Sex, Gender, and Puberty Suppression: A Qualitative Analysis of Transgender Youth |url=https://doi.org/10.1007/s10508-016-0764-9 |journal=Archives of Sexual Behavior |language=en |volume=45 |issue=7 |pages=1697–1703 |doi=10.1007/s10508-016-0764-9 |issn=1573-2800 |pmc=4987409 |pmid=27251640}}</ref><ref>{{Cite journal |last1=Clark |first1=Beth A. |last2=Marshall |first2=Sheila K. |last3=Saewyc |first3=Elizabeth M. |date=2020-02-01 |title=Hormone therapy decision-making processes: Transgender youth and parents |url=https://www.sciencedirect.com/science/article/pii/S014019711930243X |journal=Journal of Adolescence |language=en |volume=79 |pages=136–147 |doi=10.1016/j.adolescence.2019.12.016 |pmid=31972534 |s2cid=210882333 |issn=0140-1971}}</ref><ref>{{Cite journal |last=Priest |first=Maura |date=2019-02-01 |title=Transgender Children and the Right to Transition: Medical Ethics When Parents Mean Well but Cause Harm |url=https://doi.org/10.1080/15265161.2018.1557276 |journal=The American Journal of Bioethics |volume=19 |issue=2 |pages=45–59 |doi=10.1080/15265161.2018.1557276 |issn=1526-5161 |pmid=30784385|s2cid=73456261 }}</ref>
-Some studies have claimed that most children end up identifying with their biological sex after reaching puberty, a situation labeled "desistance", though current research agrees if gender dysphoria does continue into adolescence it is far more likely to persist into adulthood. However, the research supporting high childhood desistance rates has been criticized by other researchers on various fronts. The research depends on improper classifications of dysphoria both according to the then current DSM-IV, which conflated gender noncomformity with a stated identification with a different gender than assigned at birth, and the DSM-V which required stated gender identity for diagnosis. However, evidence shows significant positive correlation between intensity of reported dysphoria and persistence. The papers also overestimated rates of desistance by classifying those who stopped participating or identified as nonbinary as desisters. The follow up research referenced had mean participation ages ranging from 16 to 23, but studies have shown those who appear to have desisted may retransition socially or medically at later ages. The terminology of desistance was also critiqued for imposing a binary wherein a cisgender identity is valid at any point but a transgender identity must be stable to be respected. In addition, the research overemphasized the possibility of adult regret but ignored the experiences of detransitioners who expressed satisfaction with their treatment and opportunity to explore their genders. The research in favor of high desistance also contains procedures classified by numerous health organizations as [[conversion therapy]] for classifying a transgender identity in adulthood as undesirable and recommending against prepubertal social transition, in addition previous participants have described the studies as traumatizing.<ref>{{Cite journal|last1=Newhook|first1=Julia Temple|last2=Pyne|first2=Jake|last3=Winters|first3=Kelley|last4=Feder|first4=Stephen|last5=Holmes|first5=Cindy|last6=Tosh|first6=Jemma|last7=Sinnott|first7=Mari-Lynne|last8=Jamieson|first8=Ally|last9=Pickett|first9=Sarah|date=2018-04-03|title=A critical commentary on follow-up studies and "desistance" theories about transgender and gender-nonconforming children|url=https://doi.org/10.1080/15532739.2018.1456390|journal=International Journal of Transgenderism|volume=19|issue=2|pages=212–224|doi=10.1080/15532739.2018.1456390 |s2cid=150338824|issn=1553-2739}}</ref><ref>{{Cite journal |last=Winters |first=Kelley |last2=Temple Newhook |first2=Julia |last3=Pyne |first3=Jake |last4=Feder |first4=Stephen |last5=Jamieson |first5=Ally |last6=Holmes |first6=Cindy |last7=Sinnott |first7=Mari-Lynne |last8=Pickett |first8=Sarah |last9=Tosh |first9=Jemma |date=2018-04-03 |title=Learning to listen to trans and gender diverse children: A Response to Zucker (2018) and Steensma and Cohen-Kettenis (2018) |url=https://doi.org/10.1080/15532739.2018.1471767 |journal=International Journal of Transgenderism |volume=19 |issue=2 |pages=246–250 |doi=10.1080/15532739.2018.1471767 |issn=1553-2739}}</ref><ref>{{Cite thesis |last=Slothouber |first=Vanessa |title=Narratives of De/Retransition: Disrupting the Boundaries of Gender and Time |date=2021-07-22 |publisher=The University of Western Ontario |url=https://ir.lib.uwo.ca/etd/8070}}</ref>
+Some studies have claimed that most children end up identifying with their biological sex after reaching puberty, a situation labeled "desistance", though current research agrees if gender dysphoria does continue into adolescence it is far more likely to persist into adulthood. However, the research supporting high childhood desistance rates has been criticized by other researchers on various fronts. The research depends on improper classifications of dysphoria both according to the then current DSM-IV, which conflated gender noncomformity with a stated identification with a different gender than assigned at birth, and the DSM-V which required stated gender identity for diagnosis. However, evidence shows significant positive correlation between intensity of reported dysphoria and persistence. The papers also overestimated rates of desistance by classifying those who stopped participating or identified as nonbinary as desisters. The follow up research referenced had mean participation ages ranging from 16 to 23, but studies have shown those who appear to have desisted may retransition socially or medically at later ages. The terminology of desistance was also critiqued for imposing a binary wherein a cisgender identity is valid at any point but a transgender identity must be stable to be respected. In addition, the research overemphasized the possibility of adult regret but ignored the experiences of detransitioners who expressed satisfaction with their treatment and opportunity to explore their genders. The research in favor of high desistance also contains procedures classified by numerous health organizations as [[conversion therapy]] for classifying a transgender identity in adulthood as undesirable and recommending against prepubertal social transition, in addition previous participants have described the studies as traumatizing.<ref>{{Cite journal|last1=Newhook|first1=Julia Temple|last2=Pyne|first2=Jake|last3=Winters|first3=Kelley|last4=Feder|first4=Stephen|last5=Holmes|first5=Cindy|last6=Tosh|first6=Jemma|last7=Sinnott|first7=Mari-Lynne|last8=Jamieson|first8=Ally|last9=Pickett|first9=Sarah|date=2018-04-03|title=A critical commentary on follow-up studies and "desistance" theories about transgender and gender-nonconforming children|url=https://doi.org/10.1080/15532739.2018.1456390|journal=International Journal of Transgenderism|volume=19|issue=2|pages=212–224|doi=10.1080/15532739.2018.1456390 |s2cid=150338824|issn=1553-2739}}</ref><ref>{{Cite journal |last1=Winters |first1=Kelley |last2=Temple Newhook |first2=Julia |last3=Pyne |first3=Jake |last4=Feder |first4=Stephen |last5=Jamieson |first5=Ally |last6=Holmes |first6=Cindy |last7=Sinnott |first7=Mari-Lynne |last8=Pickett |first8=Sarah |last9=Tosh |first9=Jemma |date=2018-04-03 |title=Learning to listen to trans and gender diverse children: A Response to Zucker (2018) and Steensma and Cohen-Kettenis (2018) |url=https://doi.org/10.1080/15532739.2018.1471767 |journal=International Journal of Transgenderism |volume=19 |issue=2 |pages=246–250 |doi=10.1080/15532739.2018.1471767 |s2cid=149606144 |issn=1553-2739}}</ref><ref>{{Cite thesis |last=Slothouber |first=Vanessa |title=Narratives of De/Retransition: Disrupting the Boundaries of Gender and Time |date=2021-07-22 |publisher=The University of Western Ontario |url=https://ir.lib.uwo.ca/etd/8070}}</ref>
 In ''[[Bell v Tavistock]],'' the [[High Court of Justice]] of England and Wales ruled that it was unlikely that a child under the age of 16 could be [[Gillick competence|''Gillick'' competent]] to consent to puberty blocking treatment.<ref name=":78">{{Cite news|title = Puberty blockers: Under-16s 'unlikely to be able to give informed consent'|work = BBC News|date = December 2020|url = https://www.bbc.com/news/uk-england-cambridgeshire-55144148|access-date=29 December 2020}}</ref> This was overturned by the court of appeal, which ruled that children under 16 could consent to receive puberty blockers.<ref>{{cite web |last1=Siddique |first1=Haroon |title=Appeal court overturns UK puberty blockers ruling for under-16s 17 September 2021 |url=https://www.theguardian.com/society/2021/sep/17/appeal-court-overturns-uk-puberty-blockers-ruling-for-under-16s-tavistock-keira-bell |website=Guardian |date=17 September 2021 |publisher=Guardian |access-date=17 September 2021}}</ref>
@@ Line 58: / Line 58: @@
 ===Physical, sexual, and verbal abuse===
-Transgender youth are at an increased risk for [[physical abuse|physical]], [[verbal abuse|verbal]], and [[sexual abuse]]. Children who experience physical abuse, verbal abuse, and sexual abuse are also more likely to be gender dysphoric; the evidence is not clear as to the relationship between abuse and sexual identity in regards to which is the cause and which is the effect, but does show a correlation between childhood abuse and gender identity.<ref name="GrossmanII" /><ref name="Tobin Delaney pp. 576–583">{{cite journal | last=Tobin | first=Valerie | last2=Delaney | first2=Kathleen R. | title=Child abuse victimization among transgender and gender nonconforming people: A systematic review | journal=Perspectives in Psychiatric Care | publisher=Wiley | volume=55 | issue=4 | date=2019-05-19 | issn=0031-5990 | doi=10.1111/ppc.12398 | pages=576–583}}</ref>} As one transgender youth said, "Throughout my whole life, I was abused physically and mentally by relatives in my family. Have marks on my body. I have things that I remember happened to me."<ref name="Grossman" /> Youth who have parental support of their preferred gender presentation are much more likely to be better off in several ways: mentally, financially, academically, etc. Transgender youth who face physical abuse may be forced to leave their homes, or choose to leave, which can be a particularly traumatic experience. The lack of housing was found to often lead to financial difficulties for such youth. Lack of support at home and constant harassment at school may lead to academic difficulties for the youth as well, who face a much higher drop out level compared to their cisgender counterparts.<ref name="Grossman" />
+Transgender youth are at an increased risk for [[physical abuse|physical]], [[verbal abuse|verbal]], and [[sexual abuse]]. Children who experience physical abuse, verbal abuse, and sexual abuse are also more likely to be gender dysphoric; the evidence is not clear as to the relationship between abuse and sexual identity in regards to which is the cause and which is the effect, but does show a correlation between childhood abuse and gender identity.<ref name="GrossmanII" /><ref name="Tobin Delaney pp. 576–583">{{cite journal | last1=Tobin | first1=Valerie | last2=Delaney | first2=Kathleen R. | title=Child abuse victimization among transgender and gender nonconforming people: A systematic review | journal=Perspectives in Psychiatric Care | publisher=Wiley | volume=55 | issue=4 | date=2019-05-19 | issn=0031-5990 | doi=10.1111/ppc.12398 | pages=576–583| pmid=31104337 | s2cid=159038640 }}</ref>} As one transgender youth said, "Throughout my whole life, I was abused physically and mentally by relatives in my family. Have marks on my body. I have things that I remember happened to me."<ref name="Grossman" /> Youth who have parental support of their preferred gender presentation are much more likely to be better off in several ways: mentally, financially, academically, etc. Transgender youth who face physical abuse may be forced to leave their homes, or choose to leave, which can be a particularly traumatic experience. The lack of housing was found to often lead to financial difficulties for such youth. Lack of support at home and constant harassment at school may lead to academic difficulties for the youth as well, who face a much higher drop out level compared to their cisgender counterparts.<ref name="Grossman" />
 === Homelessness and survival sex ===
@@ Line 99: / Line 99: @@
 Youth are generally predisposed to life-threatening behaviors due to a number of conditions, such as self-hatred, victimisation via [[bullying]], [[substance abuse]], etc. Transgender youth may also face [[victimization]] from peers and family members’ negative reactions to their atypical gender presentation, increasing their risk of life-threatening behaviors.<ref name="GrossmanII" />{{better source needed|date=March 2021}} Awareness of the suicide rates of LGBT youth spiked post-2010, as a result of significant publicity being given to the suicides of [[Death of Leelah Alcorn|Leelah Alcorn]], Skylar Lee, and Ash Haffner only being a few.<ref>{{Cite web|title = Skylar Lee and the Crisis of Transgender Youth Suicides in America|url = http://mic.com/articles/126218/skylar-lee-and-the-crisis-of-transgender-youth-suicides-in-america|website = Mic |access-date=27 October 2015}}</ref>
-Critics such as [[Andrew Gilligan]] have claimed that figures for youth transgender suicide are grossly exaggerated by transgender groups. Gilligan in particular has claimed that rates in the United Kingdom are less than 1%.<ref>{{Cite news|url=https://www.thetimes.co.uk|title=Trans groups under fire for huge rise in child referrals|last=Gilligan|first=Andrew|date=25 November 2018|work=The Sunday Times|access-date=25 November 2018}}</ref> Numerous studies, though, across various countries, have noted suicide attempt rates for transgender children ranging from 30 to 50%, at least double the rates of age-matched cisgender peers.<ref name="Bachmann">{{cite journal |last1=Bachmann |first1=S |title=Epidemiology of Suicide and the Psychiatric Perspective. |journal=International Journal of Environmental Research and Public Health |date=6 July 2018 |volume=15 |issue=7 |pages=1425 |doi=10.3390/ijerph15071425 |pmid=29986446 |pmc=6068947 |doi-access=free }}</ref><ref name="IJPM">{{cite journal |last1=Virupaksha |first1=HG |last2=Muralidhar |first2=D |last3=Ramakrishna |first3=J |title=Suicide and Suicidal Behavior among Transgender Persons. |journal=Indian Journal of Psychological Medicine |date=2016 |volume=38 |issue=6 |pages=505–509 |doi=10.4103/0253-7176.194908 |pmid=28031583 |pmc=5178031 }}</ref><ref name="PediatricsSep2018">{{cite journal |last1=Toomey |first1=Russell B. |last2=Syvertsen |first2=Amy K. |last3=Shramko |first3=Maura |title=Transgender Adolescent Suicide Behavior |journal=Pediatrics |date=11 September 2018 |volume=142 |issue=4 |pages=e20174218 |doi=10.1542/peds.2017-4218 |pmid=30206149 |pmc=6317573 |issn=0031-4005}}</ref><ref name="WaPoBecker">{{cite news |last1=Stanley-Becker |first1=Isaac |title=More than half of transgender male adolescents attempt suicide, study says |url=https://www.washingtonpost.com/news/morning-mix/wp/2018/09/14/more-than-half-of-transgender-male-adolescents-attempt-suicide-study-says/?noredirect=on |access-date=25 November 2018 |work=Washington Post |date=14 September 2018 }}</ref>
+Critics such as [[Andrew Gilligan]] have claimed that figures for youth transgender suicide are grossly exaggerated by transgender groups. Gilligan in particular has claimed that rates in the United Kingdom are less than 1%.<ref>{{Cite news|url=https://www.thetimes.co.uk|title=Trans groups under fire for huge rise in child referrals|last=Gilligan|first=Andrew|date=25 November 2018|work=The Sunday Times|access-date=25 November 2018}}</ref> Numerous studies, though, across various countries, have noted suicide attempt rates for transgender children ranging from 30 to 50%, at least double the rates of age-matched cisgender peers.<ref name="Bachmann">{{cite journal |last1=Bachmann |first1=S |title=Epidemiology of Suicide and the Psychiatric Perspective. |journal=International Journal of Environmental Research and Public Health |date=6 July 2018 |volume=15 |issue=7 |pages=1425 |doi=10.3390/ijerph15071425 |pmid=29986446 |pmc=6068947 |doi-access=free }}</ref><ref name="IJPM">{{cite journal |last1=Virupaksha |first1=HG |last2=Muralidhar |first2=D |last3=Ramakrishna |first3=J |title=Suicide and Suicidal Behavior among Transgender Persons. |journal=Indian Journal of Psychological Medicine |date=2016 |volume=38 |issue=6 |pages=505–509 |doi=10.4103/0253-7176.194908 |pmid=28031583 |pmc=5178031 }}</ref><ref name="PediatricsSep2018">{{cite journal |last1=Toomey |first1=Russell B. |last2=Syvertsen |first2=Amy K. |last3=Shramko |first3=Maura |title=Transgender Adolescent Suicide Behavior |journal=Pediatrics |date=11 September 2018 |volume=142 |issue=4 |pages=e20174218 |doi=10.1542/peds.2017-4218 |pmid=30206149 |pmc=6317573 |issn=0031-4005}}</ref><ref name="WaPoBecker">{{cite news |last1=Stanley-Becker |first1=Isaac |title=More than half of transgender male adolescents attempt suicide, study says |url=https://www.washingtonpost.com/news/morning-mix/wp/2018/09/14/more-than-half-of-transgender-male-adolescents-attempt-suicide-study-says/?noredirect=on |access-date=25 November 2018 |newspaper=Washington Post |date=14 September 2018 }}</ref>
 === Court experiences ===
@@ Line 148: / Line 148: @@
 === Malta ===
-In early April 2015, Malta adopted a bill titled the 'Gender Identity, Gender Expression and Sex Characteristics Act' (GIGESC Bill). The bill allows minors to have their parents apply to have their legal gender marker changed for them or to have a gender marker held from their birth certificate until their gender identity has been self-determined. The bill also prevents surgeries from being performed on [[intersex]] infants until their [[gender identity]] has been discovered; the parents are no longer required to make an immediate decision and medical personnel cannot override this decision because the bill also outlaws the request to view medical records.<ref name="TGEU">{{cite web|last1=Kohler|first1=Richard|title=Malta Adopts Ground-breaking Trans and Intersex Law – TGEU Press Release|url=http://tgeu.org/malta-adopts-ground-breaking-trans-intersex-law/|website=Transgender Europe|publisher=TGEU|access-date=3 December 2016}}</ref> For individuals who are no longer a minor, they only need to request a notary for self declaration, again the individual cannot be asked for medical records when changing their legal gender or performing any other legal changes in conjunction to their gender identity. Also, the entire process can be completed in less than thirty days.<ref name="TGEU"/> In order to continue Malta's progress in LGBT protections and rights, the government has set up a council called the LGBTIQ Consultative Council, this action shows their commitment and dedication to actually enforcing the Bill. While there are other European countries who have created allowances and encouraged acceptance of transgender individuals, most require [[compulsory sterilization]] and have lengthy legal proceedings.<ref>{{Cite web |title = Document {{!}} Amnesty International|url = https://www.amnesty.org/en/documents/EUR01/001/2014/en/ |website= www.amnesty.org |access-date=27 October 2015}}</ref>
+In early April 2015, Malta adopted a bill titled the 'Gender Identity, Gender Expression and Sex Characteristics Act' (GIGESC Bill). The bill allows minors to have their parents apply to have their legal gender marker changed for them or to have a gender marker held from their birth certificate until their gender identity has been self-determined. The bill also prevents surgeries from being performed on [[intersex]] infants until their [[gender identity]] has been discovered; the parents are no longer required to make an immediate decision and medical personnel cannot override this decision because the bill also outlaws the request to view medical records.<ref name="TGEU">{{cite web|last1=Kohler|first1=Richard|title=Malta Adopts Ground-breaking Trans and Intersex Law – TGEU Press Release|url=http://tgeu.org/malta-adopts-ground-breaking-trans-intersex-law/|website=Transgender Europe|date=April 2015|publisher=TGEU|access-date=3 December 2016}}</ref> For individuals who are no longer a minor, they only need to request a notary for self declaration, again the individual cannot be asked for medical records when changing their legal gender or performing any other legal changes in conjunction to their gender identity. Also, the entire process can be completed in less than thirty days.<ref name="TGEU"/> In order to continue Malta's progress in LGBT protections and rights, the government has set up a council called the LGBTIQ Consultative Council, this action shows their commitment and dedication to actually enforcing the Bill. While there are other European countries who have created allowances and encouraged acceptance of transgender individuals, most require [[compulsory sterilization]] and have lengthy legal proceedings.<ref>{{Cite web |title = Document {{!}} Amnesty International|url = https://www.amnesty.org/en/documents/EUR01/001/2014/en/ |website= www.amnesty.org |access-date=27 October 2015}}</ref>
 === United States ===