Adolescents may be eligible to begin cross-sex hormones, where hormone regiments are
adapted to account for the somatic, emotional, and mental development occurring throughout
adulthood, to progress with their transition.
229 Because irreversible physical changes can result
from feminizing/masculinizing hormone therapy, “hormone therapy should be provided only to
those who are legally able to provide informed consent.”
230 This gives rise to the question of
whether a minor is capable of giving consent for their own procedure.
While parental consent is preferred, many countries allow sixteen-year-olds to legally
consent to medical decision-making.
231 Decisions regarding the youth’s capability of
understanding the magnitude of the following treatment and regarding the timing and degree of
care to be used must be made on a case-by-case basis.
232 When the court is approached with a
cross-sex hormone treatment issue, a judge should examine the youth under the mature minor
doctrine233 and determine whether that youth has the ability to legally consent even where one
parent fails to support this type of treatment.
Gender reassignment surgery should not be carried out until patients have lived
continuously for at least a year in the gender role congruent with their gender identity and have
reached the legal age of majority to give consent, where the age threshold should be viewed as
minimum criteria and not an indication in and of itself for active intervention.234
The landscape of children’s rights may be complicated, but determining how to address a
transgender minor’s rights during parental dispute over custody provisions should be simple – it
should involve treatment based on best practices and be based on empirical evidence and the
experience of trained professionals. Courts today are allowing too many custody decisions to be
made based on subjective opinions—court protocol needs to be established to protect children’s
It is ultimately the role of the state, acting as a trustee of a child’s rights, to ensure that the
child in question is able to fully exercise his or her rights upon reaching the age of majority. When
parents are unable to make decisions with the child’s best interests in mind, the court needs to step
up and advance the rights of transgender youth by supporting their gender identification.
230 Id. at 187; see also Turner, supra note 12, at 561. (“As with most medical procedures, informed consent is required
for medical treatment for [gender dysphoria].”).
231 Coleman et al., supra note 9, at 178.
232 Turner, supra note 12, at 561.
233 Arshagouni, supra note 34, at 336 (The mature minor doctrine involves youth, typically between fourteen and
eighteen years of age, who show a sufficient level of maturity, but fail to satisfy the criteria for emancipation.).