Can children get a surgical sex change in NYS? Do they need parental permission?
Children can get a sex change in New York State. Parental approval for hormonal or surgical sex change procedures can help but appears to be irrelevant as it's usually "medically necessary."
In short, children are legally able get a surgical sex change in New York State, with some restrictions.
On January 31, The NYS Attorney General’s office updated a transgender rights notice that said parents can reject surgery for their children, but only if it is not “medically necessary.”
Later in the notice, the New York State Attorney General’s Office describes hormonal and surgical treatments for ‘gender dysphoria’ as “medically necessary.”
“… things related to transition should be covered if it is medically necessary and you have a diagnosis of gender dysphoria. This includes puberty blockers, hormone replacement therapy, surgeries, and other procedures related to your care.”
NYS guidelines based on a particular stage of puberty prevent most ‘gender-confirming’ or ‘gender-affirming’ surgeries from happening until a patient is about twelve years old.
By twelve-years-old, most children are in what is called Tanner Stage II and are therefore eligible for hormonal treatments, which must precede any “gender-confirmation” surgeries, excluding mastectomies, or breast removal.
According to the University of Cincinatti, Tanner Stage II usually begins for biological males and females at the approximate ages of 12.5 and 11.9 years of age respectively.
Notably, the Cleveland Clinic said stage II can start in females as early as age 8 and boys as early as age 9.
Before starting hormones, the child must be diagnosed with ‘gender dysphoria,’ a condition that must persist for at least six months, according to the American Psychiatric Association.
Therefore, if symptoms of ‘gender dysphoria’ are observed at least 6 months before Tanner Stage II, an 8 or 9-year-old could be just one year’s worth of hormone treatments away from surgical procedures.
The Legal Aid Society of NYC appears to have understood these key guidelines on age restrictions cited above to have essentially remained the same since at least Fall 2020.
The most extreme ‘gender affirming’ surgeries often involve genital reconstruction and may be accompanied by particularly gruesome complications.
This is especially true for ‘trans females’ as the “neo vagina” is essentially a wound that continually attempts to seal or scar over itself until the end of the patient’s life.
In order to prevent this sealing, University of California’s (UC) Gender Affirming Health Program advises that biologically male (or ‘trans female’) patients use an insert to dilate their ‘neo vagina’ at least twice a week for the remainder of their lives.
If the first surgical attempt fails or breaks down, a secondary procedure using the bowel, colon or stomach lining to line the neo vagina can be performed.
Using the stomach lining appears to be a newer method as UC experts wrote only of using the colon or bowel in 2016 and used the word “malodor."
“The primary indication for an intestinal approach is the revision of prior penile inversion vaginoplasties. Since the secretion is digestive there is a risk of malodor and frequent secretions, and secretions are constant rather than only with arousal.”
For ‘transmen,’ the phalloplasty procedure might be considered the vaginoplasty’s mildly safer opposite.
An implant used for an erection is often mounted to a neighboring bone, which it can erode and necessitate removal of the “erectile implant.”
UC recommended “avoiding an excessively large implant [to] reduce the risk of erosion.”
Other complications include infection, but according to UC, the turnaround to give it a second try is just half a year:
“If an implant becomes infected, it typically has to be removed. A new implant may be replaced six months later.”
The first known sex change operation took place in Germany in 1906 when Martha Baer 'transitioned' into Karl Baer. Baer later left Germany to avoid detention under the Third Reich.
Baer is buried in a cemetery in Tel Aviv, Israel.
The recommendation for the sex change came from a fellow Jew, Magnus Hirschfeld.
Hirschfeld—who was homosexual and Jewish—headed the Berlin-based Insitute for Sexual Science. Founded in 1919, the Hirschfeld-led Institute performed the first male-to-female, 'gender affirming' surgery in 1922.
In the United States, a Jewish family with a transgender child was featured in a recurring reality show called I am Jazz that was started in 2015 and ran until 2023.
Jazz Jennings first appeared in media as transgender in 2007 as “one of the youngest known cases of an early transition from male to female.”
While many insurance plans—including Medicaid—appear to cover ‘gender affirming care’ like the phalloplasty or vaginoplasty, some people pay out of pocket or through grants.
As of October 9, 2024, the Gender Confirmation Center (GCC) in San Francisco, California was charging out-of-pocket patients around $23,000 for a vaginoplasty and anywhere from $35,000-$50,000 for a phalloplasty.
For comparison, Care Credit, a company that finances medical procedures, recently wrote that a total knee replacement costs about $32,000.
In November 2024, New York voters approved the “Equal Rights” constitutional amendment that reinforced existing protections for sex changes.
While no new rights were granted, the change makes it significantly harder to roll back safeguards on transgender procedures and did nothing to disqualify sex change and transitioning hormone treatments as “medically necessary.”