Christine McGinn, estimated that she had done more than 30 operations on children under 18, about half of them vaginoplasties for biological boys becoming girls, and the other half double mastectomies for girls becoming boys.
If a psychological evaluation confirms gender dysphoria, teenagers are treated with cross-sex hormones estrogen for boys, testosterone for girls , so they will, in effect, go through opposite-sex puberty.
A meeting of teenagers in April began with each one declaring a name and pronoun of the day.
The theory is that this drug-induced lull from about 12 to 16, sometimes younger, will help teenagers decide if they truly are transgender, without committing to irreversible physical changes.