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Around this time, Claire started watching YouTube videos made by transgender young people. She recalled that the specialist was very open to putting her on a track toward transition, though he suggested that her discomfort could have other sources as well.

What does it mean to be affirming while acknowledging that feelings of gender dysphoria can be exacerbated by mental-health difficulties, trauma, or a combination of the two? If a teenager finds that his dysphoria lessens significantly when he presents himself in a more feminine way or once his overlapping mental-health problems have been treated, he may develop a different view on the necessity of hormones or surgery.

At one point, he dipped down to 70 pounds. These colleagues are approving teenagers for hormone therapy, or even top surgery, without fully examining their mental health or the social and family influences that could be shaping their nascent sense of their gender identity.

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