When we talk about gender-affirming healthcare for children, our thoughts immediately turn to transgender children. The mere mention of the term brings puberty blockers, hormones, and surgeries to mind, along with the familiar question: Should children have access to these interventions?

But gender-affirming care is much broader than that. It is not exclusive to transgender people. I understand it in a broader sense: any form of care that affirms a person's gender. And we have been affirming our children's genders for a very long time.

When a girl asks her family to call her by a nickname, paints her nails, wears dresses, or grows her hair long, we consider it perfectly natural. No one worries that allowing these things will somehow force her to become a woman, that wearing a dress will convince her that femininity is defined by clothing, or that painting her nails amounts to indoctrination into femininity. The same applies to boys.

I know that gender stereotypes are harmful and that society pushes children toward particular forms of expression based on what it expects of men and women and the roles it prepares them to occupy. I support the abolition of gender itself, but I cannot imagine abolishing gender by erasing those who live it. As I see it, many of these everyday practices, which society has long accepted as ordinary forms of parenting and care, affirm a child's gender because they allow children to express themselves in ways that feel comfortable and consistent with their gender.

So what changes when the child is transgender?

When a transgender girl asks for a name commonly given to girls, wants long hair, dresses, or nail polish, or wishes to live and be treated socially as a girl, the very same actions we once considered "natural" suddenly become "turning a child transgender" or a form of indoctrination.

The questions begin: Isn't she too young to know her gender? Couldn't her family, friends, or surroundings be influencing her? Couldn't expressing herself in ways that make her comfortable actually make her transgender?

A dress is still a dress. Nail polish is still nail polish. Hair is still hair. What has changed is our attitude toward the gender assigned to the child at birth.

Forms of Gender-Affirming Care: Weighing Risks and Benefits by the Same Medical Standards

Gender-affirming care can take social, medical, surgical, or psychological forms. These forms differ in how reversible they are, and gender-affirming care cannot be reduced to any single intervention. The discussion becomes more complicated when we move from social transition to medical care.

Social transition can involve changing one's name, pronouns, hairstyle, clothing, or the way a person presents themselves and expresses their gender, including through their behaviour. These are generally changes that transgender people can reverse relatively easily.

Medical care, however, is another matter. Puberty blockers, hormone therapy, and surgical interventions have different effects, risks, and degrees of reversibility. It is therefore a mistake to treat them as a single form of treatment or as a pathway that applies to everyone.

I want to pause at the question of surgery and make my position clear: I do not consider it an appropriate option for children. In most cases, and perhaps all, surgical procedures are largely irreversible. Surgically altering biological sex characteristics before sexual and psychological development is complete can also involve significant side effects and risks for the child.

I want to emphasize that this principle applies to all children, whether they are transgender, cisgender, or intersex.

Medical interventions affecting children's puberty and biological sex characteristics are nothing new. Puberty blockers have been used for decades to treat children who experience unusually early puberty, because we recognize the effects that early puberty can have on their bodies and psychological well-being. Some children also receive estrogen or testosterone because their bodies do not produce sufficient amounts of these hormones.

These treatments carry risks and side effects, yet no one calls for their outright prohibition. Instead, we ask: Is the treatment medically appropriate? What are its benefits, side effects, and risks? What alternatives are available? How will the child's condition be monitored?

So why does this reasoning disappear as soon as the child is transgender?

I recognize that treating early or delayed puberty is different from treating gender dysphoria. Yet the underlying principle remains the same: we accept that a child's sexual development may be regulated or medically modified when a qualified healthcare professional determines, following an assessment, that such intervention is necessary.

What, then, prevents gender dysphoria from being considered within this framework when a specialist assesses a child's need for gender-affirming care and determines that it is the only appropriate treatment for their condition?

Risks alone are not an argument against care. Almost every medical intervention carries risks, particularly those affecting the body and its development. We do not ordinarily deny people treatment for that reason. Instead, we weigh the risks against the benefits. I believe transgender children should be included in that same process.

I am not claiming that gender-affirming care is risk-free. It is not. What I want is a serious assessment that considers the child's age, health, development, psychological well-being, and wishes, alongside the potential risks and benefits of treatment.

This standard should apply to all children, transgender and cisgender alike. When treatment is necessary for a cisgender child, we do not suddenly deny it simply because it carries risks. We assess the child's individual circumstances. Transgender children deserve the same consideration.

Some children who identify as transgender or gender-diverse may later discover that these identities no longer describe them and move away from those labels. Others may continue to identify as transgender without wishing to pursue any form of medical transition.

Transgender identities are diverse, and every child's experience of gender is unique. That is perfectly acceptable. Children change their minds and explore who they are all the time. Their interests, clothes, names, and even their understanding of themselves and their identities can change as they grow. They have the right to explore who they are, whether through self-expression, gender expression, or any other means.

This becomes particularly important when discussing reversible forms of care, such as social transition. If a child changes their name, pronouns, clothing, hairstyle, or the way they present themselves, they can return to their previous choices if they later discover that they are not transgender.

But what if they do not?

The opposite possibility also deserves consideration: What if the child really is transgender and we deny them the care they need?

Puberty does not wait, and some of its changes are difficult or impossible to reverse. We should not underestimate the effects that these irreversible changes can have on the mental health and well-being of transgender people, whether children or adults.

If uncertainty is our concern, fairness requires us to consider both possibilities: What happens if a child is not transgender and we affirm their gender? And what happens if a child is transgender and we withhold care?

Not intervening is not always a neutral position.

Transgender Children and Their Participation in Decision-Making: The Reality in Lebanon

There is another question I want to raise: Are children too young to know their gender?

I do not think so. If that were true, we would raise every child without a gender until they were old enough to identify it for themselves. But that is not what we do.

From a very early age, we regard children as boys or girls and treat them accordingly. We give them gendered names, address them using gendered language, buy them gendered clothing, and allow them to express themselves in ways that align with their gender and make them comfortable.

I am not suggesting that the existing gender binary is a coherent or flawless system. Nor do I believe that imposing gender roles or assigning particular names, clothes, and hairstyles to specific genders is a good thing. Nevertheless, we live in a gendered society, where many things are associated with particular genders. And I certainly believe we must make space for children who do not fit within that binary.

But seeking to abolish gender, or to stop associating everything with it, does not give us the right to force children to stop living their gender.

We do not ask cisgender children to prove that they understand gender before allowing them to live it. We do not expect them to comprehend everything it means to be a man or a woman, or to understand gender philosophically, socially, biologically, and psychologically.

So why do we demand this of transgender children?

I want to be clear that children should not make complex medical decisions on their own. Medical decisions should involve the child, their parents, and a qualified, unbiased healthcare professional, taking into account the child's age, maturity, health, psychological well-being, wishes, and ability to understand the treatment.

Yet in our region, transgender children are excluded from decisions concerning them.

In Lebanon, this issue becomes particularly urgent for me. Transgender children are almost entirely absent from public discussion. Even within queer communities, there is limited understanding of transgender children, or even of the possibility that children can be transgender in the first place. There is even less understanding of what gender-affirming care might mean for minors.

Our knowledge of healthcare for transgender people remains limited, even within our own community spaces. The subject is already controversial, but what happens when it concerns children?

It is then treated as an entirely Western concept, something that has no place in our society and is disconnected from our reality. If transgender adults in Lebanon already face significant barriers to accessing safe healthcare, the situation for minors is far more complicated, with appropriate care virtually unavailable to them.

When safe pathways to care are absent, the need for care does not disappear. Instead, people often turn to unsafe alternatives. Children may conceal their identities and live double lives. Some may attempt to obtain hormone treatments without medical supervision or sufficient knowledge, or use medications that were not intended for that purpose.

My intention here is not to debate self-medication itself as a practice through which transgender people assert their identities in the face of society. Rather, I want to emphasize that when children resort to these alternatives, it demonstrates that the absence of safe healthcare does not eliminate their desire for care. It may instead push them toward unsafe and poorly informed forms of treatment, with potentially serious consequences.

Denying transgender children gender-affirming care will not stop them from being transgender. It may simply push them to seek what they need through unsafe pathways.

Lebanon must begin talking about transgender children as children who exist today, rather than continuing to treat them as a theoretical problem belonging to the future.

These children need families who understand them, schools where they feel safe, mental health professionals who know how to support them, and healthcare providers capable of properly assessing their needs.

What is needed is a system that allows transgender children to be assessed and supported, rather than automatically denying them care simply because they are transgender.

This certainly does not mean prescribing hormones, puberty blockers, or any other medical intervention to every transgender child. Nor does it mean leaving children to make complex medical decisions on their own.

In short, transgender children deserve the same medical standards we apply to everyone else. We would not give every child every treatment simply because they asked for it. Equally, we should not deny a child appropriate care simply because their gender makes adults uncomfortable.

We already allow cisgender children to express their gender and to receive medical treatment affecting their sexual development when necessary. We accept that medical decisions should be based on an assessment of the child's individual circumstances, their parents' views, and the judgment of qualified professionals.

All these principles must continue to apply when the child is transgender, without gender-based prejudice.

Transgender children do not suddenly become transgender on their eighteenth birthday. They experience their difference long before then.

And the question we must ask ourselves as a society is this:

Are we prepared to let them grow up safely?

They deserve the same standards of medical care as everyone else.

Translation Note: This blog was translated from Arabic into English with the assistance of artificial intelligence (AI). The translation aims to preserve the author’s original meaning, tone, and perspective.

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