How Should Decision-Sharing Roles Be Considered in Adolescent Gender Surgeries?

The nascent field of gender-affirming surgery (GAS) for binary and nonbinary transgender adolescents is growing rapidly, and the optimal use of shared decision making (SDM)-including who should be involved, to what extent, and for which parts of the decision-is still evolving. Participants include the adolescent (whose goals might center on aesthetics and functionality), the surgeon (who might focus more on minimizing complications), the referring clinician (whose participation is mandated by present standards of care), and the caregiver (whose participation is required for patients below the age of consent). This article argues that effective, ethical SDM in adolescent GAS care requires a different conceptualization of roles than might be expected in other situations and should be a longitudinal experience rather than a singular event.