Gender affirmation surgery has significantly improved since it was introduced 90 years ago in Europe. Over the past 50 gender affirming surgery has become a well validated treatment for patients who suffer from gender dysphoria.The first “sex reassignment surgery” was performed in Germany at the institute for sexual science in 1931. In 1952 gender affirming surgery became internationally recognised following the sex reassignment surgery of an American veteran Christine Jorgnesen (George Jorgensen) in Denmark. Following this, gender affirmation surgery demand increased and clinics specialising in this surgery opened in the USA. With increasing demand the World Professional Association for Transgender Health (WPATH) was founded in 1979 which publishes standards of care for transgender health. Their most recent release reports improved gender congruence and body satisfaction post gender affirming surgery and approximately a 0-4% rate of regret post gender reassignment surgery. As such, new guidelines to determine if an adolescent is a surgery candidate state that patients are not eligible for genital surgery until they have reached the age of majority and have lived for at least a year in their affirmed gender, and have completed twelve months of hormone therapy, unless hormone therapy is not clinically indicated. It is also recommended that there is a multidisciplinary team involved in the decision-making process. 1. Ethically Navigating the Evolution of Gender Affirmation Surgery | Journal of Ethics | American Medical Association (ama-assn.org) 2. australian-standards-of-care-and-treatment-guidelines-for-trans-and-gender-diverse-children-and-adolescents.pdf (rch.org.au)