It works the same way that children approach other invasive medical interventions. If there’s great harm and a costly intervention, then child, parents, and doctors work to decide if the intervention is appropriate. As a nice black and white example, it would be unthinkable to avoid giving a young leukemia patient chemotherapy where necessary.

Thus, the threat of harm has to be measured, and the danger of the treatment has to be measured. This happens. We understand that cases of gender dysphoria can cause real harm. These are only diagnosed when a child demonstrates a “persistent, insistent, and consistent” transgender identity. The doctors working with these children do the due diligence to ensure these are real cases with a strong need: the cases where we would be doing harm by failing to act.

Puberty blockers, despite unwarranted infamy, are excellent for buying a little time to ensure the proper judgement. These do not usually have permanent consequences. Other HRT treatments can be applied when we have high confidence that they are preventing harm. Again, that’s pretty much like any other invasive pediatric treatment.