The first thing a transgender kid does is socially transition, meaning they change their name, pronouns, clothing and appearance. If they are pubescent they might start HRT or puberty blockers. They may also have a double mastectomy (bottom surgery typically delayed until the patient is over 18 years of age). Any of these treatments are given with the consent of the child, the child’s guardian(s) and a mental health professional. When a patient is 18 or older they can do any of this on their own.