Now aged 23, the then 15-year-old Keira, troubled and depressed throughout her adolescence, became convinced that she was really a boy in a girl’s body. That psychological trauma led ultimately to a double mastectomy and years of hormone treatments that have left her sterile.

What is the background to this case? Keira Bell is a 23 year old English woman who experienced gender dysphoria (GD) as a teenager. GD is a condition where “persons experience distress because of a mismatch between their perceived identity and their natal sex”, i.e. Keira Bell, who is a girl, wished to live as...