(NewsNation) — Access to gender-affirming care for transgender teens has become a hot-button political issue in the U.S., with debates over medical and surgical interventions. But how are guidelines for health care providers determined when it comes to trans care?

The World Professional Association for Transgender Health is an interdisciplinary group that publishes guidelines for health professionals caring for trans patients.

Most recently in 2022, WPATH has made the following major changes regarding care for trans youth:

• Separating guidance for adolescents from children, which focuses primarily on social transition without medical intervention
• Removing age limits for adolescents seeking medical or surgical transition, with parental consent
• Acknowledging social influences on transition
• Recommending care for non-binary patients including options for medical and surgical gender-affirming procedures

While the WPATH guidelines give healthcare providers a standard of care, compliance with them is voluntary, and they haven’t been without controversy.

The latest guidelines were issued in response to legislation introduced in several states banning or attempting to ban those under 18 from accessing gender-affirming care, including hormones, surgery and puberty blockers.

This is the latest round of changes for a group that was founded in 1979, and gender-affirming surgeries have been documented as far back in history as the 1920s.

WPATH also recommends the use of puberty blockers for adolescents who haven’t begun hormone therapy and suggests providers counsel patients on non-medical elements of transitioning, such as chest binding, as well as making patients and parents aware of the risks that come with medical transition.

The transgender community has criticized previous versions for creating barriers to care, including earlier rules requiring mandatory psychiatric care and mandating patients spend a specific amount of time undergoing social transition before accessing hormones or surgical care.

Others in the trans community argue the risks of delaying care are higher than the risks that come with medical treatment.

At the same time, opponents of gender-affirming care for teens worry people are being rushed into something they may regret.

In a public statement against an emergency ban on care for trans youth in Missouri, WPATH accused the state’s attorney general of “cherry-picking” data and relying on unverified sources. “Medical decisions must remain between providers and patients and their families.”