The list of things 15-year-olds are not legally allowed to do in Oregon is long: Drive, smoke, donate blood, get a tattoo -- even go to a tanning bed.
But, under a first-in-the-nation policy quietly enacted in January that many parents are only now finding out about, 15-year-olds are now allowed to get a sex-change operation. Many residents are stunned to learn they can do it without parental notification -- and the state will even pay for it through its Medicaid program, the Oregon Health Plan.
"It is trespassing on the hearts, the minds, the bodies of our children," said Lori Porter of Parents' Rights in Education. "They're our children. And for a decision, a life-altering decision like that to be done unbeknownst to a parent or guardian, it's mindboggling."
In a statement, Oregon Health Authority spokeswoman Susan Wickstrom explained it this way: "Age of medical consent varies by state. Oregon law -- which applies to both Medicaid and non-Medicaid Oregonians -- states that the age of medical consent is 15."
While 15 is the medical age of consent in the state, the decision to cover sex-change operations specifically was made by the Health Evidence Review Commission (HERC).
Members are appointed by the governor and paid by the state of Oregon. With no public debate, HERC changed its policy to include cross-sex hormone therapy, puberty-suppressing drugs and gender-reassignment surgery as covered treatments for people with gender dysphoria, formally known as gender identity disorder.
HERC officials refused repeated requests by Fox News for an interview and even gave Fox News inaccurate information about the medical director's work schedule.
Oregon Health Authority officials directed Fox News to their website. It shows transgender policy was discussed at four meetings in 2014. It was passed without any opposition or even discussion about teenagers' new access to undergoing a sex change.
Gender dysphoria is classified by the American Psychiatric Association as a mental disorder in which a person identifies as the sex opposite of his or her birth. It is rare, affecting one out of every 20,000 males and one out of every 50,000 females.
According to a 2008 study published in the Journal of the American Academy of Child and Adolescent Psychiatry, "most children with gender dysphoria will not remain gender dysphoric after puberty."
Dr. Paul McHugh, who led the Johns Hopkins Psychiatry Department and still practices, said Oregon's policy amounts to child abuse. "We have a very radical and even mutilating treatment being offered to children without any evidence that the long-term outcome of this would be good," McHugh said.
Dr. Jack Drescher, a member of the APA who worked on the Sexual and Gender Identity Disorders Work Group, says treatment for gender dysphoria has received a lot more attention in recent years. He said this year New York changed its policy to cover cross-sex hormone drugs and sex-reassignment surgery for Medicaid recipients who are at least 18 years old. He thinks Oregon is offering the treatment too early.
"Children age 15 may not fully understand all the consequences of the procedures they are undergoing," he said.
Jenn Burleton disagrees. She underwent a sex-reassignment surgery and started the Portland non-profit group TransActive. She said requiring parental consent would lead to more suffering and teen suicide attempts.
"Parents may not be supportive," Burleton said. "They may not be in an environment where they feel the parent will affirm their identity, this may have been going on for years."
The science is unsettled. A 2010 Murad study concluded "very low quality evidence suggests sex reassignment ... improves gender dysphoria and overall quality of life." The authors admitted the evidence was "sparse and inconclusive."
Lisa Maloney, a parent and Scappoose, Ore., School Board member, is outraged.
"To know that taxpayers are now on the hook for that, that a child can do that without their parent's knowledge or information or consent, parents have absolutely no say, that's appalling," Maloney said.
The Oregon Health Authority could not say how many Medicaid recipients have been treated for gender dysphoria since the new policy took effect in January. Oregon has 935,000 people enrolled in the Oregon Health Plan. HERC assumes between 14 and 112 of them may be gender dysphoric. It estimates the total cost of adding cross-sex hormone therapy, puberty-suppressing drugs and sex reassignment surgeries to the coverage will be no more than $150,000 per year.
But HERC also believes the state will save money due to fewer suicide attempts. It estimates there will be one less suicide attempt per year. The Centers for Disease Control and Prevention estimates the average cost per suicide attempt in the U.S. is $7,234.
But Dr. McHugh says a sex-change operation, especially for young people with gender dysphoria, is never appropriate.
"We can help them if we begin to explore with them and their families what they're fearing about development, what they're fearing about being a young boy, a young adolescent appropriate to themselves."