Some people argue that, because it is easier to create working female sex organs than working male sex organs, the decision over which gender to raise a child may be driven by this rather than what’s best for the child, therefore making surgery unethical. The issue is whether the procedure for sex reassignment is ethical, what would it involve? Who decides? Should it be different for children? Sex reassignment is not frequently undertaken, but is documented over the years in many different countries, so is an issue worth considering. Sex reassignment would involve changes in hormones and reconstructive surgery, both of which should not be undertaken lightly and there is an ethical discussion over when such biological interventions should be allowed and what measures should be taken to ensure such procedures are ethical. There is, for example, the issue of whether only adults should be treated, since children cannot give consent and parents usually consent for them. On the other hand, reassignment as a child might be more straightforward and biological interventions might be safer then as well. The question is should transgender operations be undertaken at all, and if so, when is it ethical to carry out such interventions and when is it not ethical?