Health insurance providers in California have been warned by an insurance commissioner they cannot deny gender-affirming surgery for young trans people based on their age.

Ricardo Lara, California’s insurance commissioner, took the step to ensure that trans youth are not denied gender-affirming surgery after reports that insurance companies were using the age of trans patients to refuse treatment.

On 30 December, Lara directed the Department of Insurance to issue a General Counsel Opinion Letter clarifying that under state law, insurance companies cannot refuse to cover gender-affirming top surgery based on a patient’s age.

“For far too long, individuals diagnosed with gender dysphoria have had to battle a host of challenges to get access to gender-affirming care in order to be their true selves,” Lara, who is gay, told the Bay Area Reporter.

“Social stigma, misconceptions about gender dysphoria and its treatment, and outdated medical criteria create barriers to necessary medical care that can lead to tragic results for individuals with gender dysphoria, especially for our transgender youth,” he said.

The clarification issued to insurers states that under-18s who have been referred for gender-affirming surgery by their medical team should not be denied coverage, but instead that the insurance company should consider patients – and their specific clinical situation – on a case-by-case basis.

According to the state agency, health insurance companies should avoid needlessly delaying or interfering with healthcare recommended by a patient’s doctor.

Lara’s move comes after TransFamily Support Services, an organisation that supports young trans people and their families through medical transition, contacted the state department to report that under-18s had been refused cover for gender-affirming healthcare by their insurance companies.

“TransFamily Support Services is proud to partner with the California Department of Insurance to remove the age barrier for gender-affirming care,” said Kathie Moehlig, the agency’s executive director.

“This barrier was discriminatory and detrimental to the lives of trans youth. To have to navigate the overwhelming barriers to health care should not be a part of their experience. Transgender youth already face so many challenges from unsupportive families, bullying at school, social stigmas, and even violence.”

The World Professional Association for Transgender Health states that gender-affirming surgeries can be offered to under-18s “depending on an adolescent’s specific clinical situation and goals for gender identity expression”.