More recently, she's begun cross-sex hormones, which will cause feminising changes. This decision came after further assessment, after years of living consistently in her gender, and with full understanding that some effects are permanent.
What the pathway doesn't involve, at least not until adulthood and after years of living in role, is surgery.
I find the language used here interesting.
I have never, to my knowledge lived 'in [my] gender' (I don't really know what that means to be honest). I have never lived 'in role' as a woman (or before that, as a girl). It's only people who are pretending to be the opposite sex who do this. By talking about your child 'living in her gender' and 'living in role', you also recognise that this is not real, that it's a real-life, 24-hours-a-day performance of trying to show the world that they are something they are not. It must be exhausting for them.
Quite apart from the harmful effects of the drugs, why is anyone encouraging vulnerable children and young people to spend the rest of their lives living 'in role', rather than just living as themselves?