I absolutely have sympathy for anyone with mental illness, I just oppose hacking off bits of children's bodies and sterilising them as a solution. What other mental illnesses do we treat with surgery of affirmation? Do we help anorexics to lose more weight seeing as they genuinely think they're obese? Not a single one of these "surgeries" had ever been successful anyway, no one had ever switch med from male to female or vice -versa. Its a scam.
As for any ignorance about this type of child abuse, you're the guilty one here. There's numerous examples of those under 18 being butchered by surgeons outside of the places you listed.
The must obvious case is Chloe Cole who began treatment at 13 and had her breasts amputated at just 15!
Chloe Cole, from California, said she launched legal action against the doctors to hold them 'accountable' for removing her breasts.
www.dailymail.co.uk
And as with most victims of these types of crimes, for every single person speaking out and brave enough to expose their abusers there will be 100 more too traumatised to do so.