F Ashley. “Gender self-determination as a medical right.” (2024) CMAJ, 196, E833–35 Abstract: In this article, I argue that the principle of gender self-determination grants trans people have a presumptive right to gender-affirming care, and that physicians should accordingly rethink barriers to gender-affirming care. By considering gender self-determination as a presumptive right, physicians are more likely to avoid unnecessary barriers to care. This presumption can be rebutted by showing that encroachments are adequately justified by clear and compelling evidence. Many common barriers to gender-affirming care—such as rigid age requirements and the requirement that adolescents prove several years of gender incongruence—do not satisfy this threshold.