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"If M.L. undergoes surgery," continued Rand, "she can expect reduced anxiety and defensiveness at the fear of being 'found out,' increased comfort in social and sexual situations, increased acceptance by friends, employers, and sexual partners, increased personal comfort with her own body, and the right to change her name and gender on official documents to the extent allowed by law. We must also take into consideration that this surgery ('SRS') is a monumental decision made by the child; M.L. is ready both mentally and physically for this procedure which will require that she be monitored for the rest of her life."

Rand first ordered ACS to provide the procedure a year ago, when M.L. was 20. ACS appealed that ruling to the Appellate Division, claiming that Rand had not given it adequate opportunity to present its reasons for opposing the procedure, and case was returned to him.