FAYETTEVILLE, Ark. — For years, Zara Banks had been looking forward to her 14th birthday — the moment, last June, when her life would no longer be on pause.

Ever since Zara, a transgender girl, was 8, she has been certain she wanted to grow up to be a woman. After conversations with her parents and sessions with a therapist, she began transitioning socially: changing her name to Zara and pronouns to she/her.

When she turned 9, she began treatment with puberty blockers, drugs that would place her physiological development in limbo until she was old enough — 14 according to her doctor — to begin estrogen therapy and develop a feminine body.