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The distinction is that we're not talking about sex. Or cigarettes, or tattoos, or lottery tickets, or any of the other things that kids want to do that have laws preventing them from doing, with or without parental consent. We're talking about medical treatment that a large part of the medical establishment believes is necessary. When it comes to age of consent laws, the state's interest is that young people are susceptible to being abused by older people due to the inevitable power dynamic between children and adults, and even if we were to grant that there were some situations where a fourteen year old would be able to have a sexual relationship with a 35 year old that wouldn't be abusive, that wouldn't be the case in the vast majority of situations where that happens. So given that the high likelihood of abuse and the strong state interest in preventing child abuse, the laws can be justified.
The most prevalent argument I hear against allowing teenagers to transition before 18 is that such transitioning can lead to irreversible changes that will have a permanent effect on one's body, and that teenagers are notoriously emotional and fickle and may come to regret making such a drastic decision with regard to what may turn out to have been simply a phase, in the same sense that most adults wouldn't want the clothing and hairstyle decisions they made at that age to be permanent. I'm not unsympathetic to that argument. The problem is that, unlike most phases, this isn't something you can just wait out to see if it goes away; the consequences of not taking any action are similar. If going through puberty as the undesired sex or staying on puberty blockers too long also causes irreversible effects, then the decision to transition has to be weighed in consideration of these effects. If subsequent data shows that a large percentage (i.e. at least 50%) of those who transition as young teenagers go on to regret their decision or retransition as young adults, then the argument for state involvement becomes much stronger. But I'm not aware that any such data exists apart from anecdotal examples, and that's not enough for me to think that the state should be interfering with a personal medical decision.
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