The American Society of Plastic Surgeons (ASPS), one of the largest surgical organizations in the United States, has recently updated its professional guidance on gender-related surgeries for minors. In a significant departure from the existing medical consensus on pediatric gender medicine, ASPS now recommends deferring such surgical procedures until individuals are at least 19 years old.
The newly released position statement by ASPS is grounded in the assessment that the current scientific evidence, which supports endocrine and surgical treatments for children and adolescents with gender dysphoria, is insufficient to warrant irreversible medical interventions. The organization has described the evidence base as "low quality/low certainty," expressing that it fails to demonstrate a favorable risk-benefit balance for these long-term procedures.
ASPS's decision follows a comprehensive federal review by the Department of Health and Human Services (HHS), which scrutinized available research and best practices concerning pediatric gender dysphoria. The review highlighted the uncertainty around long-term outcomes and ethical considerations of performing permanent surgeries on minors without conclusive data on the efficacy and potential harm.
Federal health officials have welcomed this announcement. HHS Secretary Robert F. Kennedy Jr. praised ASPS for "defending sound science," while Deputy Secretary Jim O’Neill saw it as a reaffirmation of biological realities. Dr. Mehmet Oz, Administrator of the Centers for Medicare & Medicaid Services, compared the sex-rejecting procedures for minors to historical medical practices that were eventually abandoned due to a lack of evidence.
Established in 1931, ASPS represents over 11,000 physician members and is keen to emphasize that this guidance does not represent a binding clinical practice guideline. The organization opposes criminal or punitive action against physicians, advocating for professional self-regulation over legislative enforcement in addressing these evolving medical questions.
ASPS has also highlighted research suggesting that a majority of children diagnosed with gender dysphoria may see resolution without medical intervention. For adolescents, evidence indicates that many also experience remission over time, raising further ethical concerns about irreversible procedures during developmentally fluid stages of life.
The guidance advises heightened caution, robust documentation, and clear disclosure of uncertainties when considering irreversible interventions. It reflects years of internal review and is reinforced by international evidence assessments, such as the UK's Cass Review, which has similarly questioned the quality and reliability of current studies.
Scot Bradley Glasberg, former ASPS President, stated that the timing of the announcement during President Donald Trump's administration was coincidental and not directed by federal officials. He described the decision as the culmination of a process of evaluating evidence that has evolved over time.
This move by ASPS diverges from the positions of other medical bodies, like the American Academy of Pediatrics and the American Medical Association (AMA), which continue to endorse certain forms of gender-related care for minors. Nevertheless, the AMA has concurred that evidence supporting surgical intervention for adolescents is insufficient and generally advocates postponing such procedures until adulthood.
Commentators have described ASPS's decision as a significant development, marking it as the first major U.S. medical association to explicitly disavow gender-transition surgeries for minors. The statement has also raised concerns regarding puberty blockers and cross-sex hormones, pointing out unresolved questions about their long-term effects.
Federal officials view this announcement as indicative of a broader reevaluation of pediatric gender medicine, which could have far-reaching implications for national medical standards in the future.
