For years, critics argued that so-called gender-affirming care for minors rested on shaky science and irreversible harm. Now, one of the nation’s largest surgical bodies appears to agree.
The American Society of Plastic Surgeons has reversed its earlier position and is urging doctors to step back from performing gender-related surgeries on minors, citing weak evidence, growing uncertainty, and serious ethical concerns.
The move follows mounting legal pressure, shifting public opinion, and a wave of international medical reviews that have scrutinized the practice more closely than ever before.
From Firm Belief to Formal Doubt
Back in 2019, the ASPS took a confident stance, stating it firmly believed “that plastic surgery services can help gender dysphoria patients align their bodies with whom they know themselves to be and improve their overall mental health and well-being.” At the time, the organization also criticized Republican-backed restrictions on such procedures.
That confidence has now evaporated.
In a new policy statement released Wednesday, the group addressed its position “on breast/chest, genital, and facial gender surgery for individuals under the age of 19,” signaling a dramatic reassessment.
Global Reviews Raise Red Flags
According to the ASPS, the shift did not happen in a vacuum. The organization pointed to international developments, noting that “a number of international health systems and professional bodies initiated formal re-examinations of earlier clinical practice assumptions in response to patient presentation and a growing uncertainty about the benefits of medical and surgical interventions.”
Those reassessments, the surgeons said, uncovered troubling gaps. “Systematic reviews and evidence reassessments have subsequently identified limitations in study quality, consistency, and follow-up alongside emerging evidence of treatment complications and potential harms.”
The group specifically referenced the United Kingdom’s Cass Review, a sweeping 388-page analysis, as well as a 410-page peer-reviewed report from the Department of Health and Human Services titled “Treatment for Pediatric Gender Dysphoria: Review of Evidence and Best Practices.”
Evidence Thin, Risks Persistent
Taken together, those reports led to sobering conclusions. The ASPS acknowledged that they “have contributed to a clearer understanding of potential harms, while also highlighting limitations of the available evidence, including gaps in documenting long-term physical, psychological, and psychosocial outcomes.”
Perhaps most striking, the organization conceded that “available evidence suggests that a substantial proportion of children with prepubertal onset gender dysphoria experience resolution or significant reduction of distress by the time they reach adulthood, absent medical or surgical intervention.”
In plain terms, many children grow out of the distress without drastic medical steps.
A Clear Recommendation for Delay
The conclusion was unambiguous.
The ASPS stated that “there is insufficient evidence demonstrating a favorable risk-benefit ratio for the pathway of gender-related endocrine and surgical interventions in children and adolescents.”
As a result, the group recommended that surgeons “delay gender-related breast/chest, genital, and facial surgery until a patient is at least 19 years old.”
It also urged doctors to proceed with extreme care, adding that “plastic surgeons should adopt a posture of heightened caution, enhanced documentation, and explicit uncertainty disclosure, recognizing that their role is not simply technical but ethical.”
Applause From Federal Officials and Advocates
The announcement drew immediate praise from federal leaders and medical reform advocates.
Health and Human Services Secretary Robert F. Kennedy Jr. said, “We commend the American Society of Plastic Surgeons for standing up to the overmedicalization lobby and defending sound science.”
“By taking this stand, they are helping protect future generations of American children from irreversible harm,” Kennedy added.
Dr. Stanley Goldfarb, chairman of the advocacy group Do No Harm, echoed that sentiment. “High praise to the American Society of Plastic Surgeons for taking an important step toward ending the unscientific and harmful practice of sex-rejecting procedures on minors,” he said.
Goldfarb went further, stating, “The ASPS becomes the first major medical organization to support evidence-based and ethical medicine and reject, in their words, these harmful and irreversible procedures.”
Lawsuits Add Pressure to the Debate
The timing of the policy shift was notable. It came just days after a woman who underwent a sex-rejection surgery as a minor was awarded $2 million in the first malpractice lawsuit of its kind brought by a detransitioner.
The plaintiff, Fox Varian, 22, sued her New York-based psychologist and plastic surgeon over a 2019 procedure she later regretted.
Long before the verdict, some experts predicted this moment. Psychiatrist Miriam Grossman warned that litigation could force a reckoning. She said such cases would make doctors “think twice before they pick up a scalpel and remove the healthy breasts” of a young girl.
She also cautioned that insurers might step away, adding, “It could be the malpractice carriers will stop covering — if they have to pay out huge amounts, they may think twice about covering the malpractice of these surgeons.”
A Line in the Sand
For the ASPS, the message now is restraint, skepticism, and ethics over ideology. After years of firm support, the nation’s leading plastic surgeons are drawing a clear line, and the implications could ripple across the medical world.
