American Society of Plastic Surgeons Recommends Delaying Gender-Affirming Surgery Until Age 19

The American Society of Plastic Surgeons (ASPS), the nation’s leading professional organization for plastic surgeons, recently recommended that gender-affirming surgeries be postponed until patients reach the age of 19. This marks a shift in the group’s stance on a subject that is often the center of political debate.

The ASPS stated that its recommendation is based on the conclusion that current evidence does not prove that the benefits of surgeries such as chest, genital, and facial interventions for minors experiencing gender dysphoria outweigh the associated risks. The decision follows a review of two significant yet debated publications: the Cass Review led by a senior English doctor, and a future report from the Department of Health and Human Services anticipated in 2025.

This position statement doesn’t seek to deny or minimize the reality of any patient’s distress, and it does not question the authenticity of any patient’s experience. Instead, ASPS affirms that truly humane, ethical, and just care, particularly for children and adolescents, must balance compassion with scientific rigor, developmental considerations and concern for long-term welfare.

Although the statement does not serve as a clinical guideline, it was released without independent evidence assessment or new care guideline procedures.

Responses from Other Medical Associations

During President Donald Trump’s administration, there was considerable pressure on healthcare providers to restrict or halt gender-affirming treatments for transgender individuals, particularly minors. Following the ASPS’s announcement, Deputy Health and Human Services Secretary Jim O’Neill remarked on the decision as a victory for ‘biological truth’. Health and Human Services Secretary Robert F. Kennedy Jr. applauded the decision, stating it protects future generations from ‘irreversible harm’.

The American Medical Association expressed partial agreement with the ASPS but did not endorse the stance of deferring all surgeries until adulthood. The AMA emphasized the lack of conclusive evidence to make a definitive recommendation, agreeing with the ASPS that such surgical interventions should generally be delayed.

Other major medical organizations continue to recommend caution when it comes to surgery for minors, noting that gender-affirming surgeries are relatively rare among U.S. children. Reports indicate fewer than 1 in 1,000 U.S. adolescents receive gender-congruent medical treatments.

Dr. Andrew Racine, president of the American Academy of Pediatrics, stated that their guidelines do not broadly recommend surgery for minors experiencing gender dysphoria. He noted the importance of allowing patients, families, and physicians, rather than politicians, to make these personal health decisions.

Global Guidelines and Principles

The World Professional Association for Transgender Health (WPATH) maintained its support for surgical care access for minors, provided it follows ‘cautious guidelines and criteria’. Opposing a fixed age for every patient, WPATH supports decisions made on a case-by-case basis, informed by assessments from diverse health and adolescent development experts.

WPATH reaffirmed its dedication to developing evidence-based clinical guidelines aimed at enhancing transgender individuals’ well-being and quality of life worldwide.

Impact of Federal Policy

Gender-affirming care for transgender youth in the U.S. generally involves formulating an inclusive care plan involving medical experts and family members. This plan may include supportive therapies and might involve puberty blockers or hormone treatments, although it is not mandatory.

Despite this, the Trump administration’s push to restrict gender-affirming care for minors led to legal challenges from several states. In response to this pressure, institutions like Children’s Minnesota paused their prescribing of puberty blockers and hormones to minors, highlighting the federal ‘threats’ they faced.

The health system, despite not wishing to halt care, made the decision to protect its operations and health providers, asserting the safety and lifesaving nature of evidence-based gender-affirming care.

The ASPS agrees that ‘variability in regulatory and legal environments’ contributed to its singular statement. Without concrete evidence of the long-term benefits of gender-affirming surgeries, the ethical, clinical, and legal risks of these surgical decisions require careful consideration.

Dr. Scot Glasberg, who assisted in drafting the statement, clarified that the statement developed over time and was not politically driven. He acknowledged the diversity of opinions on the matter and expressed respect for these differing views.