The American Society of Plastic Surgeons (ASPS) has become the first major medical association in the United States to recommend delaying gender-transition surgeries until age 19, citing “insufficient evidence” that the benefits of such procedures outweigh the potential risks for minors.
The new guidance, approved by the ASPS board of directors in January and distributed to its 11,000 members on Tuesday, represents a significant break from other U.S. medical organizations that have broadly endorsed pediatric so-called ‘gender-affirming care.’ The recommendation covers gender-related breast, chest, genital, and facial surgeries.
The ASPS stated that while it respects patient autonomy, that principle “does not create an obligation for a physician to provide interventions in the absence of a favorable risk–benefit profile,” according to a position statement obtained by The Washington Post. The organization further noted “substantial uncertainty” regarding the long-term effects of hormonal treatments and puberty blockers.
Rising Public and Legal Scrutiny
The shift in policy arrives as public concern over the permanence of pediatric medical transitions intensifies. Last week, a New York jury awarded $2 million in damages to a woman who sued her plastic surgeon after receiving a mastectomy at age 16 and subsequently detransitioning. Dr. Mark Glasberg, a member of the ASPS, told the Post he has seen an increase in patients seeking reversal operations for transition surgeries.
Public sentiment largely supports the ASPS decision, with growing concerns about the irreversible nature of these procedures on minors. This domestic debate mirrors international trends; England’s National Health Service recently banned puberty blockers for minors outside of clinical trials after a review concluded the supporting evidence was “remarkably weak.”
Political and Medical Friction
The ASPS decision was met with immediate approval from the Trump administration, which has sought to restrict medical interventions for youth gender transition. Health Secretary Robert F. Kennedy Jr. said in a statement that he commends the group for “standing up to the overmedicalization lobby and defending sound science.”
However, the medical community remains divided. The World Professional Association for Transgender Health (WPATH) has historically supported surgeries for minors in certain circumstances. Loren Schechter, president-elect of WPATH, told the Post that the solution is not to ban or allow surgery in all cases, stating, “The answer is somewhere in the middle.”
Despite its new recommendation, the ASPS clarified that it remains opposed to the criminalization of physicians who provide gender-affirming care. According to data published in the American Medical Association’s journal, fewer than 1,000 minors in the U.S. undergo such surgeries annually, with the vast majority being mastectomies.