The American Society of Plastic Surgeons (ASPS) on Tuesday became the first major medical organization to oppose gender transition for minors when it recommended “that surgeons delay gender-related breast/chest, genital, and facial surgery until a patient is at least 19 years old.” The ASPS represents “more than 11,000 physician members worldwide,” which is more than the number of surgeons the American Board of Plastic Surgery has certified since 1937.
In support of this recommendation, the ASPS cited “recent publications reporting very low/low certainty of evidence regarding mental health outcomes,” “emerging concerns about potential long-term harms and the irreversible nature of surgical interventions,” and “insufficient evidence demonstrating a favorable risk-benefit ratio.”
ASPS previously joined with other mainstream medical organizations in supporting gender transition surgeries for minors. However, it moderated its stance two years ago. “In August 2024, ASPS communicated to members that the Society had not endorsed any external organization’s clinical practice guidelines or recommendations for the treatment of children or adolescents with gender dysphoria,” ASPS described, citing the “considerable uncertainty” over such treatments.
Since then, “ASPS’s understanding has continued to evolve in light of additional comprehensive evidence reviews,” the statement explained, including the United Kingdom’s Cass Review and the 2025 review by the Trump administration’s Department of Health and Human Services. “In some areas,” the statement summarized, these reviews “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.”
Indeed, “available evidence” was a fundamental theme of the ASPS’s new position statement. “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,” they wrote. “Evidence regarding adolescent-onset presentation, which has become increasingly common since the mid-2010s, is more limited but similarly does not allow for confident prediction of long-term trajectories.”
“Importantly, clinicians, even those with extensive experience, currently lack reliable methods to distinguish those whose distress will persist from those whose distress will remit,” the ASPS noted. “The HHS report underscores that this uncertainty has significant ethical implications: when the likelihood of spontaneous resolution is unknown and when irreversible interventions carry known and plausible risks, adhering to the principles of beneficence and non-maleficence (i.e., promoting health and well-being while avoiding harm) requires a precautionary approach.”
Despite the fact that “many plastic surgical clinical recommendations and standards rely on lower levels of evidence compared to those of other medical specialties,” they wrote, “ethical decision-making in medicine does not depend on evidence quality alone, but on the relationship between evidence uncertainty, anticipated benefit, potential harm, and patient vulnerability.”
The statement committed to an “ongoing review of emerging evidence and to revisiting this position as higher-quality data become available. Should the evidence base evolve to demonstrate clear benefit with acceptable risk, ASPS will reassess its recommendations accordingly.” Naturally, the medical organization committed itself to its new evidence-based position so long as this is the position warranted by the evidence.
In reaching this decision, the statement appealed to the ASPS Code of Ethics, which pledges “full respect for human dignity.” The language of human dignity reflects a view of human nature informed by a biblical worldview, which undergirds human dignity with the fact that “God created man in his own image” (Genesis 1:27). A modern, naturalistic conception of humanity, which posits evolutionary origins, has nothing on which to base a concept of human dignity, unless it borrows from the West’s Christian heritage, the very heritage it rejects.
The ASPS statement also responded to various rationales offered for gender transition surgeries on minors. In response to appeals to “patient values and preferences,” it questioned “whether fully informed patients and their caregivers would endorse” a “framework that places a higher value on achieving more favorable aesthetic effects in adolescence and places a lower value on avoiding potential harm from early pubertal suppression.”
In response to appeals to “emerging adolescent autonomy,” the statement argued that “patient autonomy is more properly defined as the right of a patient to accept or refuse appropriate treatment; it does not create an obligation for a physician to provide interventions in the absence of a favorable risk–benefit profile, particularly in adolescent populations where decision-making capabilities are still developing.”
At the same time, ASPS did not fully endorse the patchwork of state laws that have been passed by lawmakers seeking to protect minors from the harmful effects of gender transition procedures. “The regulation of medical care is best achieved through professional self-regulation, rather than criminal law or punitive legislative approaches,” the statement argued. However, it advised members “to remain aware of state laws concerning transgender and gender-diverse individuals that may impact their practices.”
This last statement underscored the overall nature of the ASPS statement as “a position statement, rather than a clinical practice guideline.” This choice was both because “ASPS has not undertaken a formal guideline development process” and because of “the current state of the evidence and variability in legal and regulatory environments.”
The statement by ASPS is significant because its members are the physicians called upon to carry out gender transition surgeries, which are the most invasive, permanent, and harmful type of gender transition procedures.
Its new position statement reflects a small but subtle change to the consensus pro-transgender medical organizations reached in response to conservative pushback. These organizations often claimed that gender transition surgeries on minors were vanishingly rare because they were almost never advisable — but they flatly repudiated any governmental attempt to ban the procedures they claimed never happened.
When the Biden White House told the press, “We believe these [gender transition] surgeries should be limited to adults,” left-wing activists raised such a furor that the White House retreated to a milder claim, “Gender-affirming surgeries are typically reserved for adults, and we believe they should be.”
In response to the ASPS decision, the American Medical Association — long infamous as one of the most vehement medical organizations in favor of gender transition procedures for minors — told National Review, “the AMA agrees with ASPS that surgical interventions in minors should be generally deferred to adulthood.”
While National Review did not interpret this as a reversal of the AMA’s previous pro-transgender position, other news outlets were less careful; one claimed that the AMA “has reversed course on its position concerning transgender surgical procedures for minors.”
In reality, the AMA statement leaves the door open to an undefined number of gender transition surgeries on minors — a stance identical to that taken by the Biden White House to satisfy left-wing activists. But perhaps the real fault lies with the AMA for claiming it “agree[d]” with ASPS, when in fact it does not.
Regardless of the AMA’s obfuscation, Trump administration officials celebrated the change in ASPS’s position, which is attributable in part to the HHS evidence review. HHS Secretary Robert Kennedy commended ASPS “for standing up to the overmedicalization lobby and defending sound science,” as well as “helping protect future generations of American children from irreversible harm.”
Meanwhile, Deputy HHS Secretary Jim O’Neill called it “another victory for biological truth,” as ASPS “has set the scientific and medical standard for all provider groups to follow.”
