The American Society of Plastic Surgeons recommended on Tuesday that its members refrain from performing gender transition procedures on young patients until they reach age 19, a shift that comes at a time of mounting opposition to such care at the state and federal levels.
The group’s new position stands in contrast to those taken by most major medical associations in the United States, which endorse a range of treatments for adolescents and teenagers struggling with gender dysphoria. The treatments include puberty-blocking drugs, hormone therapies and, in rarer cases, surgeries.
In its statement, the society said the new recommendations were prompted by what it described as a lack of quality research on the long-term outcomes for young people who had undergone surgical interventions like mastectomies and cited “emerging evidence of treatment complications and potential harms.”
The announcement drew praise from the Trump administration, which issued a statement commending the group for “disavowing pediatric sex-rejecting procedures.” In the statement, Jim O’Neill, the deputy health secretary, said, “Today marks another victory for biological truth in the Trump administration.”
Kinnon Ross MacKinnon, a social scientist who studies transgender medicine at York University in Toronto, said the medical group’s new position reflected the growing political backlash over gender-affirming care as well as liability concerns for practitioners in the field.
Last week, a jury in New York State ruled in favor of a woman who claimed a mastectomy she received as a teenager had left her disfigured, making it the first malpractice verdict against providers of gender transition care by a patient who later came to regret the decision.
“I would imagine that this is a potentially protective decision for the field, but it also comes at time when we increasingly are seeing governments around the world step in and respond to some of the debates and uncertainty,” Professor MacKinnon said.
That includes the Trump administration, which announced in December that it would pull federal funding from hospitals that provide medical treatment for transgender young people.
Last summer, the Supreme Court upheld a Tennessee law that prohibits some medical treatments for transgender youths, allowing similar restrictions to stand in more than 20 other states.
In recent years, a growing number of countries have moved to restrict or ban gender-affirming care for young people, among them Finland, Norway and Britain.
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The plastic surgery association’s position on gender transition surgery for minors has evolved in recent years. In 2019, in response to government efforts to limit access to such care, the group said it believed that plastic surgery could “help gender dysphoria patients align their bodies with whom they know themselves to be and improve their overall mental health and well-being.”
In 2024, the group said it would re-examine its position, citing “considerable uncertainty as to the long-term efficacy for the use of chest and genital surgical interventions.”
In its statement on Tuesday, the group said that plastic surgeons must bear responsibility for any long-term implications arising from a young patient’s desire for irreversible gender transition procedures.
“This includes assessing whether the adolescent patient can meaningfully engage with information about uncertainty, alternative approaches, and the possibility that distress or perceived identity may evolve over time,” the organization advised.
Dr. Scot Glasberg, a plastic surgeon who is a past president of the association and was involved in the deliberations over its new stance, said the shift had been prompted by a systematic review of existing research on the long-term outcomes for young people who had undergone gender treatments. The research, he said, was limited and of low quality.
“There’s no data to suggest that you can predict who will benefit from surgery and who will have a negative outcome,” he said. “That requires taking the side of caution, which means deferring or postponing these surgeries until the age of 19.”
Systematic reviews by international health bodies have consistently found that evidence for the benefits of the treatments is weak, as is the evidence on the potential harms. Small studies have suggested that hormonal treatments can improve mental health outcomes and well-being in some adolescents, while preventing the physical changes of puberty that might make it more difficult to live as the opposite sex. But few have followed children in the long term.
The group’s statement also reflected some of the mounting apprehension among practitioners in the field amid a rise of lawsuits from so-called detransitioners, individuals who come to regret their decisions to undergo surgical procedures and blame their providers.
Plastic surgeons, it noted, “should adopt a posture of heightened caution, enhanced documentation and explicit uncertainty disclosure, recognizing that their role is not simply technical but ethical.”
Andrew Jacobs is a Times reporter focused on how healthcare policy, politics and corporate interests affect people’s lives.
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