Plastic Surgeons Advocate Delaying Gender-Affirming Surgery for Minors

The American Society of Plastic Surgeons (ASPS), the largest professional body for plastic surgeons in the United States, has revised its recommendation to delay gender-affirming surgeries, such as chest, genital, and facial procedures, until patients reach the age of 19. The decision follows a review of recent research findings and extensive debate on this sensitive topic.

The ASPS bases its updated stance on two significant publications: the Cass Review, led by a senior medical professional in England, and an upcoming 2025 report from the U.S. Department of Health and Human Services. According to the ASPS, the current evidence is insufficient to assert that the advantages of performing these surgeries on minors with gender dysphoria outweigh the risks involved.

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.

It’s important to note that the ASPS statement is not a clinical guideline. The society clarified that it had not conducted an independent assessment of the evidence or taken additional actions required to establish new care protocols.

Varied Responses from Medical Organizations

Other prominent medical organizations have reacted differently to the ASPS statement. Under the pressure of former President Donald Trump’s administration, which advocated for the limitation or cessation of gender-affirming care for transgender minors, this stance has been hailed by some political figures. However, the American Medical Association (AMA) has expressed partial agreement with the ASPS, acknowledging the lack of clear evidence but refraining from a blanket statement to defer all surgeries to adulthood.

The American Academy of Pediatrics (AAP) and the World Professional Association for Transgender Health (WPATH) maintain their support for thoughtful, individualized evaluation of each case rather than employing a universal age criterion.

WPATH stands firm in its commitment to advancing evidence-informed clinical guidelines to help improve the lives and well-being of transgender people worldwide.

Despite variations in viewpoints, many hospitals in the U.S. have paused gender-affirming care for minors in response to federal pressures. This includes Children’s Minnesota, which halted the prescription of puberty blockers and hormone treatments due to perceived federal threats, although it emphasized its belief that gender-affirming care is both evidence-based and lifesaving.

Laws, Ethics, and Gender-Affirming Care

The ASPS acknowledges that differing legal and regulatory environments also influenced their new position, stressing that the current uncertainty about the benefits of gender-affirming surgeries for minors could increase ethical, clinical, and legal risks for surgeons.

Dr. Scot Glasberg, who was involved in creating the statement, has noted that the deliberation process began in 2024 without any political pressure, recognizing that opinions on the issue vary and respecting diverse perspectives.

This development underscores the complex nature of providing care for transgender minors, where the balance between clinical evidence, ethical considerations, patient welfare, and legal implications intertwines.