Plastic surgeons group recommends against gender surgeries on minors due to low evidence of benefit

In an official break with major medical organizations in the U.S., the American Society of Plastic Surgeons (ASPS) issued a position statement this week recommending that due to the “low certainty” of benefit, plastic surgeons should delay surgeries related to treating gender dysphoria in children — including breast and chest, genital, and facial surgeries — until a patient is at least 19 years old.

In its Feb. 3 statement, the ASPS, which represents more than 11,000 plastic surgeons, or 90% of those in the U.S. and Canada, said there is “insufficient evidence demonstrating a favorable risk-benefit ratio for the pathway of gender-related endocrine and surgical interventions in children and adolescents.”

The group also cited low certainty of long-term benefits, the likelihood of potential harms, and the irreversible nature of surgeries in a developmentally vulnerable population.

The procedures, which supporters call “gender-affirming care,” include surgeries to remove or reconstruct healthy genitals to make them resemble those of the opposite sex.

They also include chest procedures that remove the healthy breasts on girls or implant prosthetic breasts on boys and facial surgeries that attempt to feminize boys and masculinize girls.

According to the ASPS statement, the recommendation is based on a review of evidence including the 2024 Cass Review from the United Kingdom and a 2025 report from the U.S. Department of Health and Human Services.

The U.S. report detailed the lack of evidence to support such procedures for minors along with the potential for irreversible harm. The report came out one year after the Cass Review arrived at similar conclusions, which led to the near-total restriction of puberty blockers and cross-sex hormones for minors in the United Kingdom. Surgeries for minors have been banned there for longer.

In July 2024, the ASPS first broke with the consensus of all major medical associations in the U.S. — including the American Academy of Pediatrics, the American Medical Association, World Professional Association for Transgender Health, and the American Psychological Association — when it cited the evidence as “low quality” for the benefits of so-called “gender-affirming care” for minors in a statement to City Journal.

“This position statement is not a retroactive judgment but a forward-looking response to evolving evidence,” the Feb. 3 statement reads.

The ASPS emphasized that its position statement is not a clinical practice guideline, however, “given the current state of the evidence and variability in legal and regulatory environments.”

Instead, the group encourages its members to use their “personal and professional judgment” as they “balance compassion with scientific rigor, developmental considerations, and concern for long-term welfare” of their patients.

Alfonso Oliva, a board-certified plastic and reconstructive surgeon and a board member at the Catholic Medical Association, told EWTN News that he welcomes the statement, but it does not go far enough.

“It goes a long way to try to protect adolescents from harm,” he said, “but I would like to see it go through age 25, which is when the young adult brain is completely formed, so they’d have better decision-making ability.”

“At least by 19 we’re not going to transition children who would desist when cared for and loved and counseled appropriately,” he continued.

Oliva said it is “almost impossible to pick out which adolescents will persist in their gender dysphoria into adulthood and which will desist” and that according to the evidence, “most adolescents who have gender dysphoria will over time, on their own, desist.”

“It makes more sense to treat them through psychotherapy primarily, rather than irreversibly change their physical biology and possibly prevent them from a normal adulthood in terms of sexual function and reproduction,” he said.

Health Secretary Robert F. Kennedy Jr., Centers for Medicare & Medicaid Administrator Mehmet Oz, and other officials applauded ASPS for the new position in a news release published by the health department.

“We commend [ASPS] for standing up to the over-medicalization lobby and defending sound science,” Kennedy said. “By taking this stand, they are helping protect future generations of American children from irreversible harm.”

Oz said the move places ASPS “on the right side of history,” adding: “When the medical ethics textbooks of the future are written, they’ll look back on sex-rejecting procedures for minors the way we look back on lobotomies.”

In a statement this week, meanwhile, the American Medical Association told media that the “evidence for gender-affirming surgical intervention in minors is insufficient for us to make a definitive statement.”

But the group said it “agrees with ASPS that surgical interventions in minors should be generally deferred to adulthood.”

President Donald Trump signed an executive order in January 2025 to prevent hospitals from performing those procedures on children, calling it “surgical mutilation.” The ban, which also prohibited “chemical mutilation” with cross-sex hormones and puberty blockers, threatened to block Medicare and Medicaid reimbursements for hospitals that perform the procedures on minors.

Oliva said he thinks “part of the motivation for the position statement is to limit the legal liability of its members.”

Referring to the $2 million awarded by a New York jury in a medical malpractice suit this week to Fox Varian, a young woman who detransitioned after having a double mastectomy at age 16, Oliva said it is “not a coincidence that the ASPS issued the statement this week as they recognize there are lots of other lawsuits coming down the line.”

The U.S. Conference of Catholic Bishops (USCCB) has repeatedly opposed doctors performing such procedures on children. Last year, in response to Trump’s executive order on the procedures, USCCB Committee on Laity, Marriage, Family Life, and Youth chairman Bishop Robert Barron welcomed the federal restrictions.

“So many young people who have been victims of this ideological crusade have profound regrets over its life-altering consequences, such as infertility and lifelong dependence on costly hormone therapies that have significant side effects,” Barron said at the time.

“It is unacceptable that our children are encouraged to undergo destructive medical interventions instead of receiving access to authentic and bodily-unitive care,” he said.

Source: https://www.ewtnnews.com/world/plastic-surgeons-group-recommends-against-gender-surgeries-on-minors-due-to-low-evidence-of