"ASPS Calls for Caution: New Guidelines Recommend Delaying Gender-Affirming Surgeries Until Age 19"
ASPS Recommends Delaying Gender-Affirming Surgeries for Minors Until Age 19
WASHINGTON — In a significant shift in policy, the American Society of Plastic Surgeons (ASPS) announced on Tuesday that it recommends delaying gender-affirming surgeries for transgender and nonbinary patients until they reach at least 19 years of age. This guidance, issued by the organization’s board of directors, diverges from the positions held by several major U.S. medical associations that have previously supported such procedures for minors.
The ASPS, which comprises over 11,000 physician members, clarified that this statement is not a clinical practice guideline but rather “professional guidance” reflecting the rapidly evolving and contentious nature of gender-affirming care. The recommendation encompasses various procedures, including facial, chest, and genital surgeries.
Context and Rationale
Scot Bradley Glasberg, a former president of ASPS, indicated that the organization began reassessing the evidence surrounding gender-affirming care for minors during the Biden administration. He noted that recent reviews of the available data have led to the conclusion that the evidence supporting these procedures is of “low quality, low certainty.” Glasberg emphasized the need for a more robust position, stating, “We felt it was time to make our position a little sounder.”
This announcement comes amid heightened scrutiny and political pressure from the Trump administration, which has sought to limit gender-affirming care for individuals under 19. However, Glasberg clarified that the timing of the ASPS’s guidance was coincidental and not influenced by the administration. He refrained from discussing any private meetings with government officials regarding this issue.
Government Response
The Department of Health and Human Services (HHS) and Health Secretary Robert F. Kennedy Jr. praised the ASPS for its stance, framing it as a defense of “sound science” against what they termed the “overmedicalization lobby.” Deputy Health Secretary Jim O’Neill referred to the announcement as “another victory for biological truth.”
The administration’s agenda has included investigations into hospitals and healthcare providers offering gender-affirming care, as well as conditions on federal funding that could affect the availability of these services. In response, several hospitals have announced plans to cease providing gender-affirming care for minors.
Diverging Medical Opinions
Despite the ASPS’s new guidance, major medical organizations, including the American Academy of Pediatrics (AAP), have continued to advocate for gender-affirming surgeries for adolescents on a case-by-case basis. The AAP has consistently pushed back against the administration’s efforts to restrict such care, emphasizing the importance of individualized treatment plans.
William Malone, founder of the Society for Evidence-Based Gender Medicine, welcomed the ASPS’s cautious approach, stating, “We’re encouraged to see a major U.S. medical association engage with the evolving evidence base.” This sentiment reflects a growing trend among some medical professionals who question the existing evidence supporting gender-affirming care for minors.
Evidence and Ethical Considerations
The ASPS’s statement references the HHS report and the controversial Cass review from the U.K., both of which categorize the evidence base for gender-affirming care as low quality. Critics of gender-affirming procedures often cite this lack of robust evidence as justification for restricting access. However, proponents argue that many medical practices are similarly supported by limited research.
The ASPS leadership included surgeons who perform gender-affirming procedures, but Glasberg noted that a majority of board members do not, aiming to avoid conflicts of interest. The organization stopped short of issuing full clinical practice guidelines due to insufficient clear data.
Surgeons typically collaborate with a multidisciplinary team, including therapists and endocrinologists, to assess a minor’s readiness for surgery. The ASPS emphasized that surgeons share the responsibility of determining whether a minor can comprehend the nature and long-term implications of the procedures.
Broader Implications
Supporters of maintaining access to gender-affirming surgeries for adolescents often draw parallels to other plastic surgeries performed on minors, such as breast reductions. According to a 2024 ASPS report, over 23,000 individuals aged 19 and under underwent some form of plastic surgery that year, including more than 5,300 breast reductions.
The ASPS’s statement argues for an “ethical distinction” between gender-affirming procedures and other plastic surgeries, suggesting that the former may lead to lifelong medical dependency or limit future developmental pathways. However, the group did not specify which procedures this applies to.
As the debate over gender-affirming care continues, the ASPS’s new guidance marks a pivotal moment in the ongoing discourse surrounding the treatment of transgender and nonbinary youth. The implications of this recommendation will likely resonate across the medical community and influence future policies regarding gender-affirming care for minors.