The American Society of Plastic Surgeons (ASPS) announced today, in a nine-page position statement, that it opposes gender-related surgeries for individuals under the age 19. The largest association of board-certified plastic surgeons in the world cited “insufficient evidence” that the benefits of such surgeries outweigh the risks.
This is the first major medical professional association that has come out in opposition to sex change, or gender transition surgeries for minors.
More specifically, the society reports that it has studied the issue of breast/chest, genital, and facial gender surgery in individuals under the age of 19. As a result, it has issued its position statement as guidance to its 11,000 members in North America and abroad.
The guidance points out that rapid change in treatment models for people experiencing gender dysphoria or “gender incongruence” required timely attention. For context, it lists the most common treatments provided to minors, which include counseling and therapy, “social transition,” puberty blockers and cross-sex hormones, and ultimately surgery.
The ASPS has determined that “systematic reviews and evidence reassessments have subsequently identified limitations in study quality, consistency, and follow-up alongside emerging evidence of treatment complications and potential harms.”
While the society said that its position statement is not a clinical practice guideline for physicians, its board of directors decided the ASPS needed to make clear its stance to “provide professional guidance to ASPS members in a rapidly evolving and controversial clinical area.”
It would seem that because the development of formal clinical practice guidelines takes no small amount of time, the position statement route was the more expedient approach for the ASPS based on the red flags it already sees. Clinical practice guidelines include independent systematic evidence assessment, consensus panels, and/or strength-of-recommendation determinations.
If the interests of the child are the priority, it only makes sense to issue a position statement that errs on the side of caution as scientific and medical research plays catch-up. The actual position is as follows:
ASPS concludes there is insufficient evidence demonstrating a favorable risk-benefit ratio for the pathway of gender-related endocrine and surgical interventions in children and adolescents. ASPS recommends that surgeons delay gender-related breast/chest, genital, and facial surgery until a patient is at least 19 years old.
Anticipating that it will be criticized for taking such a strong position without the usual amount of medical evidence, the society preemptively countered by saying in its statement, “ASPS acknowledges that many plastic surgical clinical recommendations and standards rely on lower levels of evidence compared to those of other medical specialties. However, ethical decision-making in medicine does not depend on evidence quality alone, but on the relationship between evidence uncertainty, anticipated benefit, potential harm, and patient vulnerability.”
In other words, when it comes to minors, who are very vulnerable and at risk of irreversible lifetime damage, it’s most ethical to consider the uncertainty of the evidence itself as compounding the risk.
U.S. Department of Health and Human Services (HHS) Secretary Robert F. Kennedy, Jr., praised the ASPS for “protecting children from harmful sex-rejecting procedures.” HHS stated that the ASPS relied in part on its report, "Treatment for Pediatric Gender Dysphoria: Review of Evidence and Best Practices."
Kennedy said, “We commend the American Society of Plastic Surgeons for standing up to the overmedicalization lobby and defending sound science. By taking this stand, they are helping protect future generations of American children from irreversible harm.”
Centers for Medicare & Medicaid Administrator Mehmet Oz, MD, added, “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. I applaud the American Society of Plastic Surgeons for placing itself on the right side of history by opposing these dangerous, unscientific experiments.”
The ASPS position statement reveals something the left has been working very hard to bury, and it's something most people already suspect. The society took into account what happens during the “natural course of gender dysphoria” when minors do not receive medical treatment. It concluded that, among children, the vast majority of those who experience gender dysphoria resolve it without any medical intervention. Among adolescents, the ASPS said that existing evidence suggests that the majority will find resolution without medical intervention as well. This is consistent with the HHS report.
Founded in 1931, the ASPS counts as members physicians who have been certified by the American Board of Plastic Surgery or the Royal College of Physicians and Surgeons of Canada.
While this development is about medical professionals taking a stand for what is right, it should not be lost on anyone that if Kamala Harris were president right now, the ASPS might not have come to this position. President Donald Trump and his administration are making it easy once again for medical associations and doctors to do what is right.
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