The American Society of Plastic Surgeons (ASPS) issued a position statement on Tuesday advising against sex change surgeries for minors.
The position statement went to the group’s 11,000 members, recommending that surgeons delay transgender-related chest, genital, and facial surgeries until a patient is at least 19 years old. The ASPS is the first major medical organization in the U.S. to reject transgender activists’ ideological push to mutilate young people without sufficient evidence.
“Consistent with ASPS’s August 2024 statement that the overall evidence base for gender-related endocrine and surgical interventions is low certainty, and in light of recent publications reporting very low/low certainty of evidence regarding mental health outcomes, along with emerging concerns about potential long-term harms and the irreversible nature of surgical interventions in a developmentally vulnerable population, 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,” the position statement reads.
ASPS pointed to a rollback on sex changes for minors in Europe, as well as a comprehensive review from the Department of Health and Human Services, the 2024 Cass Review in Britain, and other research indicating “limitations in study quality, consistency … alongside emerging evidence of treatment complications and potential harms”:
Available evidence suggests that a substantial proportion of children with prepubertal onset gender dysphoria experience resolution or significant reduction of distress by the time they reach adulthood, absent medical or surgical intervention. Evidence regarding adolescent-onset presentation, which has become increasingly common since the mid-2010s, is more limited but similarly does not allow for confident prediction of long-term trajectories. Importantly, clinicians, even those with extensive experience, currently lack reliable methods to distinguish those whose distress will persist from those whose distress will remit.
The HHS report underscores that this uncertainty has significant ethical implications: when the likelihood of spontaneous resolution is unknown and when irreversible interventions carry known and plausible risks, adhering to the principles of beneficence and non-malficence (i.e. promoting health and well-being while avoiding harm) requires a precautionary approach.
ASPS also spoke to the broad argument of transgender activists advocating for “adolescent autonomy” in light of poor-quality evidence.
“Respect for emerging adolescent autonomy is also cited as a rationale for the provision of care in the face of low certainty evidence. However, patient autonomy is more properly defined as the right of a patient to accept or refuse appropriate treatment; it does not create an obligation for a physician to provide interventions in the absence of a favorable risk–benefit profile, particularly in adolescent populations where decision-making capabilities are still developing,” the document reads. “In pediatric contexts, the threshold for intervention must be higher and safeguards more stringent.”
The group’s position on the issue has evolved since 2019, when ASPS opposed efforts by states to restrict sex changes and said “plastic surgery services can help gender dysphoria patients align their bodies with whom they know themselves to be and improve their overall mental health and well-being,” The Washington Post reported. The group changed its position first in August 2024, when it said it was working on new guidance for surgeons given the “considerable uncertainty” about long-term benefits for chest and genital sex change surgeries.
ASPS said it still opposes criminalization of the practice and advocates for “professional self-regulation.”
HHS Secretary Robert F. Kennedy Jr. praised the group for its new position “defending sound science.”
“We commend the American Society of Plastic Surgeons for standing up to the overmedicalization lobby and defending sound science,” Kennedy, Jr. said in a statement. “By taking this stand, they are helping protect future generations of American children from irreversible harm.”
“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,” Centers for Medicare & Medicaid Administrator Mehmet Oz, MD, added. “I applaud the American Society of Plastic Surgeons for placing itself on the right side of history by opposing these dangerous, unscientific experiments.”
Other large medical organizations have embraced gender ideology and touted guidance from the World Professional Association for Transgender Health (WPATH), enabling children to access sex mutilating drugs and surgeries. WPATH has suffered several scandals, including a leaked internal meeting in which an endocrinologist admitted that discussing long-term potential for infertility with a 14-year-old is like “talking to a blank wall,” and a pressure campaign from the Biden administration to remove age requirements for sex-change surgeries.
WPATH, while favored by the pro-transgender Biden administration, has been cast out by the current Trump administration and admonished by the Supreme Court. In January 2025, President Donald Trump signed an executive order called “Protecting Children from Chemical and Surgical Mutilation,” in which he tossed WPATH guidance into the dustbin, deeming it “junk science.”
“The blatant harm done to children by chemical and surgical mutilation cloaks itself in medical necessity, spurred by guidance from the World Professional Association for Transgender Health (WPATH), which lacks scientific integrity,” the order reads, before mandating all government agencies to rescind all policies relying on WPATH guidance.
Last week, a jury in New York awarded a detransitioner $2 million in a lawsuit against her doctors. The detransitioner, 22-year-old Fox Varian, accused her doctors of pushing a double mastectomy on her when she was only 16 years old, and the jury found her psychologist and surgeon liable for medical malpractice, per the New York Post.
Katherine Hamilton is a political reporter for Breitbart News. You can follow her on X @thekat_hamilton.