Plastic surgeons’ largest U.S. professional organization has changed course on gender-affirming surgery for minors, recommending that such procedures be delayed until age 19, citing what it described as insufficient evidence that benefits outweigh risks.
In a statement issued Tuesday, the American Society of Plastic Surgeons said it found “insufficient evidence” that the benefits of chest, genital and facial surgeries for minors experiencing gender dysphoria outweigh the risks. The group said its document is a position statement rather than a clinical guideline and said it did not conduct an independent evidence assessment or take other steps that would be involved in setting new care guidelines.
The society said it leaned on two recently debated publications: England’s Cass Review and a 2025 report issued by the U.S. Department of Health and Human Services. The statement said it does not seek to “deny or minimize the reality of any patient’s distress” and does not question “the authenticity of any patient’s experience,” adding that it affirms that humane care for children and adolescents must balance compassion with scientific rigor, developmental considerations and long-term welfare.
The ASPS’s shift arrives as the Trump administration pressures health care providers to limit or stop gender-affirming care for transgender people, particularly children. Deputy Health and Human Services Secretary Jim O’Neill said the development represented what he described as “another victory for biological truth in the Trump administration,” adding that the ASPS has set a scientific and medical standard “for all provider groups to follow.”
Other major medical groups continued to emphasize caution and individualized decision-making, while stopping short of ASPS’s recommendation. The American Academy of Pediatrics said it does not include a blanket recommendation for surgery for minors with gender dysphoria, and President Dr. Andrew Racine said the “patients, their families, and their physicians — not politicians — should be the ones to make decisions together about what care is best for them.”
The World Professional Association for Transgender Health also reiterated that it supports access to surgical care for minors under “cautious guidelines and criteria,” saying decisions should not follow a single “one-size-fits-all” approach. The group said clinical decisions should be case-by-case and based on evaluations by multiple types of health experts, including those focused on adolescent development.
The American Medical Association said it backed evidence-based treatment, including gender-affirming care, but stopped short of endorsing deferral to adulthood for all cases as a definitive statement. In a statement issued late Wednesday, the AMA said “currently, the evidence for gender-affirming surgical intervention in minors is insufficient for us to make a definitive statement,” and it agreed with ASPS that surgical interventions in minors should generally be deferred to adulthood in the absence of clear evidence.
Beyond guidance, the developments follow broader policy fights and institutional changes. The AP report said the Trump administration moved in December to cut off gender-affirming care for minors, prompting a third of states to sue, and said hospitals across the country have suspended gender-affirming care for minors under pressure from federal actions. It cited Children’s Minnesota as the most recent hospital action, saying it planned to pause prescribing puberty-suppressing medications and hormones for patients under 18, citing federal “threats,” while also stating that it viewed gender-affirming care as evidence-based, safe and lifesaving.
The ASPS also acknowledged that “variability in regulatory and legal environments” influenced its decision to issue the statement, and it said that the lack of evidence means surgical decision-making carries heightened ethical, clinical and legal risk. Dr. Scot Glasberg, who helped develop the statement, said deliberations over the language began in 2024 and were not politically influenced, saying in a quote provided by the surgeons group that the process was “an iterative process that took time, with no outside pressure.”