Two major medical organizations have walked back their support for surgical interventions on transgender youth following a successful medical malpractice lawsuit brought by a detransitioner.
The American Society of Plastic Surgeons (ASPS), which represents more than 11,000 plastic surgeons in the United States, told members to delay transition-related chest, genital, and facial surgeries until patients are at least 19, according to The Washington Post.
Fewer than 1,000 minors in the United States receive surgery for gender dysphoria each year, according to research published in JAMA, and the overwhelming majority of those procedures are mastectomies, or “top surgery,” rather than genital surgeries, or “bottom surgery.”
Much of the debate over transgender youth centers on when they should be able to access medical interventions, amid disputes over the strength of the supporting evidence.
The ASPS recommendation is significant because it marks a continued shift in the organization’s thinking on gender-affirming care and makes it the first major medical group to explicitly oppose transition-related surgery for minors.
In 2019, ASPS opposed state efforts to restrict gender-affirming care for minors, arguing that plastic surgery could improve patients’ mental health and well-being. But five years later, in August 2024, the group said it was developing new guidance, citing “considerable uncertainty” about the long-term benefits of chest and genital surgeries for minors.
The new guidance, approved by ASPS’s board of directors last month, states that there is “insufficient evidence demonstrating a favorable risk-benefit ratio” for gender-related endocrine and surgical interventions in children and adolescents.
Under the new guidance, surgeons must determine whether a minor can understand the irreversibility and long-term implications of surgery and meaningfully engage with uncertainty, alternative approaches, and the possibility that their distress or “perceived identity may evolve over time.”
The document further cites “substantial uncertainty” about the long-term benefits of hormones and puberty blockers but stops short of making recommendations about their availability.
Scot Bradley Glasberg, a past president of ASPS who participated in discussions but did not vote on the guidance, told the Post the recommendation was based on reviews examining the medical evidence for gender-affirming care.
Glasberg cited three systematic reviews by researchers at McMaster University in Canada finding limited evidence for the effects of puberty blockers and hormone therapy, as well as the Cass Review, a 2024 British report that described evidence supporting hormonal interventions for minors as “remarkably weak.”
The U.S. Department of Health and Human Services released a similar report rejecting hormonal and surgical interventions and recommending “exploratory psychotherapy,” a conclusion critics say was politically driven and conceived with a predetermined end result.
Although none of the reviews examined surgical outcomes in depth, Glasberg said the broader lack of evidence prompted ASPS to revise its position, even if it meant “going in a different direction from other organizations.”
He also noted that he has started performing more operations for people seeking a reversal of gender-affirming surgical interventions.
ASPS’s shift coincides with a New York jury’s decision to award $2 million to a female detransitioner who underwent a double mastectomy at age 16 and later alleged she and her mother were pressured by her psychologist and surgeon to consent to the procedure.
Since ASPS publicized its stance, the American Medical Association has also signaled a more cautious position on surgical interventions, which it previously recommended primarily for adults while allowing adolescent cases on an individualized basis.
The shifts by ASPS and the AMA come amid a broader policy landscape in which 27 states and Puerto Rico bar doctors from performing gender-affirming surgeries on minors, and the Trump administration has proposed regulations that would strip federal funding from providers offering such care to patients under 19.
Other medical organizations have not backed away from their opposition to blanket bans. The American Academy of Pediatrics has maintained that treatment decisions should be made by patients, families, and physicians, while the World Professional Association for Transgender Health continues to support surgery in limited circumstances, with its president-elect Loren Schechter saying, “The answer is somewhere in the middle.”
Judge Mustafa Kasubhai has ruled that Health and Human Services Secretary Robert F. Kennedy, Jr. overstepped his authority by trying to restrict hospitals from providing gender-affirming care to transgender minors. He found that Kennedy failed to follow required administrative procedures when issuing a declaration last December claiming such care does not meet accepted medical standards.
The so-called "Kennedy declaration" accompanied an HHS announcement proposing two rules aimed at restricting gender-affirming care for transgender minors.
U.S. Secretary of War Pete Hegseth boasted on February 27 that the Pentagon and Scouting America had reached a settlement preserving their century-old relationship while eliminating pro-diversity initiatives and other policies he has denounced as "woke."
The U.S. military and the Boy Scouts have long been linked, with the military providing logistical support for the National Boy Scout Jamboree since its inception in 1937. The military has also hosted Scouting programs on bases and maintained close ties with Eagle Scouts -- Scouting's highest rank -- many of whom later enlist in the Armed Forces.
President Donald Trump has threatened to bring the government to a standstill by refusing to sign any legislation until Congress passes the SAVE America Act, a bill requiring voters to prove their citizenship.
The bill, approved by the U.S. House of Representatives last month, is currently stalled in the Senate. It would require voters to prove their citizenship by submitting a U.S. passport or birth certificate matching the name on their voter ID when registering and present valid photo identification before casting a ballot. The measure would also require states to share voter information with the Department of Homeland Security to verify citizenship.
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