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.”
A New York State jury has awarded $2 million to a woman who underwent a double mastectomy at age 16 as part of treatment for gender dysphoria.
The verdict, which marks the first successful medical malpractice lawsuit brought by a detransitioner, was announced last week following a three-week trial in White Plains, N.Y.
The plaintiff, 22-year-old Fox Varian of Yorktown Heights, accused her psychologist, Kenneth Einhorn, and plastic surgeon, Dr. Simon Chin, of failing to obtain adequate consent by fully informing her of the risks associated with the procedure before she agreed to undergo it in 2019.
The U.S. Department of Health and Human Services has launched an investigation into Seattle Children's Hospital over its alleged provision of gender-affirming care to transgender minors, a practice the Trump administration has aggressively sought to end.
In a post on X, the HHS official account said the hospital had been referred to the Office of the Inspector General for "failure to meet professional recognized standards of health care" under a declaration issued on December 18 by HHS Secretary Robert F. Kennedy, Jr., according to The Hill.
A recent study of injectable pre-exposure prophylaxis found that twice-yearly injections of lenacapavir -- marketed as Yeztugo by Gilead Sciences -- do not have clinically significant interactions with gender-affirming hormone therapy.
"In the most gender-diverse Phase III PrEP trial conducted to date, lenacapavir had no clinically significant impact on feminizing or masculinizing gender-affirming therapy concentrations," the study’s researchers concluded, as reported by POZ.
The study, led by Dr. Jill Blumenthal of the University of California San Diego, examined whether lenacapavir interacts with gender-affirming hormone therapy, including estradiol (a form of estrogen) and testosterone. Because those hormones are metabolized by enzymes such as CYP3A4 -- which lenacapavir can inhibit -- the researchers analyzed whether the drug altered hormone levels.
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