The nation’s leading plastic surgery organization announced Tuesday its recommendation against gender transition surgeries for young people, citing “insufficient evidence” to support the procedures for patients under 19.
The American Society of Plastic Surgeons (ASPS), which represents 92% of board-certified plastic surgeons in the U.S., issued the new position statement to members who provide gender-related services.
Breaking from other major medical groups in the U.S. who’ve supported these treatments, the ASPS recommends that surgeons delay all chest, genital, and facial gender surgeries until a patient reaches at least age 19. The ASPS clarified it was not setting clinical practice guidelines with the statement.
The ASPS concluded that the current evidence base for these interventions is of “low certainty” regarding mental health outcomes.
“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 statement reads.
The organization specifically mentioned “emerging concerns about potential long-term harms and the irreversible nature of surgical interventions in a developmentally vulnerable population.”
The organization noted several factors prompted the statement, including the inability of clinicians to reliably predict whether a child’s gender dysphoria will persist or resolve naturally by adulthood. The ASPS also challenged the “urgency framing” often used in pediatric gender care, arguing that ethical decision-making should not be driven by “crisis claims” that characterize surgery as “life-saving” to prevent suicide.
“Established principles of biomedical ethics dictate that physicians should offer interventions only when there is a reasonable expectation that anticipated benefits outweigh potential harms, with proportionately greater caution required as uncertainty and risk increase,” the ASPS stated.
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“This ethical calculation differs materially when interventions are irreversible, expected benefits are uncertain, potential harms may be lifelong, and patients are minors with evolving preference and identities who have been diagnosed with a condition of unknown stability,” it continued.
The ASPS cited concerns raised in the 2024 Cass Review and the May 2025 evidence review from the U.S. Department of Health and Human Services (HHS). Both reports identified significant limitations in study quality and highlighted gaps in documenting long-term physical and psychological outcomes.
HHS officials hailed the announcement Tuesday. Secretary Robert F. Kennedy Jr. commended the ASPS 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,” he said in a press release.
Deputy HHS Secretary Jim O’Neill called the move a “victory for biological truth,” adding that the ASPS “has set the scientific and medical standard for all provider groups to follow.”
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The ASPS statement emphasized that while surgeons must treat all patients with “full respect for human dignity,” truly ethical care for children must balance compassion with scientific rigor. The group also reaffirmed its opposition to the criminalization of medical care, stating that regulation is best achieved through “professional self-regulation” rather than punitive legislation.
The statement follows a landmark medical malpractice lawsuit this week in favor of a former transgender teen who sued medical professionals after she had a double mastectomy at 16 when she was experiencing gender dysphoria.
