American Society of Plastic Surgeons delays sex changes for kids

The American Society of Plastic Surgeons is recommending that its members refrain from performing body-mutilating surgeries on trans-identified minors amid an ongoing debate over the effectiveness and long-term impacts of gender transition operations. 

In a statement Tuesday, the American Society of Plastic Surgeons outlined its position on gender transition procedures for minors, recommending that “surgeons delay gender-related breast/chest, genital, and facial surgery until a patient is at least 19 years old.” The ASPS Board approved the statement of Directors on Jan. 23. 

The document repeatedly cited two recent reports questioning the effectiveness of the life-altering surgeries — the 2024 Cass Review commissioned by the United Kingdom’s National Health Service and a 2025 report published by the U.S. Department of Health and Human Services. 

“Gender-related surgical interventions depend on assumptions about the persistence of gender dysphoria over time, and there are currently no validated methods that allow clinicians to reliably distinguish children and adolescents whose distress will persist from those whose distress will resolve without medical or surgical intervention,” the ASPS statement asserted.

The statement acknowledged that while “gender-related surgical interventions in minors are typically justified as providing psychological or psychosocial benefits,” “these outcomes are harder to define, measure, and attribute causally, particularly when co-occurring psychological and endocrine interventions are taking place.”

“[S]urgeons are correct to raise the ethical threshold for performing these procedures since the evidence of benefit is either insufficient or very low/low certainty,” the ASPS statement reads. 

“For gender-related surgical interventions in minors, uncertainty currently extends as to whether the intervention provides meaningful benefit across key outcomes, including mental health and psychosocial functioning, or if it may instead contribute to harm, particularly in combination with other co-occurring medical/hormonal interventions.”

Noting that “gender-related surgery procedures intervene directly in the processes of identity formation and psychosexual development,” the statement warned that “these are areas of ongoing maturation during adolescence that warrant particular caution as surgeons assess adolescent medical decision-making capacity.” 

The ASPS says it is committed to an “ongoing review of emerging evidence” and will revisit “this position as higher-quality data become available.”

“Should the evidence base evolve to demonstrate clear benefit with acceptable risk, ASPS will reassess its recommendations accordingly,” the society stated. 

Amid concerns about the long-term impacts of gender transition surgeries for minors, 27 states have banned youth from obtaining them: Alabama, Arizona, Arkansas, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Mississippi, Missouri, Montana, Nebraska, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, West Virginia and Wyoming.

Penny Young Nance, president of the socially conservative advocacy organization Concerned Women for America, called the ASPS statement “shocking” but a “long-needed reversal that will help protect children from life-altering, sex-rejecting procedures.”

“Ironically, ASPS is now going to follow the science,” Nance said. 

“Perhaps it was due to the recent lawsuit filed by a 22-year-old woman against her doctors for pushing her into a double mastectomy while she was a minor, winning $2 million in a landmark ruling,” Nance suggested. “Regardless, it is time for sex-rejecting procedures for minors to end.” 

The case involved a Westchester County, New York jury awarding $1.6 million to detransitioner Fox Varian for past and future pain and suffering and $400,000 for future medical expenses. Varian, who once identified as a man but no longer does, underwent a double mastectomy at the age of 16. The jury awarded Varian the damages after determining that medical professionals rushed into performing the life-altering surgery and did not follow adequate protocols in what they characterized as a “departure from the standard of care.”

“Many children and teens have been deceived by the medical community that took advantage of them under the veil of gender-affirming care. Drug companies make a fortune (1.73 billion dollars) from pushing cross-sex hormones. Hospitals and doctors have built their practices from procedures that permanently mutilate children’s bodies. And this can all happen before they are legally adults,” Nance added.

Nance urged the American Academy of Pediatrics, the American Medical Association and the American Psychological Association to end their support for sex-change procedures for minors.

“The medical establishment cannot justify defending the mutilation of children,” she contends. 

As medical bodies in some European countries have re-examined their approaches to care for children with gender dysphoria in recent years, the American Academy of Pediatrics pushed back on accusations it has embraced “dubious transgender science” and clarified that it doesn’t recommend gender transition surgeries to most youth. 

In August 2022, AAP President Dr. Moira Szilagyi wrote an op-ed for The Wall Street Journal stating that her organization “advises pediatricians to offer developmentally appropriate care that is oriented toward understanding and appreciating the youth’s gender experience.”

Szilagyi stated, “It doesn’t push medical treatments or surgery; for the vast majority of children, it recommends the opposite.”