Plastic surgeons group calls for delaying gender-affirming surgery until age 19

The American Society of Plastic Surgeons has revised its stance on gender-affirming surgeries, now recommending patients wait until age 19 before undergoing such procedures. This significant policy shift, announced Tuesday, places the organization at odds with several other major medical associations on this politically contentious issue.

The society cited “insufficient evidence” that the benefits of chest, genital, and facial surgeries for minors with gender dysphoria outweigh potential risks. Their position draws on two recent and controversial publications: the Cass Review conducted by a senior doctor in England and a 2025 report from the U.S. Department of Health and Human Services.

“This position statement doesn’t seek to deny or minimize the reality of any patient’s distress, and it does not question the authenticity of any patient’s experience,” the organization stated. “Instead, ASPS affirms that truly humane, ethical, and just care, particularly for children and adolescents, must balance compassion with scientific rigor, developmental considerations and concern for long-term welfare.”

The society emphasized that its announcement does not constitute a clinical guideline and noted it had not conducted an independent evidence assessment, which would typically be required for formal care guidelines.

The policy change comes amid mounting pressure from the Trump administration to restrict gender-affirming care, particularly for transgender youth. Deputy Health and Human Services Secretary Jim O’Neill praised the decision, calling it “another victory for biological truth in the Trump administration” and setting “the scientific and medical standard for all provider groups to follow.”

Other prominent medical organizations, however, have maintained their existing positions. Research indicates gender-affirming surgery remains rare among U.S. children, with fewer than 1 in 1,000 adolescents receiving gender-affirming medications.

Dr. Andrew Racine, president of the American Academy of Pediatrics, noted that the AAP “does not include a blanket recommendation for surgery for minors” with gender dysphoria. “The AAP continues to hold to the principle that 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 (WPATH) reaffirmed its support for surgical care access for minors under “cautious guidelines and criteria,” rejecting any “one-size-fits-all” approach and advocating for case-by-case decisions based on comprehensive expert evaluations.

The American Medical Association issued a statement Wednesday supporting evidence-based treatment, including gender-affirming care. While acknowledging insufficient evidence for surgical interventions in minors, the AMA stopped short of calling for a blanket age restriction, stating only that such surgeries should be “generally deferred to adulthood.”

Standard gender-affirming care for youth in the U.S. typically involves developing individualized plans with medical experts and family members, beginning with supportive talk therapy. These plans may include puberty blockers or hormone treatment, though many adolescents with gender dysphoria choose not to proceed with medications or surgeries.

Despite this, the Trump administration moved in December to restrict gender-affirming care for minors, prompting legal challenges from numerous states. Under this pressure, hospitals nationwide have suspended such services, including Children’s Minnesota, which recently announced it would pause prescribing puberty-suppressing medications and hormones for patients under 18.

“This is not the decision we wanted to make,” Children’s Minnesota stated. “This is the decision we had to make to protect our hospital and our providers. We stand firmly behind the fact that gender-affirming care is evidence-based, safe and lifesaving.”

The plastic surgeons’ group acknowledged that varying regulatory and legal environments influenced their decision, noting that limited evidence on benefits means “surgical decision-making carries heightened ethical, clinical and legal risk.”

Dr. Scot Glasberg, who helped develop the statement, insisted the process began in 2024 and remained free from political influence despite the contentious nature of the issue. “This was an iterative process that took time, with no outside pressure,” said Glasberg, a past president of the surgeons group. “We understand there will be different opinions about it and we respect those opinions.”