A leading U.S. medical organization issued a statement Tuesday urging doctors to delay gender-related surgeries for minors, warning that the scientific evidence supporting irreversible interventions remains weak.
The American Society of Plastic Surgeons (ASPS) said it found insufficient proof that gender-related breast, chest, genital, or facial surgeries provide a favorable risk–benefit outcome for patients under 19. The group advised its members to postpone such procedures until adulthood, framing the recommendation as a matter of patient safety, scientific integrity, and medical ethics.
The statement said pediatric and adolescent care for gender dysphoria changed rapidly over the last two decades, with treatment models expanding from psychological counseling to puberty blockers, cross-sex hormones, and surgery. Those shifts moved faster than the evidence base, particularly when it comes to long-term physical and mental health outcomes, according to the statement.
A surgical room designed to operate on specially genetically altered pigs is seen at the United Therapeutics Pathogen-free facility in Christiansburg, Virginia on November 20, 2024. On a farm in the southern US state of Virginia, David Ayares and his research teams are breeding genetically modified pigs to transplant their organs into human patients. (Photo by ANDREW CABALLERO-REYNOLDS/AFP via Getty Images)
ASPS pointed to recent international and U.S. evidence reviews that questioned earlier assumptions about benefits. Those reviews, including government-commissioned reports in Europe and a 2025 review by the U.S. Department of Health and Human Services, identified low-quality data, short follow-up periods, and gaps in documenting long-term outcomes. Some reviews raised concerns about complications and lasting harms tied to irreversible interventions.
The statement added that clinicians still lack reliable tools to predict which children with gender dysphoria will continue to experience distress into adulthood and which will not. Available evidence suggests that many children with prepubertal onset dysphoria see symptoms ease or resolve without medical or surgical intervention. For adolescents, the data remains limited and uncertain.
That uncertainty carries ethical weight, the group said. When potential benefits remain unclear and risks include permanent changes to fertility, sexual function, and lifelong medical needs, surgeons should adopt a precautionary approach. ASPS said patient autonomy does not require physicians to provide interventions absent a favorable risk–benefit profile, especially when patients are minors with developing decision-making capacity.
The statement rejected claims that patient preference alone justifies surgery in the face of low-certainty evidence. It said high-quality research on fully informed patient and family values in this area does not exist, raising questions about whether families would endorse current treatment frameworks if uncertainty and risk were clearly presented. (RELATED: Majority Liberal Group Rejected Child Sex Changes Due To ‘Very Weak Evidence,’ One Group Member Explains)
While recommending delay, the organization opposed criminalizing medical care and said that professional self-regulation, not punitive law, should guide medical practice. It encouraged surgeons to remain aware of state laws and legal risks while exercising independent judgment grounded in evidence and ethics.
The Department of Health and Human Services announced major initiatives in December aimed at stopping hospitals from offering sex-change procedures to minors. The proposed rules would bar Medicaid from funding the procedures and restrict Medicare- and Medicaid-participating hospitals from performing them on patients under 18.
“The Trump Administration will not stand by while ideology, misinformation and propaganda push vulnerable young people into decisions they cannot fully understand and that they can never reverse,” Secretary Robert F. Kennedy Jr. said.
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