Plastic Surgeons Urge Age 19 Minimum for Gender Transition Surgery
- The American Society of Plastic Surgeons (ASPS) is now recommending that doctors delay gender transition surgeries for young patients until they reach at least 19 years of age.
- The ASPS statement highlights a lack of robust research demonstrating the long-term benefits of surgery for adolescents, coupled with emerging evidence suggesting potential “treatment complications and potential harms.”...
- This recommendation arrives at a time of heightened debate and evolving guidelines regarding gender-affirming care.
The American Society of Plastic Surgeons (ASPS) is now recommending that doctors delay gender transition surgeries for young patients until they reach at least 19 years of age. The shift in policy, announced on Tuesday, , reflects growing concerns about the long-term effects of these procedures and increasing political and legal pressures surrounding gender-affirming care for minors.
The ASPS statement highlights a lack of robust research demonstrating the long-term benefits of surgery for adolescents, coupled with emerging evidence suggesting potential “treatment complications and potential harms.” Dr. Scot Glasberg, a past president of the ASPS, explained that current studies are insufficient to reliably predict positive outcomes. “There’s no data to suggest that you can predict who will benefit from surgery and who will have a negative outcome,” he told The New York Times. “That requires taking the side of caution, which means deferring or postponing these surgeries until the age of 19.”
This recommendation arrives at a time of heightened debate and evolving guidelines regarding gender-affirming care. While most major medical organizations in the United States continue to support access to gender-affirming care for teens – which can include puberty blockers, hormone therapy, and, in limited cases, surgery – the ASPS decision aligns with a growing trend toward more cautious approaches in some parts of the world.
The timing of the ASPS announcement also coincides with increased political scrutiny. The Trump administration publicly praised the decision, with Deputy Health Secretary Jim O’Neill calling it “another victory for biological truth.” This support follows a announcement from the administration to end federal funding to hospitals providing gender-affirming care to minors. The last summer allowed Tennessee to enforce restrictions on medical care for transgender youth, effectively upholding similar limitations in over 20 states.
The trend toward restricting gender-related care for young people is not limited to the United States. Countries like Britain, Finland and Norway have also implemented restrictions on access to these treatments.
Kinnon Ross MacKinnon, a researcher at York University in Toronto specializing in transgender medicine, suggests the ASPS position statement is influenced by both political pressure and increasing legal risks for practitioners. The recent malpractice verdict in New York, where a jury sided with a woman who alleged permanent harm from a mastectomy received as a teenager, is likely contributing to this cautious approach. This case marked the first malpractice verdict tied to gender transition care brought by someone who later regretted their surgery.
“I would imagine that this is a potentially protective decision for the field, but it also comes at time when we increasingly are seeing governments around the world step in and respond to some of the debates and uncertainty,” MacKinnon said.
The ASPS emphasizes the importance of thorough evaluation and informed consent, urging doctors to take responsibility for long-term outcomes and to clearly explain potential risks to young patients. The society’s statement stresses the need to assess a patient’s ability to “meaningfully engage with information about uncertainty, alternative approaches and the possibility that distress or perceived identity may evolve over time.”
The ASPS’s current position represents a shift from its previous guidance. In , the society stated that surgery could “help gender dysphoria patients align their bodies with whom they know themselves to be and improve their overall mental health and well-being.” By , the ASPS began to re-evaluate this stance, acknowledging “considerable uncertainty as to the long-term efficacy for the use of chest and genital surgical interventions.”
Now, the ASPS advises surgeons to proceed with “heightened caution, enhanced documentation and explicit uncertainty disclosure, recognizing that their role is not simply technical but ethical.” This reflects a growing recognition of the complexities surrounding gender-affirming care and the need for a more nuanced and cautious approach, particularly when it comes to irreversible surgical interventions in young people.
More information on gender-affirming care is available from the AAMC: https://www.aamc.org/news/what-gender-affirming-care-your-questions-answered