The American Academy of Pediatrics has reaffirmed its support for gender-affirming care for minors, including surgeries on a case-by-case basis, amid shifts by other medical organizations. While the American Society of Plastic Surgeons and American Medical Association have expressed reservations about such procedures, the AAP emphasizes decisions by patients, families, and physicians. This stance comes as detransitioner lawsuits gain traction, including a recent $2 million judgment.
The American Academy of Pediatrics (AAP), representing tens of thousands of pediatric professionals, stated on Wednesday that its guidance on care for youth with gender dysphoria remains unchanged. "The guidance from the American Academy of Pediatrics for health care for young people with gender dysphoria does not include a blanket recommendation for surgery for minors," AAP President Dr. Andrew Racine said. He added, "The A.A.P. 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."
AAP publications describe puberty blockers as "reversible" and cross-sex hormones as "partially reversible," while recommending gender surgeries—such as "top" surgeries removing healthy breasts from girls and "bottom" surgeries on genitals—for minors on a "case by case basis." This follows a June 2025 reaffirmation after a U.S. Supreme Court decision allowing states to ban such procedures. The AAP tweeted then: "The Supreme Court’s decision today does not change the science. Gender-affirming care remains evidence-based, medically necessary care that improves the health and well-being of transgender youth."
In contrast, the American Society of Plastic Surgeons (ASPS) stated on Tuesday that available evidence does not support genital procedures or breast removal for young girls identifying as boys, citing insufficient support for puberty blockers and cross-sex hormones. The American Medical Association (AMA) agreed, saying "the evidence for gender-affirming surgical intervention in minors is insufficient for us to make a definitive statement" and that such interventions should generally be deferred to adulthood, while supporting other evidence-based treatments.
These shifts coincide with legal developments. Last week, Fox Varian won a $2 million judgment in the first detransitioner trial, after her healthy breasts were removed at age 16 amid mental health issues. More than two dozen similar cases are pending, with experts like Dr. Richard Bosshardt predicting wins due to poor informed consent and unaddressed underlying psychiatric issues. "I would predict there’s going to be a wave of judgments in favor of the plaintiffs," Bosshardt said. A World Professional Association for Transgender Health (WPATH) president-elect testified that surgeries are not suicide prevention, echoing admissions in court.
