The American Society of Plastic Surgeons has recommended delaying gender-related surgeries for minors until age 19, citing insufficient evidence of benefits outweighing risks. This policy shift follows a $2 million malpractice award to a detransitioner who underwent a double mastectomy at 16. The statement marks a departure from prior medical consensus on pediatric gender care.
The American Society of Plastic Surgeons (ASPS), the world's largest organization of plastic surgeons, issued a policy statement recommending that surgeons delay gender-related breast/chest, genital, and facial surgeries until patients are at least 19 years old. The organization concluded there is 'insufficient evidence demonstrating a favorable risk-benefit ratio for the pathway of gender-related endocrine and surgical interventions in children and adolescents.' This position draws on reviews including the Department of Health and Human Services (HHS) report on gender dysphoria treatment and the Cass Review, highlighting low-certainty evidence and potential long-term harms.
The statement, released on a Tuesday, represents the first major medical association to strongly disavow such surgeries for minors, potentially influencing global practices. It comes days after a New York State jury awarded $2 million in damages to Fox Varian, a 22-year-old from Yorktown Heights who detransitioned after a double mastectomy at age 16 in 2019. Varian sued her psychologist and surgeon, alleging inadequate consent on risks and deviation from standard practices. Her mother opposed the procedure but was warned of suicide risks if transition was denied.
Experts noted the significance of the ASPS citing the HHS report, which found pediatric gender medicine risks 'significant harms' based on flawed science. Leor Sapir, PhD, a co-author of the report and senior fellow at the Manhattan Institute, told The Daily Wire, 'This is the first major medical group to cite the HHS report in a favorable way... it suggests that leaders of a doctor organization have read it, engaged with its findings in a serious way, and found it persuasive.'
Dr. Kurt Miceli, chief medical officer at Do No Harm, emphasized the influence of medical societies: 'Medical societies shape far more than professional opinion — they set the guardrails for how medicine is practiced, taught, and reimbursed.' He added that the ASPS stance challenges the 'standard of care' pushed by activists.
The American Academy of Pediatrics (AAP) has criticized the HHS report as prioritizing 'opinions over dispassionate reviews of evidence' in a May 2025 release. It also pressured the World Professional Association for Transgender Health to remove age minimums from its Standards of Care Version 8 in 2024, except for phalloplasty, according to an October 2024 Supreme Court brief by Alabama Attorney General Steve Marshall. The AAP did not respond to inquiries about the ASPS statement.
Author J.K. Rowling celebrated Varian's case on X, stating, 'As the floodgates open, and more and more detransitioners sue the clinicians who subjected them to an unregulated medical experiment...' She called it 'one of the worst medical scandals of all time.' This verdict is the first malpractice ruling against providers of gender-affirming care for minors, amid growing lawsuits from detransitioners.
