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The American Society of Plastic Surgeons (ASPS), representing over 11,000 specialists, issued a position statement on February 3, 2026, advising members to postpone breast/chest, genital, and facial gender-related surgeries for individuals under 19 due to insufficient evidence of benefits outweighing risks. This guidance, issued from the society’s headquarters in Arlington Heights, Illinois, responds to evolving research highlighting low-quality data on long-term mental health outcomes and potential harms in developing youth. The move marks a cautious shift in a field marked by rapid changes and controversy, prioritizing patient safety over current practices.
Key Findings from ASPS Statement
ASPS reviewed recent systematic reviews, including the 2024 Cass Review from the UK’s NHS and a 2025 U.S. Department of Health and Human Services (HHS) report, concluding the evidence for gender-affirming surgeries in minors is “low quality/low certainty.” The society notes uncertainties in the natural course of pediatric gender dysphoria, where many prepubertal cases resolve without intervention, and no reliable predictors exist for persistence into adulthood. Emerging data raise concerns about irreversible effects on fertility, sexual function, and lifelong medical needs, especially when combined with prior hormone therapies.
The position explicitly states there is “insufficient evidence demonstrating a favorable risk-benefit ratio,” recommending delay until age 19 to allow fuller physical and cognitive development. Unlike clinical guidelines, this is professional guidance to aid informed consent and ethical decision-making amid legal variations across U.S. states.
Expert Commentary and Perspectives
Dr. Scot Bradley Glasberg, former ASPS president involved in the discussions, described the stance as an “evolution” based on new evidence reviews, stating, “There is no data to indicate who will benefit from surgery and who may experience negative outcomes. This necessitates a cautious approach.” He emphasized the process included surgeons offering gender-affirming care but prioritized avoiding conflicts of interest.
William Malone, founder of the Society for Evidence-Based Gender Medicine, hailed it as a “watershed moment in U.S. medicine,” crediting the society’s engagement with “evolving evidence.” HHS Secretary Robert F. Kennedy Jr. commended ASPS for “defending sound science” against “overmedicalization,” aligning with federal pushes to restrict such care for minors. These views underscore a precautionary ethic, drawing from Beauchamp and Childress’s principles of beneficence and non-maleficence.
Broader Context of Gender-Affirming Care
Gender dysphoria involves distress from incongruence between one’s experienced gender and assigned sex at birth; treatments historically include social transition, puberty blockers, hormones, and surgery as a last step. Surgeries like mastectomies (top surgery), phalloplasty, or vaginoplasty are rare in minors—fewer than 1,000 U.S. cases yearly pre-2026, mostly chest procedures—with many clinics already limiting to adults due to risks. ASPS distinguishes these from other adolescent plastics like breast reductions (over 5,300 in under-19s in 2024), citing identity-linked uncertainties and higher stakes.
Internationally, Finland, Sweden, and the UK now restrict such interventions to research settings or adulthood, mirroring ASPS concerns. In the U.S., state bans proliferate, opposed by groups like the American Academy of Pediatrics (AAP) and AMA, who argue restrictions ignore evidence and harm patient-physician bonds.
Contrasting Views and Limitations
Major organizations like the World Professional Association for Transgender Health (WPATH), AAP, and Endocrine Society support individualized care, including rare adolescent surgeries after multidisciplinary assessment. The Cass Review critiqued their guidelines for methodological flaws, such as poor conflict management and weak evidence links. ASPS has never endorsed these, noting low certainty on mental health gains and suicide risk claims, which evidence shows as rare without clear surgical impact.
Limitations include the statement’s non-binding nature, reliance on reviews critics say undervalue real-world data, and lack of granular procedure distinctions. ASPS commits to revisiting with better evidence but opposes criminalizing care, favoring self-regulation.
Public Health Implications
This guidance could influence thousands, as ASPS members perform many such procedures, potentially standardizing delays nationwide. For youth, it stresses comprehensive psychological support first, given high desistance rates (e.g., studies show substantial prepubertal resolution). Public health benefits include reduced regret risks—though rates vary—and preserved options for stable adults.
For families, it means prioritizing therapy and monitoring over surgery, with practical steps like seeking multidisciplinary teams and tracking state laws. Policymakers may cite it in debates, balancing access against harms in a field needing high-quality longitudinal studies. Healthcare professionals should enhance informed consent, discussing uncertainties like developmental brain changes affecting decisions.
Ultimately, ASPS promotes evidence-driven caution, urging focus on holistic well-being for gender-diverse youth without denying their dignity.
References
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American Society of Plastic Surgeons. Position Statement on Gender Surgery for Children and Adolescents. February 3, 2026. https://www.plasticsurgery.org/documents/health-policy/positions/2026-gender-surgery-children-adolescents.pdf
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Reuters. US plastic surgeons group advises delaying gender surgery until age 19 due to insufficient evidence. February 3, 2026.[reuters]
Medical Disclaimer: This article is for informational purposes only and should not be considered medical advice. Always consult with qualified healthcare professionals before making any health-related decisions or changes to your treatment plan. The information presented here is based on current research and expert opinions, which may evolve as new evidence emerges.
