WASHINGTON.D.C.—The American Society of Plastic Surgeons (ASPS) issued a position statement on Tuesday, February 3, recommending that surgeons delay gender-related breast, chest, genital and facial surgeries for children and adolescents with gender dysphoria until patients reach at least 19 years old.
ASPS concluded there was “insufficient evidence demonstrating a favorable risk-benefit ratio for the pathway of gender-related endocrine and surgical interventions in children and adolescents.” It based the guidance on recent evidence reviews showing low-certainty data on long-term outcomes, including mental health effects and complications.
In its position, ASPS said the overall evidence base for gender-related endocrine and surgical interventions remained low quality, with emerging concerns about irreversible harm. The society recommended postponing surgeries until adulthood, emphasizing that clinicians lacked reliable ways to predict which young patients’ distress would persist or resolve naturally.
“Available evidence suggests that a substantial proportion of children with prepubertal onset gender dysphoria experience resolution or significant reduction of distress by the time they reach adulthood, absent medical or surgical intervention,” the ASPS statement read.
The ASPS statement aligns with several European studies and reviews (Finland, Sweden, and the United Kingdom) that reached similar conclusions about the resolution or desistance of gender dysphoria in children with prepubertal onset, often finding that a majority experience a reduction in distress without medical or surgical interventions by adolescence or adulthood.
A 2016 systematic review by Italian and Dutch researchers Jiska Ristori and Thomas D. Steensma examined 10 longitudinal studies on childhood gender dysphoria. The review reported persistence rates ranging from 2% to 39%, with an overall average persistence of about 15.8% (39 out of 246 children across the studies), indicating that roughly 84% desisted by adulthood.
A 2024 German study analyzing insurance claims for over 14 million youths aged 5-24 showed that over 60% no longer had a gender identity disorder diagnosis after five years, with the lowest persistence (27.3%) among adolescent females. National guidelines in Finland also note that cross-sex identification in childhood, even in extreme cases, generally disappears during puberty.
ASPS’s understanding of the evidence evolved from reviews like the 2024 Cass report from Britain and its own 2024 systematic review on mastectomies for those under 26. Those analyses revealed limitations in study quality and follow-up, alongside risks from prior endocrine therapies. The society noted that patient values and emerging autonomy did not override the need for a favorable risk-benefit profile, especially in pediatrics where decision-making matured gradually.
“We commend the American Society of Plastic Surgeons for standing up to the overmedicalization lobby and defending sound science,” Health and Human Services Secretary Robert F. Kennedy, Jr. said. “By taking this stand, they are helping protect future generations of American children from irreversible harm.”
CMS Administrator Mehmet Oz compared the procedures to outdated practices like lobotomies, applauding ASPS for opposing “dangerous, unscientific experiments.”
ASPS drew an ethical distinction between gender surgeries for minors and other adolescent plastic procedures, such as breast reductions. ASPS argued that uncertainties in predicting dysphoria’s persistence, combined with potential lifelong consequences like altered fertility and sexual function, warranted greater caution. In contrast, other surgeries addressed more objective physical issues without relying on identity projections. It pointed out that gender interventions often aimed at psychological benefits, which has proved harder to measure amid co-occurring treatments.
ASPS opposed criminalizing medical care, favoring professional self-regulation:” ASPS commits to ongoing review of emerging evidence and to revisiting this position as higher-quality data be come available. Should the evidence base evolve to demonstrate clear benefit with acceptable risk, ASPS will re assess its recommendations accordingly.”
ASPS also critiqued existing U.S. guidelines from groups like the World Professional Association for Transgender Health and the American Academy of Pediatrics (AAP), noting that independent appraisals found studies from these organizations lacking “rigor, transparency” and have a “conflict of interest.”
Author: Mario Lotmore
