The American Society of Plastic Surgeons (ASPS), the world’s largest organization of certified plastic surgeons, has issued a guidance discouraging gender transition procedures for minors due to potential long-term medical risks.
The recommendation, sent to ASPS’ 11,000 members on Feb. 3, urged surgeons to delay “gender-related breast/chest, genital, and facial surgery” until a patient is 19 years old, since “there is insufficient evidence demonstrating a favorable risk-benefit ratio for the pathway of gender-related endocrine and surgical interventions in children and adolescents.”
According to a Journal of the American Medical Association study, about 3,700 patients 18 years old and younger underwent gender transition surgery between 2016 and 2020, the number nearly tripling during that span. Most of these surgeries were top removal surgery.
ASPS’ statement specified that “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. Evidence regarding adolescent onset presentation, which has become increasingly common since the mid-2010s, is more limited but similarly does not allow for confident prediction of long-term trajectories.”
The statement, obtained by The Washington Post, was first approved by the ASPS board of directors in January. The guidance also addressed the long-term effects of hormones and puberty blockers for minors. Although the statement said there was “substantial uncertainty” about the long-term effects, the statement neither recommended nor discouraged such treatments.
According to the guidance, ASPS’s understanding “has continued to evolve in light of” two major studies— the “2024 Plastic and Reconstructive Surgery article Mastectomy for individuals with gender dysphoria younger than 26 years: a systematic review and meta-analysis” report; and the “Treatment for Pediatric Gender Dysphoria: Review of Evidence and Best Practices,”a report released by the U.S. Department of Health and Human Services (HHS) in May 2025.
The HHS applauded the recommendation in a press release.
“When the medical ethics textbooks of the future are written, they’ll look back on sex-rejecting procedures for minors the way we look back on lobotomies,” said Mehmet Oz, administrator of Centers for Medicare & Medicaid. “I applaud the American Society of Plastic Surgeons for placing itself on the right side of history by opposing these dangerous, unscientific experiments.”
In response to HHS’s “Treatment for Pediatric Gender Dysphoria, Review of Evidence and Best Practices,” Al Mohler, president of Southern Baptist Theological Seminary, reminded Christians of the spiritual side of transgender treatments.
“There’s so many Christians who want to say, ‘I don’t want to be involved in these things. I really don’t want to be involved in a culture war. I don’t want to get involved in politics,’” Mohler said. “Well, this is politics and this is medicine. And let me just point out, this is male and female, and this is your kids, and this is your family, and these are your parental rights. Every bit of it is at stake. So yes, you are involved in it or you’re out to lunch. And I would say sinfully negligent in that respect as well. I think most Christians are going to understand exactly what this means.”
